bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-72. VOXEL-WISE, MULTIVARIABLE, COX PROPORTIONAL HAZARD STATISTICAL PARAMETER MAPPING TO INVESTIGATE THE INTERPLAY BETWEEN TUMOR LOCATION, PROGNOSTIC VARIABLES, AND EXPERIMENTAL TREATMENT IN A PHASE 3 TRIAL OF NEWLY-DIAGNOSED GLIOBLASTOMA TREATED WITH CHEMORADIATION WITH OR WITHOUT BEVACIZUMAB
Authors: Sanvito Francesco , Raymond Catalina , Abrey Lauren , Garcia Josep , Simmons Brian , Chinot Olivier , Saran Frank , Nishikawa Ryo , Henriksson Roger , Mason Warren , Wick Wolfgang , Cloughesy Timothy , Ellingson Benjamin 
Published: November 2024

Abstract

BACKGROUND
Tumor location is known to impact overall survival (OS) in glioblastoma. However, there is a lack of quantitative tools for studying the interplay between tumor location, prognostic variables, and treatments. In the current study we develop a voxel-wise statistical parameter mapping technique using a multivariable Cox regression model to describe the influence of tumor location on treatment effects in newly diagnosed glioblastoma.

METHODS
598 newly diagnosed glioblastoma patients from the phase 3 AVAglio trial were studied. Areas of T2/FLAIR hyperintensity and resection cavities on post-surgical MRI scans were segmented and aligned to MNI atlas space. Voxel-wise Cox proportional hazards models for OS were run for each image voxel and included tumor presence in a specific voxel, age, MGMT promoter methylation, baseline tumor volume, and treatment (chemoradiation with or without bevacizumab). Results. After adjusting for other variables, tumor location was an independent predictor of favorable OS for tumors with involvement in the right prefrontal cortex (p&lt;0.05, HR ranging ~0.48–0.65) and a predictor of shorter OS for tumors in the left mesial/basal temporo-occipital areas (p&lt;0.05, HR ~3–6.2) and in the left hemisplenium of the corpus callosum (p&lt;0.05, HR ~2.5–3). Baseline tumor volume (HR ~4–6 x10-6), MGMT status (HR ~0.38–0.41), and age (HR ~1.020–1.025) were significative predictors regardless of location (p&lt;0.05 in all locations). Interestingly, chemoradiation plus bevacizumab treatment showed a favorable OS compared with chemoradiation alone for tumors with involvement in the right corticospinal tract, right motor and sensory cortices, and left hemisplenium of the corpus callosum (p&lt;0.05, HR ~0.82).

CONCLUSIONS
Tumor involvement in the prefrontal cortex is associated with favorable prognosis, while tumors in mesial/basal temporo-occipital areas or splenium of the corpus callosum are associated with shorter OS. Chemoradiation plus bevacizumab may improve OS for tumors involving eloquent motor areas and the corticospinal tract.
NIMG-78. THE ROLE OF FDG PET/CT IN MANAGING DIFFUSE MIDLINE GLIOMA WITH H3K27M MUTATION: A CASE STUDY AND PATHOLOGICAL CORRELATION
Authors: Choi Yoon , Kong Xiao-Tang 
Published: November 2024

Abstract
The clinical utility of fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in the management of high grade gliomas has been a topic of ongoing debate, with limited cases reported that correlated FDG PET/CT findings with pathology, particularly in diffuse midline glioma with HdK27M mutation cases. We present the case of a 24-year-old male patient with diffuse midline glioma with H3K27M mutation centered in the left thalamus. Head FDG PET/CT was used for clinical management decisions with pathological correlation. Patient had stable follow up brain magnetic resonance images(MRIs) after initial Stupp protocol treatment comprised 6-week radiation therapy with concurrent temozolomide, followed by 12 cycles of adjuvant temozolomide. Despite stable MRI scans, subsequent evaluation using FDG PET/CT demonstrated a high standardized uptake value (SUV) of 13.8 that prompted craniotomy and partial resection of the lesion to confirm tissue diagnosis. Pathological findings confirmed the persistence of densely cellular malignant glioma, but with Ki-67 proliferation index of 4-5%. Following the surgery, the patient was closely monitored with surveillance MRIs for approximately four months post-surgery and follow up MRI’s showed slow growth of the tumor prompting additional therapeutic interventions. This case is an example of FDG PET/CT and pathological correlation and highlights the potential role of FDG PET/CT as an adjunctive imaging tool in the management of high grade gliomas.
NIMG-81. PREDICTING TUMOR PROGRESSION WITH FIBER DENSITY-WEIGHTED WHITE MATTER PATHLENGTH MAPS IN PATIENTS WITH GLIOBLASTOMA
Authors: Liu Bo , Ngan Tiffany , Jakary Angela , Tran Nate , Rowley Paul , Braunstein Steve , Morin Olivier , Lin Hui , Lupo Janine 
Published: November 2024

Abstract

PURPOSE
Although histopathological evidence indicates that glioma cells preferentially migrate along large white-matter bundles, standard-of-care (SOC) radiation therapy (RT) planning remains an isotropic expansion of the anatomical lesion. We hypothesize that anisotropic expansion of RT target volumes along white-matter pathways using fiber density-weighted, white-matter pathlength maps (DW-WMPLMs) derived from diffusion tensor imaging (DTI) could improve the prediction of tumor cell migration beyond surgical margins by a deep learning model compared to SOC clinical target volumes (CTVs).

METHODS
DTI and anatomical MRI from 118 patients newly-diagnosed with glioblastoma were retrospectively analyzed with anatomical imaging from post-surgical resection and latest progression scan before intervention. Parallel-transport tractography seeded from the pre-surgery T2-lesion was used to estimate white-matter fiber propagation. Fibers that intersected with the resection cavity were weighted by their density to control the length of expansion and create a DW-WMPLM that was used together with T2-FLAIR and T1-post-contrast images as inputs to a novel 3D-Swin-UNetR network, trained to predict the recurrence region using 4-fold cross-validation and evaluated in a holdout test-set (95/23 CV/test). New weighted-overlap, coverage, and sparing indices were introduced to evaluate coverage of the progressed lesion and healthy brain excluded.

RESULTS
52% of patients had progression outside the standard 2cm-isotropic CTV margin, motivating the need for anisotropic CTVs. Our novel DW-WMPLMs had 87±20% and 83±18% overlap with contrast-enhancing and T2-lesion progression, respectively. The deep-learning model trained with DW-WMPLMs and anatomical images achieved 19% and 56% higher Dice and weighted-overlap indices compared to the isotropic 2cm-CTV(p&lt;0.02), with less normal brain included.

CONCLUSION
This study demonstrates the feasibility and benefit of incorporating a novel metric of white-matter track characterization into deep learning progression prediction models of glioblastoma for RT-planning. Current work is validating findings in a prospective cohort acquired immediately prior to RT and incorporating other imaging metrics.
NIMG-84. BELZUTIFAN REDUCTION OF CEREBRAL BLOOD FLOW IN VHL-ASSOCIATED HEMANGIOBLASTOMA PREDICTS RESPONSE TO TREATMENT
Authors: Persad Amit , Yagmurlu Ayse Banu , Park David , Zamarud Aroosa , Huang Yuhao , Hori Yusuke , Chang Steven , Iv Michael 
Published: November 2024

Abstract
Hemangioblastoma (HMB) is a vascular-origin tumor occurring primarily in the cerebellum. Treatment typically involves surgical resection of the solid part of the tumor or stereotactic radiosurgery. An emerging treatment for hemangioblastoma is belzutifan (BZF), a hypoxia-inducible factor 2a (HIF2a) inhibitor. A recent trial found BZF to control hemangioblastoma in patients with von Hippel Lindau (vHL) syndrome. Perfusion MRI techniques including arterial spin labelling (ASL) and can be used to determine relative cerebral blood flow (rCBF). No prior studies have investigated rCBF in hemangioblastoma with relation to belzutifan, and the mechanism of action of belzutifan on hemangioblastoma is not well understood. Here, we aim to measure the response in rCBF in patients with vHL-associated hemangioblastoma treated with belzutifan. This retrospective cohort study constituted a group of seven patients with vHL-associated hemangioblastoma treated with Belzutifan at a daily oral dose of 120mg. Perfusion MRI with ASL sequences were acquired as part of the tumor imaging protocol. We quantified rCBF of the tumors prior to treatment, following intiation of BZF, and at most recent follow-up. Statistics were performed using R studio. The long axis diameter, volume of the solid tumor, rCBF mean, rCBF max, N mean, N max of lesions all decreased after Belzutifan treatment (p&lt;0.001). While the long axis diameter of the cyst in cystic lesions did not show statistically significant change, the volume of cysts decreased significantly on Belzutifan (p=0.016). Spearman’s rank correlation analysis demonstrated association between change in rCBF mean, rCBF max, N mean and N max to % reduction in tumor volume. In addition, change in rCBF mean, change in rCBF max and change in N max all showed statistically significant association on multiple linear regression. Finally, early change in CBF and N predicted further volumetric response to treatment with belzutifan. We demonstrate that vHL-associated hemangioblastoma demonstrates decrease in rCBF in conjunction with and predictive of decreased volume following treatment with belzutifan.
NIMG-89. MULTI-THRESHOLD VOLUMETRIC MAPPING OF18F-FLUOROETHYLTYROSINE POSITRON EMISSION TOMOGRAPHY (18F-FET PET) IMPROVES TUMOR DETECTION IN PRIMARY MALIGNANT BRAIN TUMOR PATIENTS
Authors: Grega Shaun , Gauger Andrew , Larson Matthew , Nevel Kathryn , Territo Wendy , Green Mark , Veronesi Michael 
Published: November 2024

Abstract

PURPOSE
The purpose of this study was to determine whether additional volumetric measurements yielded significant prognostic information than typically reported tumor-to-brain ratio thresholds (TBRmax) alone for accurately distinguishing progressive disease from treatment induced changes.

METHODS
Hybrid 18F-FET PET/MRI was obtained on pathology confirmed high-grade glioma in sixty patients from August 6th, 2022 to March 9th, 2023 at one US institution. We compared the diagnostic accuracy of various TBR thresholds and volumetric measurement combinations in identifying progressive disease. Specifically, we assessed TBR &gt;1.6, 2.0, 2.5, 3.0, 3.5, 4, 4.5, and 5.0 alone and in combination with volumetric measurements greater than 1 mL. Survival data for all patients were analyzed using Kaplan-Meier curves.

RESULTS
Our analysis revealed that TBR &gt; 2.5 and &gt;1 mL yielded the highest diagnostic accuracy (100%) in distinguishing progressive disease from treatment induced changes. This was followed by the combination TBR &gt;2.0 and &gt;1 mL (98%), TBR &gt; 2.5 alone (98%), TBR &gt; 2.0 alone (86%), TBR &gt;1.6 and &gt;1 mL (84%), and TBR &gt;1.6 alone (77%). TBR &gt;3.0, 3.5, 4.0, 4.5, and 5.0 with and without volumetric measurements showed accuracies of 100%. Kaplan-Meier survival analysis showed significant results for all thresholds: TBR &gt;1.6 alone (p = 0.047), TBR &gt;1.6 and 1 mL (p = 0.003), TBR &gt; 2.0 alone (p = 0.019), TBR &gt;2.0 and &gt;1 mL (p &lt; 0.001), TBR &gt;2.5 alone (p &lt; 0.001), and TBR &gt;2.5 and &gt;1 mL (p = 0.002).

CONCLUSION
Our findings suggest that although TBRmax &gt; 2.5 alone continues to be a reliable metric for distinguishing progressive disease from treatment induced changes, TBRmax &gt;2.5 when volume is greater than 1 mL shows the greatest accuracy in detecting disease progression. Understanding the volumetric contribution to static FET TBRmax is important for tumor response assessment at TBRmax thresholds above 1.6 TBRmax.
NCMP-04. IMPLANTATION METASTASIS FOLLOWING BIOPSY OF THALAMIC GERMINOMA – A CASE REPORT AND REVIEW OF LITERATURE
Authors: Saundt Yu Llarx , Malilay Oliver Ryan , Navarro Joseph Erroll 
Published: November 2024

Abstract
Germ cell tumors commonly develop in the pineal and suprasellar regions, with the most common germ cell tumor being germinomas. In this report, a 22-year-old male presented with progressive right-sided weakness and his imaging was consistent a thalamic high grade glioma. A stereotactic biopsy was performed, revealing a germinoma, but radiation therapy was not done and patient was lost to follow up. He was readmitted due to ulcerative tumor growth at the previous skin incision, and imaging revealed tumor progression with implantation metastasis along the tract of the previous biopsy. The scalp tumor was excised and histopathologic studies confirmed that it was proliferation of the previous germinoma. He was discharged well but was unfortunately unable to follow up at the clinic. Thalamic germinomas are difficult to diagnose and treat because of their rarity. Here we underscore the importance of careful patient selection, precise biopsy techniques, thorough postoperative management and close radiographic surveillance to minimize the risk of implantation metastasis and promptly treat it if it occurs.
NCMP-06. GENOTYPE AND SEX IMPACT MEMORY FUNCTION AFTER BRAIN IRRADIATION
Authors: Oyewole Aboyeji , Yang Joyce , Lee Megan , Sei Yoshi , Sims Jeffrey , Bisoyi Padmini , Nakamura Ken , Nakamura Jean 
Published: November 2024

Abstract

PURPOSE/OBJECTIVE
Cognitive changes are a serious complication that can occur after brain radiotherapy. There is a need to better understand which individuals are more susceptible to develop strategies to preserve their function. The apolipoprotein E type 4 allele (APOEe4) APOE4 is the most prevalent genetic risk factor for Alzheimer Disease. We hypothesized that APOE genotype influences memory function after a subtherapeutic dose of whole brain irradiation in male and female mice.

MATERIALS/METHODS
Age-matched adult female and male mice engineered with either human APOE3 or APOE4 gene knocked-in were randomized to no treatment or whole brain irradiation (0 Gy or 5 Gy x 2), then evaluated with longitudinal neurobehavioral tests of learning, memory, pain threshold and anxiety. We performed immunohistochemical analyses of mouse brain sections at 1 month and at 4 months post-radiation to quantify extracellular amyloid beta plaques and other neuropathologic hallmarks associated with neurodegeneration.

RESULTS
Neurobehavioral testing identified significant sex and genotype-dependent changes in memory and anxiety measures developing longitudinally after brain irradiation. At baseline (unirradiated), APOE4 mice (male and female) performed worse on multiple memory measures. However after irradiation, sex and genotype each independently impacted multiple neurobehavioral function tests and also interacted with each other to significantly influence the timing and magnitude of changes in memory function. ApoE4 significantly impacted the toxicity of radiation in a sex-dependent manner. Neuropathologic analyses including amyloid beta plaque deposition and ApoE levels are ongoing.

CONCLUSIONS
After brain irradiation of relatively moderate dose, neurobehavioral performance including memory are impacted in a genotype and sex-dependent manner and dynamically over time. In addition to suggesting important sex-dependent differences in memory vulnerability, these data point to new opportunities for personalizing care for patients receiving brain irradiation.
NCMP-08. PRE-OPERATIVE AND INTRA-OPERATIVE RISK FACTORS OF POST-OPERATIVE CEREBELLAR MUTISM SYNDROME IN PEDIATRIC PATIENTS UNDERGOING POSTERIOR FOSSA TUMOR SURGERY: A SYSTEMATIC REVIEW
Authors: Salman Afia , Kumar Kanwal Ashok , Javaid Aaisha , Fahim Muhammad Ahmed Ali , Bashir Hafiza Hifza , Sohail Ayesha , Hussain Nasr , Shamim Muhammad Shahzad 
Published: November 2024

Abstract

INTRODUCTION
Post-operative cerebellar mutism syndrome (pCMS) is a complication of surgical removal of posterior fossa tumors. The neurological and linguistic symptoms of pCMS may resolve in approximately 6 months, however, the children are vulnerable to the burden of significant long-term residual deficits. The current literature lacks a review of intraoperative and preoperative risk factors of postoperative pCMS. The authors addressed this issue by conducting a systematic review of studies investigating these risk factors in pediatric patients with posterior fossa tumors.

METHODS
The authors extracted potential citations from Google Scholar, PubMed, Scopus, and Cochrane. The eligible studies included pediatric patients less than 18 years of age, who were diagnosed with posterior fossa tumors and developed CMS following the posterior fossa tumor surgery.

RESULTS
A total of 64 studies involving 6,420 patients were included in this systematic review. The preoperative risk factors delineated in this review are oncological, tumor location, tumor extension, structural invasion, radiological predictors, preoperative hydrocephalus, age, gender, and pre-operative language impairment. Of these factors, a substantial number of studies reported histopathological diagnosis of medulloblastoma, high-grade tumor histology, and midline location of posterior fossa tumor as significant risk factors of pCMS. The intraoperative risk factors significantly associated with pCMS included vermis incision, superior cerebellar peduncle involvement, medulloblastoma diagnosis, and gross total tumor resection. Only a few studies identified protective factors that reduced the risk of developing pCMS.

CONCLUSION
In this systematic review, we have pooled all the available studies with extractable data to identify the intraoperative and preoperative risk factors of postoperative pCMS in pediatric patients undergoing surgery for posterior fossa tumors. This data can be utilized by healthcare professionals including neurosurgeons in identifying factors that compound the risk of postoperative pCMS and factors that have opposite effects on postoperative outcomes.
NCMP-09. SPONTANEOUS RESOLUTION OF PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML) DEVELOPED AFTER RITUXIMAB TREATMENT FOR LOW-GRADE B-CELL LYMPHOMA
Authors: Alshawa Anas , Latta Shadi , Dixit Karan 
Published: November 2024

Abstract
Progressive multifocal leukoencephalopathy (PML) is a rare viral infection caused by the reactivation of the JC virus, which causes significant morbidity and mortality. Rituximab, a CD20 inhibitor used for B-cell neoplasms as well as autoimmune diseases, is associated with the development of PML. Here, we report a case of a 74-year-old woman with a history of low-grade B-cell lymphoma with biopsy-proven PML with spontaneous immune reconstitution with clinical and radiographic improvement. For her low-grade B-cell lymphoma, she received six cycles of rituximab and bendamustine, followed by one cycle of maintenance rituximab, which was discontinued due to intolerance. Ten months later, she developed progressive left-sided paresthesias, paresis, and incoordination. Brain MRI revealed a large right subcortical frontal-parietal FLAIR hyperintense and peripherally enhancing lesion with leading-edge diffusion restriction. CSF studies revealed elevated protein (385 mg/dL) and negative JCV PCR. A brain biopsy was performed with tissue staining positive for SV40, consistent with PML. Her CD4 count was 88 cells/mm3. A repeat CSF sample one month later showed near normalization CSF protein (47 mg/dL) and negative CSF JCV PCR. MRI of the brain one month later demonstrated complete enhancement resolution and decreased FLAIR abnormality, which correlated with subjective and objective clinical improvement. Her serum CD4 also increased to 134 cells/mm3. This highlights a rare case of PML related to rituximab with spontaneous improvement, which may help guide clinicians in counseling patients who may also develop this complication. Furthermore, this supports the biological rationale for continued investigation of T-cell therapies to achieve immune reconstitution.
NCMP-11. FACTORS INFLUENCING MANAGEMENT STRATEGY AND CLINICAL OUTCOMES IN LOW-GRADE IDH-MUTANT ASTROCYTOMA: A 10-YEAR INSTITUTIONAL CASE SERIES
Authors: Golub Danielle , Shah Harshal A , Mishra Akash , Lynch Daniel G , Modi Siddhi , Garrel Shimon , Ronnen Rebecca , Unadkat Prashin , Sreenivasan Sanjeev , Goenka Anuj , Dehdashti Amir R , Eichberg Daniel G , Gruber Deborah , Li Jian Y , Ziemba Yonah , Schulder Michael , Singer Samuel 
Published: November 2024

Abstract

BACKGROUND
Low-grade IDH-mutant astrocytomas are rare primary brain tumors that typically affect young adults and slowly progress to more aggressive lesions when untreated. Since lengthy follow-up is required to identify high-risk subgroups and useful therapeutic strategies, consensus recommendations after maximal safe resection are still based on low-level evidence and remain unclear.

METHODS
Retrospective chart review of all adult patients with a pathological diagnosis of low-grade (grade 2) IDH-mutant astrocytoma from 2013–2023 at a multi-site tertiary care center was performed. Cases without confirmatory IDH-mutation testing or at least 6-month follow-up imaging were excluded.

RESULTS
A total of 32 patients were included with a mean age of 35.6 years (range: 18–69) and 15 (46.9%) females. Mean follow-up was 40.3 months (range: 8.1–120.7). Preoperative average maximal tumor diameter was 4.1cm (range: 1.4–7cm) with 18 (56.3%) cases involving eloquent cortex. Gross total resection (GTR) was achieved in 12 (37.5%) cases. Observation was the most prevalent postoperative management strategy (n=21, 65.6%), followed by temozolomide-based chemoradiation (n=5, 15.6%), temozolomide alone (n=2, 6.3%), PCV (n=2, 6.3%), radiation alone (n=1, 3.1%), and carboplatin (n=1, 3.1%). Progression of disease (POD) was eventually seen in 17 (53.1%) cases with a median progression-free survival (PFS) of 41.9 months. While GTR was protective against POD (OR:0.14, p=0.019*), initial postoperative management with adjuvant chemotherapy and/or radiation was not (OR:1.09, p=0.907). Additionally, seizures during the follow-up period were significantly associated with POD and a reduced PFS (median 32.5 versus 71.7 months, HR:3.88, p=0.013*). There were no differences in EOR or tumor localization between patients who did and did not have seizures during follow-up.

CONCLUSIONS
Although limited by sample size, this 10-year series confirms the importance of maximizing EOR for low-grade IDH-mutant astrocytoma and suggests that seizures during follow-up can identify high-risk cases that may benefit from more aggressive treatment.