bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-56. MAGNETIC RESONANCE SPECTROSCOPY IN THE POST-TREATMENT METABOLIC CHARACTERIZATION OF BRAIN TUMORS OF GLIAL ORIGIN OF CENTRAL NERVOUS SYSTEM
Authors: Acosta Pablo Moreno , Malaver Gina , Padin Trinidad González , Gamboa Oscar , Singh Carla , Rodriguez Cesar , Balart Josep , Zubieta Camilo , Bouleftour Wafa , Magné Nicolas , Penagos Pedro , Fino Daniel 
Published: November 2024

Abstract

BACKGROUND
and Purpose Central Nervous System tumors have a very low incidence worldwide, however they constitute an important source of mortality and morbidity. Treatment for these types of tumors in adults may include surgery, radiosurgery, radiation therapy, chemotherapy, and targeted treatment. These treatments in brain tumors of glial origen in adults can produce changes in the pathophysiology of the tumor. The purpose of this study was to characterize the different metabolic patterns as effect of treatment and identify tumor recurrences. Materials and

METHODS
A prospective study was conducted with patients with low- and high-grade tumors treated, subjecting them to the single-voxel MRS and multivoxel MRSI protocol at 1.5 T.

RESULTS
Of the 44 patients included, 21 were histopathologically diagnosed as low-grade tumors and 23 as high-grade tumors. Of the low-grade tumors, 11 were caracterized as low-grade (mean Cho/NAA and NAA/Cr ratios 1.49 ((p=0.036) and 0.92 (p=0.038) respectively), 8 cases presented gliosis (mean Cho/NAA and NAA/Cr ratios 1.57 (p=0.028) and 1.36 (p=0.026) respectively), and 4 cases presented radiation necrosis (mean Cho/Cr ratios 2.14 (p=0.03)), (mean Cho/Cr and NAA/Cr ratios 1.25 (p=0.01) and 1.25 (p=0.00)) respectively). Furthermore, tumor recurrence that presented high Cho/NAA ratio were observed in 11 cases. Of the high-grade tumors, 13 were caracterized as high-grade (mean Cho/NAA and Cho/Cr ratios 2.24 (p=0.026) and 4.48 (p=0.026) respectively), 13 cases presented gliosis (mean Cho/NAA and NAA/Cr ratios 1.82 (p=0.028) and 0.64 (p=0.026)) respectively) and radiation necrosis was detected in 10 cases (mean Cho/Cr ratio 1.47 (p=0.03), (mean Cho/Cr and NAA/Cr ratios 2.25 (p=0.01) and 0.97 (p=0.00) respectively). Moreover, tumor recurrence that presented high Cho/NAA ratio were observed in 9 cases.

CONCLUSION
MRS and MRSI contribute to identifying the recurrences, to characterizing the different metabolic patterns as an effect of the treatment and differentiate between low and high grade tumors.
NIMG-59. COMPARATIVE ANALYSIS OF LONG-TERM GLIOBLASTOMA SURVIVORS USING MACHINE LEARNING GENERATED RADIO-PATHOMIC METRICS
Authors: Aaronson Daniel , Bobholz Samuel , Duenweg Savannah , Kyereme Fitzgerald , Lowman Allison , Nath Biprojit , Winiarz Aleksandra , Connelly Jennifer , Mrachek E Kelly , Krucoff Max , Banerjee Anjishnu , LaViolette Peter 
Published: November 2024

Abstract

BACKGROUND
Glioblastoma (GBM) remains the most devastating central nervous system malignancy with poor overall survival (OS), even with gross total resection (GTR) and chemoradiation. Identifying factors associated with long-term survival (LTS) in GBM patients is challenging but crucial for improving prognostic models. This study compares an internal dataset of the top 10% long-term survivors of GBM (n=14) against a combined external cohort of 528 GBM patients who underwent GTR.

METHODS
We used a previously published machine learning-generated radio-pathomic model based on autopsy tissue as ground-truth to generate whole-brain maps of cell density and tumor probability maps (TPM) using conventional preoperative MRI sequences in both our internal dataset and a combined external cohort of GBM patients who underwent GTR from the UCSF-PDGM-v2 and UPenn-GBM databases. We then analyzed clinical and radio-pathomic metrics, including cell density and TPM values within contrast-enhancing (CE) and FLAIR hyperintense regions. Statistical comparisons were performed using t-tests.

RESULTS
Cell density metrics showed significant differences, with lower cell density in contrast-enhancing regions (t-value: 4.709, p&lt;0.001; median: 1559 vs. 1959) and in FLAIR hyperintense regions (t-value: 3.585, p&lt;0.001; median: 1356 vs. 1568) within the LTS group. TPM metrics also showed significant differences, with lower TPM values in contrast-enhancing regions (t-value: 3.312, p&lt;0.001; median: 0.71 vs. 0.72) and in non-enhancing regions (t-value: 2.606, p&lt;0.01; median: 0.68 vs. 0.69) in the LTS group.

CONCLUSION
Our comparative analysis reveals distinct radio-pathomic characteristics associated with long-term survival in GBM patients. Reduced cell density and lower TPM values in both contrast-enhancing and FLAIR hyperintense regions are significantly correlated with long-term survival. These findings suggest that integrating radio-pathomic data may enhance prognostic models and warrants further studies evaluating the relationship of these markers and OS.
NIMG-67. THE CURRENT STATE OF LARGE LANGUAGE MODELS AND NEURO-ONCOLOGY IMAGING
Authors: Aaronson Daniel , Zwagerman Nathan 
Published: November 2024

Abstract

INTRODUCTION
Large language models (LLM), such as chatGPT by OpenAI, exist at the intersection of machine learning and natural language processing, and are poised to transform healthcare with rapid growth in recent years. The ability of these models to process visual data has also advanced in recent years, with GPT-4 being the first model to publicly process visual data, and GPT-4o adding additional capabilities. There has been significant interest in the application of GPT-4o to healthcare image processing.

OBJECTIVE
This study sought to examine the ability of GPT-4o in determining a final diagnosis based on a single MRI image of an intracranial neoplasm. We then compared the performance to GPT-4, as well as to humans including neurosurgery residents, fellow, and attendings.

METHODS
GPT-4 and GPT-4o were given a standard prompt and an accompanying image requesting the most likely diagnosis for 20 brain MRI images, including 5 gliomas, 5 meningiomas, 5 pituitary tumors, and 5 sham non-tumor images. These were compared to a survey of neurosurgery attendings, fellows, senior residents, and junior residents.

RESULTS
GPT-4 supplied correct diagnoses in just 40% of the cases, while GPT-4o correctly identified the pathology in 70% of cases. Neurosurgeons yielded correct responses in 92% of cases, with neurosurgery senior residents faring the best (albeit with a small sample size).

CONCLUSION
GPT-4 and GPT-4o underperformed neurosurgery residents, fellows, and attendings in correctly identifying CNS malignancies. Still, with no additional training, GPT-4o yielded significantly better results than GPT-4, showing rapid advancement in the LLM over is predecessor in identifying intracranial neoplasms via single-image MRIs.
NIMG-68. A COMPREHENSIVE REVIEW OF THE USE OF FMRI IN EVALUATING FUNCTIONAL CONNECTIVITY AND ACTIVATION IN DISORDERS OF CONSCIOUSNESS
Authors: Leskinen Sandra , Mehta Neel H , Quelle Mica , Singha Souvik , D’Amico Randy S 
Published: November 2024

Abstract

PURPOSE
Disorders of consciousness (DoC) like vegetative and minimally conscious states pose significant diagnostic and prognostic challenges, compounded by the inherent limitations in communicating with affected patients. We performed a scoping review of the literature to examine the application of functional magnetic resonance imaging (fMRI) to the assessment of functional connectivity (FC) and activation in DoC.

METHODS
We searched the MEDLINE/PubMed, Web of Science, and Embase databases between the years 2004 and 2024 for English-language studies involving fMRI and DoC in adult populations, adhering to PRISMA guidelines. Included studies were evaluated for study design, DoC subtype, fMRI subtype, cohort size, and FC and/or activation findings.

RESULTS
Our initial search identified 17,475 results, of which 82 studies were ultimately included with a total of 3917 patients. Only one of the included studies was a randomized controlled trial, 24 were prospective cohort studies, three were retrospective cohort studies, and 54 were observational in design. The majority of studies utilized resting-state fMRI (n=54, 65.9%), and the most commonly investigated disorders of consciousness were minimally conscious states (31.9%), vegetative states (14.4%), and unresponsive wakefulness syndromes (12.9%). Among studies with higher levels of evidence like prospective and retrospective studies, FC and activation findings were heterogeneous, with several studies reporting abnormal connectivity in the default mode and auditory networks. Activation responses among patients also varied, with some patients of the same DoC displaying expected activation patterns while others did not. Normal patterns of connectivity and activation were associated with improved prognosis in eight prospective studies and one retrospective study.

CONCLUSIONS
These findings underscore the complexity of using fMRI to evaluate consciousness in DoC patients. Though fMRI has the potential to identify residual cognitive function, the variability in responses also indicates the need for personalized approaches and further research to standardize fMRI protocols for this purpose.
NIMG-75. SIMILARITY DISTANCES-BASED DELTA RADIOMICS (SDDR) ENABLES LONGITUDINAL MRI COMPARISONS FOR SURVIVAL PREDICTION IN GLIOMAS: A MULTI-INSTITUTIONAL VALIDATION
Authors: Pineda Gustavo , Veronesi Michael , Stuhlmiller Timothy J , Lee Hope , Ginn Sarah , Awawda Alaa , Cole Zachariah , Bhatia Ankush , Kesari Santosh , Ahluwalia Manmeet , Romero Eduardo , Ismail Marwa , Tiwari Pallavi 
Published: November 2024

Abstract
Radiomics (computerized feature analysis) on treatment-naive MRI scans has demonstrated great value in outcome prediction for Glioblastoma (GBM). However, delta radiomics (analysis of radiomic feature variation between different events, e.g., before and after treatment) has not been explored on account of challenges with precise spatial correspondences between pre- and post-operative scans. This work presents a survival prediction model for GBM, Similarity Distances-based delta radiomics (SDDR), based on the hypothesis that similarity distance-measures between radiomic features on pre-, and post-treatment images can accurately capture temporal changes within-and-around the tumor, and provide improved prediction of overall survival, compared to models based on a single timepoint. 150 patients from 2 publicly-available Glioma repositories (University of California San Francisco “UCSF” (n=48), LUMIERE (n=67)) and 2 two proprietary datasets (from xCures (n=13), and Cleveland Clinic (CCF) (n=74)) were obtained. UCSF and LUMIERE cohorts were used as separate hold-out sets, in each of which the remaining collections were used as discovery set. Following pre-processing, tumor segmentation into Edema (ED) and Enhancing tumor (ET) were performed. SDDR was then computed, which is the distance between probability densities functions from 156 gray co-occurrence (GLCM) and 52 gradient-based co-occurrences statistics (COLLAGE) features extracted from pre and-post-treatment MRI. Six statistical distances (e.g., Earth mover distance) normalized by the scanning interval (in weeks) yielded n=2496 SDDR measurements per tumor region (1248/region, 936 delta-GLCM, and 312 delta-COLLAGE). The same set of features were computed from pretreatment MRI (Pre-R) for comparison. Features were fed to LASSO-Cox regression for survival analysis. SDDR for GLCM features extracted from ET outperformed Pre-R, and demonstrated significant differences between high and low risk groups for both hold out tests: UCSF (p=0.0069, HR =2.8, C-index=0.69) and LUMIERE (p=0.0061, HR = 1.9, C-index 0.65). SDDR-based multi-institutional survival analysis demonstrated promise in reliable longitudinal risk-stratification in GBM.
NIMG-79. A RADIOMIC-RISK SCORE FOR SURVIVAL PREDICTION IN GLIOMA: A LARGE MULTI-INSTITUTIONAL RETROSPECTIVE VALIDATION STUDY
Authors: Pineda Gustavo , Veronesi Michael , Stuhlmiller Timothy J , Lee Hope , Ginn Sarah , Awawda Alaa , Cole Zachariah , Bhatia Ankush , Kesari Santosh , Ahluwalia Manmeet , Ismail Marwa , Tiwari Pallavi 
Published: November 2024

Abstract
Gliomas have dismal survival. Recently, radiomics has demonstrated success in developing non-invasive image-based biomarkers for survival prediction in gliomas. However, clinical applicability of radiomics-based biomarkers will ultimately require rigorous validation on large, multi-institutional data. This work attempts to evaluate a radiomic-based survival risk-assessment prognostic score on a multi-institutional cohort of Glioma patients. Our rationale is that optimizing and validating radiomic features that capture intensity-based textural variations and morphology-based changes (e.g., local curvature and global contour) on large multi-institutional cohorts can allow for robust risk assessment in Glioma. n=668 pre-operative T1w MRI scans for Glioma patients from 4 cohorts: University of California San Francisco “UCSF” (n=495), LUMIERE (n=86)), xCures (n=13), and Cleveland Clinic (CCF) (n=74) were analyzed. Subjects from UCSF, CCF, and xCures were used for training, whereas the LUMIERE cohort was used for hold-out testing. Following pre-processing, expert-vetted tumor segmentation into Edema (ED) and Enhancing tumor (ET) regions was performed. A total of n=1558 radiomic features were extracted from the tumor regions (779 per region), namely, 31 global contour, 20 curvature-based, 624 gradient co-occurrence statistics, and 104 Collage features. Cox regression model was employed to create a radiomic risk score (RRS) for every subject, which included radiomics features as well as on clinical and demographic variables (IDH, MGMT, sex, age), for survival analysis. RRS incorporated a total of 43 radiomic features, and the associated clinical and demographic variables (CDS), yielding significant differences between high and low risk groups in the training (RRS: p=0.043, HR = 2, CSD: p=0.0031, HR = 2.8) and testing sets (RRS: p=0.0096, HR = 1.8, CSD: p=0.0071, HR = 1.8). Combining RRS and CDS improved the OS prediction at group level (p=3.6e-6, 0.0011, HR=5.4, 2, for training and testing, respectively). Radiomics-based risk-stratification may be promising for reliable risk-stratification in glioma.
NIMG-86. DISSEMINATEDCRYPTOCOCCUS NEOFORMANS MIMICKING CENTRAL NERVOUS SYSTEM PROGRESSION OF DIFFUSE LARGE B-CELL LYMPHOMA
Authors: Baez Adolfo , Handley Guy , Mokhtari Sepideh , Shah Shivan , Phuoc Vania , Greene John 
Published: November 2024

Abstract
A 57-year-old male with stage IV diffuse large B-cell lymphoma (DLBCL), non-germinal center subtype, underwent 6 cycles of polatuzumab, rituximab, cyclophosphamide, doxorubicin, prednisone, and pegfilgrastim (Pola-R-CHP) then presented to the hospital with progressive confusion, double vision, hearing loss, and lower extremity weakness. MRI of the brain and spinal cord with and without IV contrast revealed extensive leptomeningeal enhancement along the brain, several cranial nerves, cervical and thoracic spinal cord with enhancement of the cauda equina. Cerebrospinal fluid (CSF) analysis studies revealed 41 nucleated cells/mm3, protein to 264 mg/dL, and an initial cryptococcal antigen titer of 1:1280; serial lumbar punctures peaked at an opening pressure of 39.5 cm H2O before improvement. Flow cytometry was negative on two CSF studies. Multiple cultures grew Cryptococcus neoformans before sterilization of CSF culture on day 13. He received induction therapy for 4 weeks with amphotericin B and flucytosine. Flucytosine treatment was limited due to cytopenias on day 9 and continued induction with amphotericin B and fluconazole. Fluconazole was switched for voriconazole based on minimal inhibitory concentrations by broth dilution, however, the drug was undetectable on therapeutic drug monitoring 2 weeks later and switched back to fluconazole. Subsequent positron emission tomography revealed ongoing hypermetabolic thoracic, mediastinal, and hilar lymph nodes compared to PET scans prior to chemotherapy for which he underwent transbronchial fine needle aspiration concerning for Cryptococcus involvement. He remained on fluconazole 800mg/day and MRI 11 months after the initial presentation demonstrated ongoing but slightly improved leptomeningeal enhancement. Due to persistent symptoms despite sterile CSF cultures, he underwent a three-day course of IV methylprednisolone 1000mg with some incomplete improvement in symptoms. The opening pressure normalized and the cryptococcal antigen titer decreased to 1:20 about 11 months after initial treatment. This case highlights the risk of opportunistic infections like cryptococcal meningitis in patients undergoing chemotherapy.
NCMP-02. UTILITY OF ICE PACK TEST FOR EARLY RECOGNITION OF IMMUNE CHECKPOINT INHIBITOR MEDIATED OCULAR WEAKNESS
Authors: Zahid Anza , Thatikonda Nithisha , Amador Dalton , Saeed Mujtaba , Tummala Sudhakar 
Published: November 2024

Abstract

INTRODUCTION
Immune checkpoint inhibitors (ICI) are associated with neurological immune-related adverse events (NiArE) such as myasthenia gravis (MG) and myositis. These conditions often present with overlapping symptoms, notably ptosis, dyspnea, and extremity weakness. Early recognition and treatment are warranted to prevent disease progression.

OBJECTIVE
To test the utility of simple bedside ice pack test (IPT) in early recognition and distinction of ICI-mediated MG and myositis ocular manifestations.

METHODS
We administered IPT in 14 patients who had received ICI in the past 6 months and presented with ptosis. Improvement in ptosis was considered positive IPT (non-fixed, fatigable ptosis) that is suggestive of Immune-mediated MG-predominant process. Work up included myasthenia antibodies, EMG, serum markers of muscle injury (creatine kinase, aldolase), myositis panel and muscle biopsy. Statistical analyses employed median for continuous and frequencies for categorical variables.

RESULTS
Positive IPT was found in 2 (14%) patients with positive myasthenia antibodies and neuromuscular junction dysfunction on EMG in one patient with repetitive nerve stimulation. These patients had mild elevation in creatine kinase (CK). Muscle biopsy did not reveal a myositic process. Twelve (86%) patients had negative IPT (fixed and non-fatigable ptosis) with significantly elevated CK (&gt;4000), positive myositis panel and muscle biopsy consistent with myositic process. Six of these patients (42%) also had positive myasthenia antibodies. Concomitant myocarditis was observed in 5 (36%) patients.

CONCLUSION
Clinical overlap between myasthenia and myositis is observed in immune mediated toxicity that may be due to cross-reactivity of antibodies, however, IPT was able to distinguish MG vs myositis-predominant process, thus helping guide management.
NCMP-07. ADVERSE NEUROLOGIC COMPLICATIONS FOLLOWING IMMUNE CHECKPOINT INHIBITORS FOR TREATMENT OF MELANOMA: COMPARATIVE ANALYSIS OF PD-1 INHIBITOR MONOTHERAPY TO COMBINATION THERAPY WITH CTLA-4 INHIBITORS
Authors: Das Nikita , Dhamija Ravi , Kaelber David , Kelly Michael , Xie Peter , Reddy Deven 
Published: November 2024

Abstract
In the past decade, FDA approval of several novel immune checkpoint inhibitors (ICI) has revolutionized treatment of advanced melanoma. However, severe immune-related adverse events (irAEs) from these medications have been reported. This study examines whether PD-1/CTLA-4 inhibitor combination immunotherapy confers increased incidence of neurologic irAEs in melanoma patients compared to PD-1 inhibitor monotherapy. A retrospective, multicenter cohort study performed using TriNetX research platform identified adult patients diagnosed with melanoma. Cohort 1 (n=9,105) included melanoma patients treated with PD-1 inhibitor monotherapy (pembrolizumab or nivolumab). Cohort 2 (n=4,727) included melanoma patients treated with PD-1/CTLA-4 inhibitor combination therapy (PD-1 inhibitor + ipilimumab). Propensity Score Matching generated final cohorts (n=4,667) using covariates: gender, race, age at diagnosis, and history of nervous system disorders. Odds ratios (OR) were determined for the occurrence of neurologic irAEs at 3 years and 5 years following therapy initiation. Kaplan Meier analysis estimated survival probabilities for each irAE subtype, as defined by the 2021 Neuro irAE Disease Definition Panel. At 3 years post-diagnosis, there was increased risk of meningitis [OR: 2.8, 95% CI: (1.8, 4.2)], encephalitis [OR: 3.1, 95% CI: (1.9, 5.1)], demyelinating syndromes [OR: 2.7, 95% CI: (1.4, 5.2)], vasculitis [OR: 1.2, 95% CI: (0.5, 2.8)], peripheral neuropathy [OR: 1.3, 95% CI (1.1, 1.5)], neuromuscular junction disorders [OR: 1.1, 95% CI: (0.7, 1.8)], and myopathy [OR: 1.4, 95% CI: (1.1, 1.9)] in melanoma patients receiving combination immunotherapy compared to those receiving anti-PD-1 monotherapy. Increased incidence of neurologic irAEs corresponded with marginally lower, yet statistically significant decreases in survival probability (p&lt;0.01), except for vasculitis (p=0.2) and neuromuscular junction irAEs (p=0.3). At 5 years following therapy initiation, these trends persisted. Melanoma patients receiving anti-PD-1/CTLA-4 combination therapies are at greater risk of neurologic irAEs than patients on anti-PD-1 monotherapy. Incidence of neurologic irAEs may confer worsened survival prognosis for these patients.
NCOG-03. DESCRIPTIVE ANALYSIS AND OUTCOME COMPARISON BETWEEN PATIENTS WITH GLIOBLASTOMA MULTIFORME WHO RECEIVE 15 VERSUS 30 FRACTIONS OF RADIOTHERAPY: A RETROSPECTIVE CHART REVIEW
Authors: Gnanasegaram Joshua , Paulin Gregory , Kutanzi Ethan , Kalyvas Maria , Mushonga Melinda , Genta Sofia , Purzner Teresa , Purzner James , Goldie Katie , Olding Timothy , de Moraes Fabio Ynoe 
Published: November 2024

Abstract
The morbidity and efficacy of abbreviated radiotherapy (RT) courses for Glioblastoma (GB) in patients over 60 years have been studied, however, outcomes in younger patients are not yet well-described. This study aims to characterize the outcomes of patients receiving either a standard versus abbreviated RT course. A retrospective chart review at Kingston Health Sciences Centre from June 2014 to March 2021 included patients with GB receiving either 40Gy in 15 fractions (Fr) or 60Gy in 30Fr. Data on age, ECOG score, and concurrent chemotherapy (Temozolomide, TMZ) were collected. Outcomes compared were treatment completion, hospital admission during treatment, progression-free survival (PFS), and overall survival (OS). Records of 156 patients (median age 61 years, range 25-87 years) were reviewed. Of these, 89 received 30Fr and 67 received 15Fr (p=0.51). MGMT methylation was recorded in 54 (35%) patients; of these, 27 received 15Fr and 27 received 30Fr. Median follow-up was 12 months. While PFS did not significantly differ between 15Fr vs. 30Fr (6 vs. 11 months, respectively; p=0.08), OS was significantly different (8 vs. 16 months, respectively; p&lt;0.001). Patients receiving 15Fr vs 30F tended to have higher ECOG scores (p&lt;0.001) and were older (median: 71 [range 45-87] vs. 57 [range 25-69] years; p&lt;0.001). Individuals receiving TMZ were more likely to receive 30Fr (67.5% vs. 32.5% for 15Fr; p&lt;0.001). Completion rates were higher for 30Fr (94.3%) than 15Fr (83.6%; p=0.03). Hospital admission rates did not differ (p=0.51). In summary, patients receiving 15Fr (40Gy) typically have poorer functional status, are less likely to receive chemotherapy, and less likely to complete treatment compared to those receiving 30Fr. Hospital admission rates during treatment are low (13%) and similar for both groups. OS, but not PFS, is better for patients receiving 30Fr compared to 15Fr.