bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-05. CHARACTERIZATION OF LONG-TERM METABOLIC CHANGES OF BRAIN METASTASES AFTER TREATMENT WITH STEREOTACTIC RADIOSURGERY USING SERIAL FET PET IMAGING
Authors: Wollring Michael , Lowis Carsten , Stoffels Gabriele , Werner Jan-Michael , Celik Eren , Baues Christian , Ruge Maximilian , Ruess Daniel , Fink Gereon , Langen Karl-Josef , Lohmann Philipp , Galldiks Norbert 
Published: November 2023

Abstract

BACKGROUND
In the present study, we characterized the long-term metabolic changes of brain metastases after treatment with stereotactic radiosurgery (SRS) by serial PET imaging using the radiolabeled amino acid O-(2-[18F]-fluoroethyl)-L-tyrosine (FET). We hypothesized that this approach is of considerable clinical value in differentiating between radiation-induced changes and local brain metastasis relapse. Patients and

METHODS
From 2010-2020, we retrospectively identified patients with brain metastases from solid extracranial primary tumors who (i) were treated with SRS with or without concurrent immunotherapy using checkpoint inhibitors, (ii) had equivocal MRI findings after SRS, and (iii) subsequently underwent two or more additional FET PET scans during follow-up for long-term evaluation. Mean tumor-to-brain ratios (TBR) were obtained. Diagnostic performances were calculated using receiver operating characteristic curve analyses. Diagnoses were confirmed by neuropathological evaluation (29%) or clinicoradiologically (71%).

RESULTS
We identified 14 patients with 42 FET PET scans (median number, 3; range, 2-4). Concurrent to SRS, 4 patients (29%) were treated with checkpoint inhibitors. Following SRS, equivocal MRI findings occurred after a median time of 7 months (range, 2-62 months). Subsequently, FET PET scans were acquired over a median 16 months (range, 7-99 months). Nine patients (64%) had radiation-induced changes, and five had local brain metastases relapse. TBRs calculated from the last available FET PET scan showed the highest accuracy (93%) in identifying radiation-induced changes (threshold, 1.95; P=0.011). In lesions consistent with local brain metastases relapse, TBR increased considerably over time (median increase, 17%; range, 11% - 32%). In contrast, in lesions considered as radiation-induced changes, TBR remained stable or even decreased (median change, -4%; range, -44% - 11%). The TBR evolution over time significantly differed between the two groups (P=0.011).

CONCLUSIONS
Serial FET PET imaging has a high diagnostic accuracy for characterizing long-term changes of brain metastases after treatment with stereotactic radiosurgery.
NIMG-18. MULTI-PARAMETRIC MRI AND SPECT ASSESSMENT OF TREATMENT DOSE AND EFFICACY IN RESPECT-GBM FOR RECURRENT GLIOBLASTOMA (RGBM)
Authors: Huang Shiliang , Brenner Andrew , Bao Ande , Michalek Joel , Moore Melissa , Hedrick Marc , LaFrance Norman 
Published: November 2023

Abstract

BACKGROUND
We have previously shown a dose-dependent association with survival for patients receiving Rhenium-186-nanoliposome (186RNL) for rGBM. This study aim, applying 3D-dosimetry and advanced-MRI features to outcome assessment, was to extend those findings.

METHODS
SPECT/CT images were acquired at mid-fusion, end-of-infusion, 24-hour, 120-hour, and 192-hour post-186RNL infusion. Baseline MRI was performed within 7days of treatment, at 28d, and every 56d until progression with: T1-3D pre-/post-contrast agent, DSC, DWI. SPECT images were processed using MIM software with treatment volumes corresponding to the 100Gy isodose curve exported as treatment-ROI. Difference (delta T1) between standardized pre-contrast (T1) and post-contrast (T1_C) anatomic images were used to measure tumor volume (IB Rad Tech). Within the tumor, various MRI-derived parameters, such as standardized-relative-cerebral-blood-volume (srCBV), time to maximum (Tmax), time to peak (TTP), were calculated.

RESULTS
Perfusion analysis(n=8) revealed significant decreases in the mean nrCBF, nrCBV, rCBF, rCBV, and srCBV with dose [nrCBF: -0.25 95% CI -0.37 to -0.14, p=0.005, nrCBV: -0.23 95% CI -0.34 to -0.13, p=0.005, rCBF: -3.5 95% CI -5.37 to -1.63, p=0.01, rCBV: -11.91 95% CI -20.45 to -3.38, p=0.03, srCBV: -0.14 95% CI -0.23 to -0.05, p=0.02], and a significant increase in the mean Tmax [1.88 95% CI 0.58 to 3.17, p=0.03]. The mean volume (n=10) not covered by treatment (-1.59 95% CI -4.81 to 1.63, p=0.36), Tumor volume (-0.76 95% CI -5.23 to 3.72, p=0.75), Treated volume (3.31 95% CI -0.44 to 7.06, p=0.12), and Tumor Volume covered by treatment (0.84 95% CI -1.2 to 2.87, p=0.44) did not vary significantly with dose although may gain significance with a larger data set.

CONCLUSION
MRI radiographic features proved valuable in assessing treatment efficacy and guiding treatment considerations. Image processing is ongoing, and the complete data set will be presented.
NIMG-25. CLINICAL FEASIBILITY OF AI-BASED T2 FLAIR SEGMENTATION FOR DETECTION OF PROGRESSION IN NON-ENHANCING LOWER GRADE GLIOMA
Authors: Luks Tracy , Damasceno Pablo , Gleason Tyler , Hawkins James , Avalos Lauro , Hervey-Jumper Shawn , Majumdar Sharmila , Lupo Janine , Crane Jason , Villanueva-Meyer Javier 
Published: November 2023

Abstract
Radiological assessment of progression in patients with non-enhancing lower grade gliomas (LrGG: grade 2 and 3) is primarily based on increase in lesion size on anatomical T2-weighted fluid-attenuated inversion recovery (T2 FLAIR) magnetic resonance imaging (MRI) sequences. We evaluated whether an AI-based method could be used routinely as part of patient care to assist in detecting non-enhancing glioma progression. The software offers the ability for real-time quality control and editing, choice of baseline exam and threshold for progression, and shows 3D image segmentations side-by-side with lesion volume graphs. The model was trained to create T2 FLAIR abnormality segmentations. The 515 training images included pre-surgical scans of newly diagnosed and recurrent patients, and post-surgical surveillance scans of patients. Clara Deploy was used for inference and to handle communication between PACS and an XNAT server, where results were stored and displayed. Following RANO criteria, lesions were marked as ‘progressed’ if volume changes were larger than 40% between baseline and the MRI of interest. The 124 AI-based segmentation model test volumes were compared to manual segmentation volumes, and achieved a mean DICE score of 0.87 ± 0.20. The sensitivity and specificity of the RANO progression assessment based on the model was compared with RANO progression assessment based on manual segmentation in 16 patients (6 serial MRIs each), with 85% sensitivity, 82% specificity. This work presents the first steps toward clinical deployment of AI-based real-time quantitative detection of LrGG progression by RANO criteria. This quantitative assessment provides supplementary information to the radiologist and can be shared with the patient’s neuro-oncologist, neurosurgeon, and other clinical team members for consideration in treatment planning.
NIMG-44. RADIOMIC FEATURES OF CONTRAST ENHANCED T1 MRI SEQUENCES PREDICT SURVIVAL IN PRIMARY GLIOBLASTOMA PATIENTS WHO UNDERWENT ADJUVANT RADIATION THERAPY
Authors: Flatley Michael , Duenweg Savannah , Bobholz Samuel , Lowman Allison , Stebbins Margaret , Winiarz Aleksandra , Nath Biprojit , Kyereme Fitzgerald , Connelly Jennifer , Coss Dylan , Agarwal Mohit , Banerjee Anjishnu , Krucoff Max , LaViolette Peter 
Published: November 2023

Abstract

PURPOSE
Glioblastoma (GBM) is an aggressive primary brain tumor that is monitored through magnetic resonance imaging (MRI). Radiomic analysis offers valuable insight into better understanding the imaging features of these tumors. We tested the hypothesis that changes in radiomic features following radiation treatment predicts overall survival. Radiomic features we were interested in included 2D and 3D shape features, first order features evaluating patterns of voxel intensity within the mask regions, and higher order GLCM features.

METHODS
Data from 19 patients from our brain bank diagnosed with a GBM at autopsy and underwent radiation therapy were used for this study. T1C tumor masks were created by manually annotating contrast enhancing tumor for patients on pre- and post-treatment MRIs. Pyradiomics was used to extract radiomic features within both pre- and post-radiation tumor masks, including 14 shape features, 18 first order features, and 75 higher order features were compared across timepoints and the difference for each variable was correlated with overall survival.

RESULTS
Of the tested radiomic features, only the following shape features were found to be correlated with overall survival: Major Axis Length (R = -0.55, p =.02), Maximum 2D Diameter Row (R= -.56, p =.02), Maximum 2D Diameter Slice (R= -.52, p =.03), and Maximum 3D Diameter (R= -.47, p = .04).

CONCLUSIONS
These results show a decrease in the Major Axis Length, Maximum 2D Diameter, Maximum 2D Diameter, and Maximum 3D diameter of the T1C masks post-radiation correlate with an overall increase in survival. These inverse trending radiomic variables may be useful to assess tumor response to radiation therapy, specifically through assessment of shape features within the contrast-enhancing tumor region. Future research should determine how tumor changes in response to other treatment modalities and/or correlates with other prognostic variables.
NIMG-47. LONGITUDINAL TRAJECTORIES FROM SERIAL SURVEILLANCE MRI IMAGING OF PROGRESSIVE IDH MUTANT LOW-GRADE GLIOMA PATIENTS
Authors: Fetcko-Fayad Kaleigh , Zheng Xiaojun , Godfrey Devon , Kirveslahti Henry , Mukherjee Sayan , Lafata Kyle , Thomas Jennifer , Peters Katherine , Ryser Marc 
Published: November 2023

Abstract

BACKGROUND
Most patients with isocitrate dehydrogenase mutant (IDHm) low-grade glioma (LGG) undergo active MRI surveillance after initial surgery. Timely biopsy referral during surveillance is a complex trade-off between avoiding the harms of unnecessary surgery and early detection of transformation. Serial surveillance MRIs could be leveraged to develop dynamic imaging markers, yet prior research has primarily focused on the prognostication of pre-treatment images. We piloted the feasibility of an automated pipeline using patient-specific imaging trajectories.

METHODS
We retrospectively identified 12 progressive IDHm LGG patients and collected serial surveillance MRIs. A previously developed segmentation model was fine-tuned on a subset of T2/FLAIR images (n=49) before automated tumor segmentation was performed on all MRIs. We extracted geometric and topological tumor features, including volume, cross product, and Euler Characteristic Transform, from each MRI. We used piecewise linear regression to quantify feature trajectories and identify change points in feature growth rates.

RESULTS
Twelve patients received 14 biopsies/repeat resections (10 with transformation, 4 without) and 282 MRIs (median per patient: 17, range: 10-40). All biopsies/repeat resections were preceded by a change point in tumor volume trajectory, indicating an increase in tumor growth rate preceding clinician-determined MRI progression and biopsy referral. The mean increase in volume growth rate, pre to post change point, was 2.3cm3/month (SE: 0.9) in biopsies/repeat resections with transformation, compared to 1.1cm3/month (SE: 0.6) in biopsies/repeat resections without transformation. Among the ten patients with transformation, the median time from IDHm LGG diagnosis to transformation was 64.8 months (range: 38.6-141.1), and the median time between volume change point and transformation was 15.6 months (range: 4.6-28.2).

DISCUSSION
This pilot study suggests that feature trajectories from serial MRIs of IDHm LGG patients may advance the detection and treatment of transformed lesions by 12-18 months. Larger studies can corroborate these findings and inform clinical decision-making.
NIMG-70. TRACKING CELLULAR SOCIAL BEHAVIOR OF PATIENT-DERIVED PRIMARY CELL LINES TO GATHER NEW INSIGHTS FOR BETTER STRATIFICATION OF GLIOBLASTOMA PATIENTS
Authors: Ferri Gianmarco , Morelli Mariangela , Lessi Francesca , Franceschi Sara , Pieri Francesco , Gambacciani Carlo , Aretini Paolo , Pasqualetti Francesco , Santonocito Orazio Santo , Stefano Anna Luisa Di , Mazzanti Chiara Maria 
Published: November 2023

Abstract
Glioblastoma is one of the most frequent and aggressive brain tumors. The average life of these patients is on average less than 15 months, due to the proliferation and invasiveness of the tumor cells, which not only constitute the tumor mass but which also infiltrate the normal parenchyma brain to form new cancerous sites. Knowing the specific behavior of the cell types that make up the tumor of every single patient, in terms of volume, shape, motility, and cell-cell interaction could be informative for patients’ tumor stratification. Here we developed a protocol that integrates imaging and image processing algorithms, to accurately and quantitatively identify the morphological and behavioral characteristics of tumor cells cultured in vitro and track their movement over time. This approach enables quantifying important biological processes such as cell migration and cell growth, both of which play a major role in the development of diseases. The cell tracking method combines segmentation methods with spatiotemporal optimization to analyze microscopy images. The method also determines various information about cell movements such as movement paths, speed, and distance covered. Knowing the behavior of the malignant glioma cells of a specific patient, in terms of shape and motility (e.g. direction and speed of movement), also in relation to other cells could be informative in the context of dynamic precision medicine. In this context, we created a model that integrates the characteristics of each patient's tumor cells and provides a new way of stratifying patients that can be correlated with clinical data.
NIMG-78. USE OF ARTERIAL SPIN LABELING TO DETECT METASTASIS OF MENINGEAL SOLITARY FIBROUS TUMORS
Authors: Costanza Katelyn , Oztek Alp , Andre Jalal , McGranahan Tresa 
Published: November 2023

Abstract
Meningeal solitary fibrous tumors (SFT), formerly known as hemangiopericytoma, are rare, highly vascular, mesenchymal dural based neoplasms. Meningeal SFT require lifelong imaging surveillance given high risk of recurrence and metastasis, even decades after initial diagnosis. Often these metastases are initially small, nodular dural masses that are difficult to detect with standard brain tumor imaging protocols. Given SFT are highly vascular tumors, we hypothesized that recurrent meningeal SFT would have elevated cerebral blood flow using Arterial Spin Labeling (ASL) perfusion imaging. ASL is a noninvasive MRI technique used to detect cerebral blood flow in high grade neoplasms and hyper vascular meningiomas without intravenous contrast. We evaluated ASL in two patients with recurrent meningeal SFT. In both patients the recurrent meningeal SFT demonstrated elevated perfusion by ASL. In one patient, the elevated ASL signature enabled identification of a small metastasis that was not initially appreciated on structural imaging. Following treatment with antiangiogenic therapy, ASL was no longer elevated while enhancement did not change. To our knowledge, this is the first study reporting utility of ASL imaging in detecting intracranial recurrence of meningeal SFT. We propose further study of sensitivity of ASL to detect recurrent meningeal SFT.
NCMP-13. CONCURRENT WOUNDED GLIOMA SYNDROME AND DISTANT WOUNDED GLIOMA SYNDROME FOLLOWING A GROSS TOTAL RESECTION OF GLIOBLASTOMA MULTIFORME – A CASE REPORT
Authors: Calubayan John Michael , Opinaldo Paul Vincent 
Published: November 2023

Abstract
Surgery is the initial form of treatment for glioblastoma, and a maximum resection without impairing neurological function improves survival. Wounded Glioma Syndrome (WGS) is a clinical picture observed after the resection of high-grade tumors. This syndrome, developing within hours or a few days after glioma surgery, is characterized by hemorrhage into the surgical bed and cerebral edema, and at times occurring in areas distant from the site of the resection, i.e., Distant WGS. We report a case of an elderly male presenting with an acute-onset left leg weakness, with a large peripherally-enhancing mass with central non-enhancement suggestive of necrosis in the right frontal lobe. A gross total resection of the tumor was done, and the histopathologic evaluation yielded a high-grade glioma, favoring a diagnosis of Glioblastoma WHO Grade-IV. During the postoperative period, he was drowsy and was able to move the right extremities. He had a series of generalized tonic-clonic seizures three hours after the operation. After eight hours, the patient became comatose with signs of increasing intracranial pressure. A cranial CT revealed diffuse cerebral edema, and hemorrhage into the operative site in the right frontal lobe, as well as subarachnoid hemorrhages in the bilateral fronto-parietal sulci. There were also small hemorrhages seen in the left caudate head, midbrain and left hemipons. Death occurred the following day. This case report demonstrates an unusual case of a WGS with a concurrent Distant WGS in the brainstem after a gross total resection of a frontal lobe glioma. This case shows a significant uncommon sequela that a patient undergoing glioma surgery can present, leading to rapid deterioration and death. Resection of a glioma carries a significant risk, and its impact in the immediate postoperative period merits evaluation when planning the perioperative management, taking prompt action if these syndromes occur.
NCMP-15. AMYLOID-BETA AND TAU-PATHOLOGY IN THE GLIOMA VICINITY
Authors: Greutter Lisa , Miller-Michlits Yelyzaveta , Schnitzenlehner Lisa , Klotz Sigrid , Krause Elena , Platzek Stephan , Kiesel Barbara , Widhalm Georg , Stepper Peter , Nenning Karl-Heinz , Langs Georg , Baumann Bernhard , Woehrer Adelheid 
Published: November 2023

Abstract
With aging societies the incidences of brain cancer and neurodegenerative disease are increasing. Although biological associations were suggested between glioma and Alzheimer's disease (AD), the rate of comorbidity is ill-defined. We here screened the tumor-adjacent cortex of a representative patient cohort for tau and Amyloid-beta deposits and correlated the results with imaging biomarkers. A total of 290 patients (37 astrocytoma, IDH-mutant, CNS-WHO grades 2-4, median-age: 39; 48 oligodendroglioma, IDH-mutant and 1p-19q-co-deleted, CNS-WHO grades 2-3, median-age: 50; 205 glioblastoma, IDH-wildtype, median-age: 65) were included. Whole-slide quantifications were performed using a digital pathology pipeline based on Matlab and QuPath codes. For a subset of 48 patients with glioblastoma 280 longitudinal MRI volumes were available for segmentation and volumetric analysis of tumor ipsi- and contralateral hippocampuses. Overall, 160 patients (55%) displayed Amyloid-beta and/or tau-pathology in tumor-adjacent cortex. AD protein deposits correlated significantly with age (p&lt; 0.001), and showed topographic variability across brain regions. Amyloid-beta plaques were commonly observed in the occipital cortex in glioblastoma (50%, n= 10/20), while tau-pathology was commonest in the temporal lobe in both IDH-mutant and -wildtype tumors (71%, n= 10/14; 56% n= 44/79). Remarkably, isolated tau-pathology was more prevalent in IDH-mutant glioma (48% vs. 18%, p&lt; 0.001, median age: 45). Median cell density in tumor-infiltrated cortex was highest in glioblastoma (1895 cells/mm²), and associated with reduced neuronal counts and AD protein deposits (p&lt; 0.001). In glioblastoma, hippocampal atrophy correlated with AD-type pathology at time of diagnosis and remained stable during follow-up in the majority of patients. In sum, our data suggests frequent co-morbidity of glioma and AD-type pathology, which increases with age. Isolated tau-pathology was more pronounced in IDH-mutant tumors. In tumor-adjacent cortex, increased tumor cell infiltration paralleled neuronal loss and diminished AD-type pathology.
NCMP-19. OUTCOMES FOLLOWING PALLIATIVE CEREBROSPINAL FLUID DIVERSION FOR NEOPLASTIC LEPTOMENINGEAL DISEASE: A SYSTEMATIC REVIEW
Authors: Wu Adela , Zhou James , Skirboll Stephen 
Published: November 2023

Abstract

BACKGROUND
Leptomeningeal disease (LMD)—cancer involvement of meninges or disseminated through the cerebrospinal fluid (CSF) system—indicates widespread or advanced cancer. LMD leads to symptomatic hydrocephalus, for which palliative CSF diversion may be indicated. We conducted a systematic review exploring published literature on outcomes of permanent CSF diversion for hydrocephalus among pediatric and adult patients with LMD from primary brain tumor or systemic cancers.

METHODS
We searched PubMed, Embase, and Web of Science from database inception until 8/20/2022, using search terms including but not limited to ‘cancer’, ‘hydrocephalus’, and ‘shunt’. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Inclusion criteria were English-language, quantitative studies of patients with LMD and hydrocephalus, with at least five subjects.

RESULTS
We screened 2440 abstracts and 152 full-text articles to yield a final cohort of 23 articles. The retrospective studies reported outcomes for 2895 patients, among which 995 patients (34.3%) specifically had LMD on presentation. Fourteen studies reported proportions of patients with LMD and hydrocephalus who underwent surgery for permanent CSF diversion (range: 9.9-100%), including endoscopic third ventriculostomy, ventriculoperitoneal or lumboperitoneal shunts. Postoperative complication rates were 0-37.7% with no cases of extraneural metastases via shunt. Rates of symptomatic relief following CSF diversion ranged from 50-100% in studies that reported data. In 14 studies, median overall survival ranged from 2.1-17.1 months. Three studies reported median survival after shunt surgery for LMD (2-3.3 months).

CONCLUSION
A rare entity with dismal prognosis, LMD and disseminated tumor can present as symptomatic hydrocephalus in patients with cancer. Symptom relief can be achieved with palliative surgery for permanent CSF diversion with relatively low complication rates. Prospective studies are needed to further assess outcomes and needs of this patient population.