bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-61. TRANSVENTRICULAR MIGRATION OF CESIUM-131 BRACHYTHERAPY SEEDS TO THE SACRAL THECAL SAC IN A PATIENT TREATED FOR RECURRENT GLIOBLASTOMA
Authors: Islam Mahnoor , Varma Abhay , Rivers Charlotte , Godwin William , Takacs Istvan , Zukas Alicia 
Published: November 2024

Abstract
Cesium-131 brachytherapy (GammaTileTM) is a relatively new form of surgically targeted radiation therapy for recurrent glioblastoma. While seed migration is a well-documented complication of solid tumor brachytherapy, it has not been reported in the treatment of glioblastoma. Here, we describe a rare occurrence of seed migration in a 71-year-old patient treated for recurrent left temporal lobe glioblastoma. The GammaTile is comprised of a resorbable collagen matrix containing four titanium-encapsulated radioactive Cs-131 seeds. Each seed emits a localized dose of radiation with a 9.7-day half-life. To prevent displacement from the resection cavity, oxidized regenerated cellulose (SurgicelTM) was applied to the cavity surface under the tiles and fibrin sealant (TisseelTM) was applied over the tiles. Margins of the lateral ventricles were not breached during the surgery and surface was non-ulcerated. The tiles remained in place on follow-up imaging for at least 7 weeks. At least 97% of the prescribed dose was delivered before seed migration. Bevacizumab systemic treatment was initiated. Abdominal CT obtained after 3 months incidentally noted migration of 2 seeds to the sacral spinal canal. Additional seeds had migrated to the suprasellar region, left lateral ventricle, and lateral cerebellomedullary cistern. Despite seed migration, the patient maintained progression-free survival for at least 10 months, with at least 30 months of overall survival from the time of diagnosis. Although the patient did not experience any symptoms related to seed migration, this has the potential to cause radiation-related toxicity to healthy tissue, particularly if it occurs early after surgery. The use of bevacizumab may have contributed to penetration of the lateral ventricle. Despite meticulous surgical technique, the potential for seed migration should be considered during treatment planning when using anti-angiogenic therapies. Further research is needed to better understand the factors contributing to seed migration and to develop strategies for minimizing this risk.
NIMG-69. INTERROGATION OF GLIOBLASTOMA FATTY-ACID SYNTHESIS AND METABOLISM WITH DEUTERIUM METABOLIC IMAGING
Authors: Chang Andrew , Ge Xia , Cho Kevin , Nunez Elena , Patti Gary , Garbow Joel , Ippolito Joseph 
Published: November 2024

Abstract
Glioblastoma, an invariably lethal brain tumor, undergoes marked metabolic alterations during tumorigenesis and is extraordinarily difficult to treat. Detecting recurrence after treatment and understanding metabolic alterations within the tumor microenvironment are extremely challenging. An exciting and emerging imaging methodology, deuterium metabolic imaging (DMI), detects metabolic adaptations via non-radioactively labeled deuterated substrates. This study developed approaches to image lipid synthesis with deuterium oxide (D2O) and metabolism with D31-palmitate (D31-Pal) in glioblastoma. A fatty-acid phantom was generated for characterization of lipid DMI signal at 12 T. DMI was performed in mice orthotopically implanted with GL261 glioblastoma utilizing either orally administered D31-Pal or D2O and was correlated with pharmacokinetic metabolic measurements from mouse serum. Mice were either orally gavaged with an emulsion of D31-Pal prior to imaging or provided 16% D2O for ad libitum consumption following tumor implantation. Although D2O administration resulted in robust enrichment of lipid signal in GBM, D31-Pal uptake and metabolism were not significantly detected within intracranial tumors. Interestingly, D31-Pal uptake and metabolism were detected in normal tissues, indicating preferential utilization of fatty acids in non-neoplastic tissues. These findings suggest de novo lipogenesis within GBM, rather than uptake of administered long chain fatty acids, is the preferential pathway for cellular lipids. DMI can assist in interrogating GBM fatty-acid synthesis and metabolism, as well as furthering our understanding of lipid distribution within the body by providing a non-invasive scaffold for dynamic interrogation of fatty-acid distribution in an oncologic model. Developing a non-invasive method for characterization of tumor fatty-acid synthesis and metabolism may improve our understanding of tumor metabolism and could dynamically guide selection of patient-tailored metabolic therapies in the future.
NIMG-83. THE PROGNOSTIC VALUE OF PARAMETRIZED KI-67 MAPS DERIVED FROM CONVENTIONAL MRI AND MACHINE LEARNING IN A LARGE RETROSPECTIVE COHORT OF ADULT-TYPE DIFFUSE GLIOMAS
Authors: Dagher Samir-Anthony , Gates Evan , Wintermark Max , Long James , Fuentes David , Schellingerhout Dawid 
Published: November 2024

Abstract

BACKGROUND
Ki-67 is a well-established proliferation marker relied upon for glioma grade assessment. Advances in machine learning (ML) now allow researchers to non-invasively predict the voxelwise Ki-67 index with reasonable accuracy based on anatomical MRI.The purpose of this study is to evaluate the prognostic ability of these predictions in adult-type diffuse gliomas.

METHODS
We included adult patients with untreated gliomas of various histopathologic grades who underwent their first resection at a comprehensive cancer center from 1993 to 2018. Anatomic MR images were pre-processed, segmented, normalized, then run through a pre-trained ML algorithm to generate Ki-67 parametric maps. The maximum estimated Ki-67 (maxKi-67) for each patient was documented, and the optimal threshold stratifying the cohort into low- and high-risk patients was computed using 10-fold cross-validation. Kaplan-Meier survival curves were then generated for both risk groups and compared using the log-rank and Breslow tests. MaxKi-67 was correlated with OS using Cox proportional hazard regression analysis adjusted for age and preoperative KPS.

RESULTS
1,179 patients (age 52±15; 701 males) were included in this study. 727 tumors were histologic grade IV, while 246 and 206 were histologic grade III and II. The mean maxKi-67 was 15.9± 5.2. A maxKi-67 threshold of 13 was computed from the 10-fold cross-validation to dichotomize the cohort by OS. The low-risk group (maxKi-67&lt;13) had a median OS = 2,435 days, significantly different from the high-risk group (maxKi-67&gt;13) which had median OS = 551 days (p&lt;.001). A maxKi-67 index above this threshold significantly increased the hazard of death: unadjusted HR = 2.53 [95% CI 2.17-2.96] and adjusted HR = 1.55 [1.31-1.83]. Age &gt; 55 and preoperative KPS &lt; 90 were also negative prognosticators in the Cox model: adjusted HR for age = 2.79 [2.36-3.31] and for KPS = 2.08 [1.77-2.46].

CONCLUSION
Image-based derivation of maxKi-67 index using ML accurately predicts survival in glioma patients with a cut-off of 13 segregating these patients into 2 risk groups.
NIMG-87. MULTIREGIONAL, MRI-LOCALIZED SAMPLING OF HIGH GRADE GLIOMAS REVEAL SEX-DISTINCT PATTERNS OF 5-ALA FLUORESCENCE AND IMAGING FEATURES
Authors: Green Destiny , Jackson Pamela , Curtin Lee , Singleton Kyle , Vogelbaum Michael , Quinones-Hinojosa Alfredo , Bendok Bernard , Swanson Kristin 
Published: November 2024

Abstract
High grade gliomas (HGGs) are aggressive brain tumors that are difficult to remove completely, leading to poor survival rates. Contrast enhancement on T1Gd magnetic resonance imaging (MRI) has traditionally been used to guide resection, however it often underestimates true tumor burden, adding a layer of uncertainty for surgeons during pre-operative planning. Fluorescence guided surgery using 5-aminolevulinic acid (5-ALA) has emerged as an intraoperative solution and understanding it in conjunction with MRI features can address the limitations of routine T1Gd imaging during surgical planning. Here we investigate sex-specific patterns in HGGs using 5-ALA fluorescence and imaging features. We analyzed a patient dataset of 202 multiregional MRI-localized biopsies from 42 HGG patients (20 male and 22 female). Data included patient demographics, 5-ALA status (positive or negative), MRI annotations (CE = contrast enhancement, NE = non-enhancement, BAT = brain around tumor non-enhancement), and survival outcomes. Statistical analyses included Wilcoxon rank-sum tests, Kruskal-Wallis tests, and chi-squared tests to assess differences in imaging annotations and 5-ALA positive vs negative status among sex cohorts. Among all samples, CE and BAT were associated with higher 5-ALA positivity, while NE was associated with higher 5-ALA negativity (p = 0.02119). Female patients were less likely to have detectable 5-ALA in their multiregional biopsy samples than males (p &lt; 0.0001). CE at the biopsy location was more likely to be indicative of 5-ALA positivity in males than females (p = 0.001927); whereas NE was associated with higher 5-ALA negativity in females than males (p = 0.03426). BAT was associated with higher 5-ALA positivity in males than females (p = 0.03895). Our study reveals sex-specific patterns in 5-ALA fluorescence and image features among HGG patients. These unique features may serve as potential pre-surgical markers for tumor regions that are more likely to benefit from 5-ALA-guided resection.
NCMP-05. CLINICAL AND RADIOGRAPHIC IMPROVEMENT WITH REPLACEMENT OF FOLATE METABOLITES IN A PATIENT WITH INTRATHECAL METHOTREXATE-INDUCED MYELOPATHY
Authors: Kim Hannah , May Jasmine L , Mencacci Niccoló E , Dixit Karan S 
Published: November 2024

Abstract
Methotrexate (MTX)-induced myelopathy is a rare but serious adverse effect of intrathecal (IT) MTX, which may mimic subacute combined degeneration (SCD). MTX disrupts the normal synthesis of methionine, which plays an important role in maintaining myelin sheath integrity, resulting in degeneration of the dorsal columns. This degeneration does not respond to classic treatment with vitamin B12 and folate supplementation, unlike SCD. Here, we describe a case of a 45-year-old woman with Philadelphia-positive B-cell acute lymphoblastic leukemia treated with hyperCVAD regimen with ponatinib, who after 14 doses of prophylactic IT MTX, developed progressive lower extremity weakness, paresthesias, gait instability, saddle anesthesia, and bowel/bladder dysfunction. Her neurologic exam was also notable for diffuse hyporeflexia. The onset of symptoms followed a diarrheal infection, and an initial MRI spine showed no evidence of abnormal enhancement. She was initially treated with intravenous immunoglobulins for presumed acute inflammatory demyelinating polyneuropathy. She then re-presented one week later with progressively worsening symptoms. A repeat MRI spine revealed a new longitudinally extensive T2 hyperintense signal within the dorsal columns from T7 to T12. CSF results were notable for mild pleocytosis and increased myelin basic protein; the latter of which is often seen in MTX-induced myelopathy. The patient received high-dose administration of key metabolites of the methyl-transfer pathway including S-adenosylmethionine (PO 400mg three times daily), folinate (IV 20mg four times daily), cyanocobalamin (PO 1000mcg once daily) and methionine (PO 5mg once daily) for 7 days. This treatment regimen resulted in both clinical and radiographic improvement. Subsequent MRI spine demonstrated complete resolution of the abnormal signal in the thoracic cord. This case highlights (1) the diagnostic complexity of IT MTX-induced myelopathy (2) the role response to treatment plays in uncovering this diagnosis, and (3) how the replacement of folate metabolites facilitates both radiographic and clinical improvement in IT MTX-induced myelopathy.
NCMP-10. EFFECT OF EXTENT OF RESECTION ON GLIOMA SEIZURE OUTCOMES BASED ON MOLECULAR GROUPS
Authors: Xu Emily , Gersey Zachary , Sussman Jonathan , Amankulor Nduka 
Published: November 2024

Abstract

INTRODUCTION
Increased extent of resection (EOR) is a known predictor of seizure freedom in glioma patients. However, it is unknown how tumor genomic alterations affect EOR-induced seizure control.

OBJECTIVE
To evaluate the genotype-specific impact of EOR on post-operative seizure control

METHODS
Records of 553 glioma patients who underwent tumor resection from 2012-2023 were reviewed. All patient tumors were analyzed with next generation sequencing and FISH analysis. The unsupervised machine learning algorithm non-negative matrix factorization (NMF) was used to cluster the genomic data. Clinical variables including extent of resection of contrast enhancing tumor and non-enhancing tumor, temozolomide therapy, and radiation therapy were analyzed using Cox Proportional Hazards models.

RESULTS
NMF clustering of tumor sequencing data revealed four molecular groups: Group 1 (n=56): CDKN2a loss, EGFR copy number gain or mutation, TERT promoter (TERTp) mutation, and MGMT methylated; Group 2 (n=27): IDH mutation, TP53 mutation, and MGMT methylated; Group 3 (n=60): TP53 mutation, TERTp mutation and MGMT methylated; Group 4 (n=244): MGMT unmethylated. Thresholds in the post-operative residual non-enhancing tumor volume (NETV) were identified which marked the most difference in seizure control. For patients in Group 1, the NETV threshold that led to improved epilepsy outcomes was &lt;94.7 cc (p=0.047), whereas the threshold for Group 4 was &lt;89.1 cc (p=0.016). When analysis was conducted for Group 2, the threshold of 10.2 cc failed to reach significance (p=0.1). Interestingly, the threshold analysis for Group 3 found that having a NETV of &gt; 10.1 cc showed improved seizure outcomes (p=0.016). A multivariable cox proportional hazard analysis found that twelve-month seizure freedom was predictive of better OS in group 1 (HR 0.02, p=0.05) and group 4 (HR 0.21, p=1.63e-9).

CONCLUSION
Our study reveals clinically distinct molecular groups of glioma that display different seizure responses. This data suggests a tumor-specific approach to aggressiveness of extent of resection in order to achieve optimal seizure control.
NCMP-12. AN ATYPICAL CASE OF POEMS WITH MACROFOCAL MYELOMA
Authors: La Janet , Graber Jerome 
Published: November 2024

Abstract
Polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome is a rare paraneoplastic syndrome secondary to an underlying plasma cell dyscrasia. Symptoms of peripheral neuropathy dominate the clinical picture and is postulated to be related to serum vascular endothelial growth factor (VEGF) mediated altered permeability of the blood nerve barrier. The classic presentation includes a solitary osteosclerotic plasmacytoma and an elevation of VEGF. In this case, we present a patient with neither of these features who met diagnostic criteria for POEMS though had predominantly osteolytic lesions and was diagnosed with macrofocal myeloma, a unique subset of multiple myeloma. Our patient is a young male who presented with progressive leg numbness/weakness and was found to have marked ankle weakness, diffuse areflexia and unilateral gynecomastia on examination. EMG showed a motor predominant demyelinating polyneuropathy. Labs showed a serum IgG lambda M protein, low estradiol and low testosterone. He had a normal serum VEGF level though the lab was drawn after treatment initiation. Bone biopsy of a dominant osteolytic lesion was consistent with a plasma cell neoplasm (light chain restricted). Of note, he had mild cauda equina nerve root and ventral conus enhancement initially concerning for leptomeningeal involvement however, two lumbar punctures were negative for malignant cells. Spinal enhancement has been reported in POEMS. The patient underwent chemotherapy, radiation therapy and autologous stem cell transplantation. We present a patient diagnosed with MFMM, a rare subset of multiple myeloma, comprising only 3% of all cases, along with POEMS, a rare paraneoplastic syndrome. Interestingly, as osteolytic lesions can be seen in POEMS alone though not predominantly so, it is possible the patient could have atypical POEMS without underlying multiple myeloma. POEMS may remain under-recognized when presentations or setting are atypical.
NCMP-15. MULTIPLE HEMORRHAGIC CNS LESIONS IN A PATIENT WITH RELAPSED SYSTEMIC CHRONIC LYMPHOCYTIC LEUKEMIA
Authors: Li Yi , Mantica Megan , Drappatz Jan 
Published: November 2024

Abstract
Although chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries, extramedullary CLL, characterized by the accumulation of clonal B cells outside of blood, bone marrow, and peripheral lymph nodes, remains rare. The central nervous system (CNS) is the most common site of extramedullary CLL involvement. However, clinically significant CLL in the CNS has been reported in fewer than 100 cases in the literature, and its true prevalence remains unknown with variable estimates. CLL in the CNS most often affects the meninges and usually spares the parenchyma unless there is a higher-grade/Richter transformation; in either case, it is typically not hemorrhagic. Furthermore, in the rare cases reported of hemorrhagic intraparenchymal CLL, patients present with isolated bleeding rather than multifocal hemorrhages. We present the case of a 63-year-old patient with multiply recurrent systemic CLL without Richter transformation who developed bilateral infratentorial and supratentorial micro and macrohemorrhages. Histopathology of a lesion showed focal subacute hemorrhage associated with reactive brain parenchyma containing CLL cells, though it was unclear whether the CLL predated the hemorrhage or if the hemorrhage introduced the CLL. Given the patient’s clinical stability, the lesions were ultimately attributed to coagulopathy in the context of CLL with subsequent secondary colonization of the hemorrhage by CLL cells. These lesions completely resolved after the patient underwent CLL-directed therapy three months after symptom onset. This case underscores the importance of considering bleeding risks associated with CLL and demonstrates that addressing the underlying CLL can lead to the improvement in bleeding sequelae.
NCMP-17. SPHENOID WING DIFFUSE LARGE B-CELL LYMPHOMA MIMICKING A MENINGIOMA: A RARE DIFFERENTIAL DIAGNOSIS
Authors: Campos Paiva Aline Lariessy , Araujo João Luiz Vitorino , Lovato Renan Maximillian , de Oliveira Jean Gonçalves , Veiga José Carlos Esteves 
Published: November 2024

Abstract

BACKGROUND
Meningioma is the most frequent dural lesion and in most cases have a benign course and surgery usually is curative. Nevertheless, there are several dural lesions, neoplastic and non-neoplastic that may mimic meningiomas. Radiological features could help to perform this differentiation. Primary dural lymphoma (PDL) is a rare entity in which adjuvant therapy is required for proper therapeutic approach.

CASE PRESENTATION
A 67-year-old female patient presented with a clinical complaint of left exophthalmos and headache. During investigation, it was noticed the presence of a hyperintense left sphenoid wing lesion with orbital invasion. The diagnosis of meningioma was initially considered and she underwent neurosurgical approach aiming maximal extension. However, histopathological investigation disclosure that was a primary dural lymphoma (diffuse large B type) and she was referred to adjuvant therapy with a proper control of the disease.

CONCLUSIONS
Dural lesions could have neoplastic and non-neoplastic origin. Although meningiomas have a high prevalence, it must be considered other pathologies during evaluation and consideration of the differential diagnosis. This help to improve therapeutic management of the patients.
NCMP-20. FACTORS RELATED TO PERMANENT AND TEMPORARY MOTOR DEFICITS IN PATIENTS UNDERGOING GLIOMA RESECTION: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Conway Brian , Armstrong Stephanie , Botros Nada , Tarima Sergey , Krucoff Max 
Published: November 2024

Abstract
Standard of care treatment for virtually all glioma subtypes starts with maximal safe resection. However, resections that result in motor deficits can negate any survival benefit from surgery and diminish quality of life. Because current evidence on functional outcomes following glioma resection often conflicts and is limited to a small number of case series, retrospective analyses, and reviews, here we performed the first PRISMA-compliant systematic review and meta-analysis of currently published data to identify factors related to permanent and temporary motor deficits after surgery. We searched Ovid Medline, Scopus, Web of Science, CINAHL/EBSCO, PsychInfo, Cochrane and Wiley for studies reporting motor outcomes following surgical resection of glioma. Outcomes were stratified by patient/tumor characteristics, pre-operative condition, and intra-operative factors for both permanent (≥3 months postop) and temporary (&lt;3 months postop) motor deficits. Generalized estimating equations were used to generate odds ratios and 95% confidence intervals. A total of 1,162 titles and abstracts were reviewed for eligibility resulting in the evaluation of 211 full-text articles. Data were extracted from 55 studies including 1,801 patients with 223 (12%) permanent postoperative motor deficits, 428 (24%) temporary motor deficits, and the remaining 1,150 (64%) without motor deficit. Pre-operative deficit was the strongest predictor of permanent post-operative motor deficit (OR 10.56, CI 5.20-21.45, p=7.2E-11), while high pre-operative Karnofsky Performance Scale (KPS) (OR 0.98, CI 0.97-0.99, p=0.036) and subcortical tumor location (OR 0.15, CI 0.025-0.90, p=0.038) were associated with no permanent deficit. Supratotal resection was significantly associated with temporary motor deficits (OR 3.54E+12, CI 3.53+E13-3.56E+17, p&lt;2E-16), and asleep craniotomies were associated with no deficit (OR 1.68E-01, CI 4.93E-02–5.71E-01, p=0.0043). Ultimately, this study represents the largest analysis of motor outcome data in glioma surgery to date.
NCOG-04. MEMORY TRACT SPARING USING DIFFUSE TENSOR IMAGING IN RADIATION PLANNING OF PRIMARY BRAIN TUMORS
Authors: Haisraely Ory , Mair Arnaldo , Lawerence Yaavoc , Taliansky Alicia 
Published: November 2024

Abstract

INTRODUCTION
Radiation therapy (RT) is a critical treatment modality for both primary and metastatic brain tumors, yet approximately 30% of patients experience cognitive decline post-radiotherapy. This cognitive toxicity is linked to low radiation doses affecting neural stem cells in the hippocampal dentate gyrus. Hippocampal Avoidance (HA)-Whole Brain Radiotherapy (WBRT) combined with Memantine has shown promising outcomes in preserving cognitive function and quality of life (QOL) in patients with brain metastases, suggesting it should be the standard of care for those with good performance status and no hippocampal metastases.

METHODS
We conducted a prospective trial approved by the IRB (SMC0307-23), including patients aged 18 and above with primary brain tumors post-resection or biopsy. Exclusion criteria included multifocal glioma crossing to the other hemisphere. RT was delivered to a total dose of 60Gy in 30 fractions with concomitant TMZ. Diffusion tensor imaging (DTI) was performed to map hippocampal-associated white matter tracts. Memory fiber tracts and hippocampi were contoured and integrated into RT planning using Eclipse treatment planning software. Dosimetric analyses compared two plans: one with memory fiber constraints and one without.

RESULTS
Twelve patients with low-grade gliomas were included, with successful contouring of memory fibers and hippocampi. VMAT treatment plans met dose constraints for memory fibers, with an average mean dose of 10.1 Gy. The average MoCA score before RT was 27.1 and 26.4 at six months post-treatment, with a p-value of 0.07. Excluding one patient, the scores were 27.1 and 26.6, respectively (p=0.13).

CONCLUSION
MRI planning using DTI for memory fiber detection and incorporation into RT planning via VMAT techniques enables hippocampal and associated white fiber sparing, potentially preserving cognitive function. Preliminary cognitive data are promising, supporting the need for further validation in a larger cohort.