bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-86. REVEALING THE BIOLOGY BEHIND MRI SIGNATURES IN GLIOBLASTOMA
Authors: Lewis Erika , Tran Nhan , Swanson Kristin , Hu Leland , Plaisier Christopher 
Published: November 2022

Abstract
The brain is notoriously difficult to access because of its location and protective mechanisms, both internal and external. Imaging-based approaches, such as multiparametric magnetic resonance imaging (mpMRI), provide a method to bypass these obstacles. mpMRI can capture a wide range of data from tumors embedded in brain tissue through various imaging features. However, the biological function captured by each imaging feature remains largely unknown, particularly within the aggressive disease glioblastoma multiforme (GBM). We integrated our GBM SYstems Genetics Network AnaLysis (gbmSYGNAL) gene regulatory network (Plaisier, et al. 2016), based on the multi-omic patient data from The Cancer Genome Atlas (TCGA), with mpMRI-localized patient tumor biopsies. The gbmSYGNAL network was reconstructed within the new image-localized biopsies, and associations revealed a strong connection between the spoiled gradient recalled echo + contrast (SPGR+C) feature and the immune hallmarks of cancer. The SPGR+C method generates an image by employing a contrast agent that bypasses the blood brain barrier (BBB) through leaky blood vessels that have weakened from the force of the rapidly growing GBM tumor. Furthermore, a significant association between SPGR+C signal and the presence of both infiltrating macrophages and T cells indicated that peripheral immune cells may also cross the BBB at these leaky sites. Separately, the mean diffusivity (MD) & T2 features were linked to the sustained angiogenesis hallmark. These features displayed high association with angiogenic genes, such as FLT1, KDR, and PDGFRB, and correlated with the presence of histologically identified vessels. Detection of these disease-relevant functions via mpMRI features has powerful clinical applications, providing a non-invasive approach to GBM diagnosis, prognosis, and treatment direction.
NIMG-88. A TRANSFER LEARNING APPROACH FOR AUTOMATIC SEGMENTATION OF TUMOR SUB-COMPARTMENTS IN PEDIATRIC MEDULLOBLASTOMA USING MULTIPARAMETRIC MRI: PRELIMINARY FINDINGS
Authors: Bareja Rohan , Ismail Marwa , Martin Douglas , Nayate Ameya , Tamrazi Benita , Salloum Ralph , Margol Ashley , Judkins Alexander , Iyer Sukanya , de Blank Peter , Tiwari Pallavi 
Published: November 2022

Abstract

PURPOSE
Superior outcomes for medulloblastoma (MB) requires precise surgical resection which can be guided by tumor segmentation. We present the first attempt at automatic segmentation of MB tumors via a hierarchical transfer-learning model that (1) segments the entire tumor habitat (enhancing tumor (ET), necrosis/non-enhancing tumor (NET), edema), followed by (2) training separate models for each of the sub-compartments. Transfer learning from adult brain tumors is used to optimize segmentation of tumor sub-compartments for pediatric MB.

METHODS
We evaluated 300 adult glioma studies (BRATS) and 49 pediatric MB studies (2-18 years old), both consisting of Gd-T1w, T2w, FLAIR sequences. The MB cohort was collected from Children's Hospital of Los Angeles (Nf19) and Cincinnati Children’s Hospital Medical Center (Nf30). Scans were registered to age-specific pediatric atlases, followed by bias correction and skull-stripping. Ground truth for the tumor sub-compartments was generated via consensus across two experts. We employed a 3D nn-Unet segmentation model on BRATS dataset using initial learning rate of 0.01, stochastic gradient descent as optimizer, and an average of dice loss and cross-entropy loss as the loss function. A hierarchical transfer learning model with Models Genesis was then applied, which allowed for fine tuning every layer on the pediatric MB dataset, across 5-fold cross validation. Dice score was used as performance metric, such that a perfect overlap between ground truth and prediction would yield a Dice score of 1.

RESULTS
Our 3D hierarchical segmentation model yielded mean dice scores of 0.85±0.03 for the entire tumor habitat; 0.77±0.048 for ET, 0.73±0.09 for edema, and 0.56±0.09 for NET + necrosis segmentation, across cross-validation runs. Overall, tumor outline and segmentation matched well with the ground truth, especially for the entire tumor, ET and enhancing tumor sub-compartments.

CONCLUSIONS
Our segmentation approach holds promise for accurate automated delineation of the tumor sub-compartments in pediatric Medulloblastoma.
NIMG-89. DISSEMINATED SPINAL METASTASES FROM A PITUITARY CARCINOMA
Authors: Anderson Mark , Pratibhu Parakash 
Published: November 2022

Abstract
Pituitary carcinomas are rare malignant neoplasms and rarely result in a solitary spinal metastasis. In this report we describe a case of pituitary carcinoma that metastasized to the spinal canal and the nerve roots at numerous spinal levels, mimicking neurofibromatosis of the spine. This patient is a 72 year old right-handed female with past medical history of pituitary adenoma which was resected 5 years prior and stable on imaging. At presentation, patient was seen for right sciatica, and an MRI showed multiple enhancing intradural extramedullary lesions mainly in the lumbar spine, felt to represent nerve sheath tumors, neurofibromas. She underwent genetic testing, but NF1, NF2, SMARC1B, SPRED1, LTRZ1 were not found to have a mutation. Over a 3 year period, she had progression of her spinal tumors. The pituitary lesion remained stable in appearance. She underwent resection of multiple lumbar lesions and pathology was consistent with pituitary carcinoma.Patient tolerated up to almost 11 full cycles of temozolomide before it was put on hold due to significant deconditioning and lethargy. Imaging revealed a partial response of the spinal cord metastases. This is an unusual presentation for metastatic pituitary carcinoma and delay in diagnosis resulted in significant morbidity.
NIMG-90. DIFFERENTIATION OF INTRACRANIAL SOLITARY FIBROUS TUMOR AND MENINGIOMA ON CONVENTIONAL, DIFFUSION-WEIGHTED, AND DYNAMIC SUSCEPTIBILITY CONTRAST PERFUSION MRI
Authors: Kurokawa Ryo , Kurokawa Mariko , Baba Akira , Kim John , Capizzano Aristides , Bapuraj Jayapalli , Srinivasan Ashok , Moritani Toshio 
Published: November 2022

Abstract

BACKGROUND AND PURPOSE
To evaluate the differences in the imaging findings of intracranial solitary fibrous tumor (SFT) and meningioma on dynamic susceptibility contrast (DSC) perfusion MRI, apparent diffusion coefficient (ADC), and conventional sequences.

METHODS
Between January 2016 and April 2022, the study enrolled 14 (median, 46 years [range, 25–74]; six females; seven with DSC-MRI) and 27 patients (median, 53 years [21–83]; 23 females; all with DSC-MRI) with pathologically proven SFT and meningioma, respectively. The normalized relative cerebral blood volume and flow (nrCBV and nrCBF), percentage signal recovery (PSR), normalized mean ADC (nADCmean), and conventional imaging features, including T1-weighted hyperintensity, were evaluated and statistically compared using Bonferonni correction.

RESULTS
PSR was significantly lower in SFT compared with that in meningioma (median, 22.5 [range, 6.4–48.8] vs. 70.1 [range, 18.6–104.2], p&lt; 0.001). The majority of SFT showed mainly T1-weighted hyperintensities compared to the gray matter, while only one meningioma showed the finding (8/14 [57.1%] vs. 1/27 [3.7%], p&lt; 0.001). No significant difference was observed in nrCBV, nrCBF, or nADCmean.

CONCLUSIONS
PFS was significantly lower in intracranial SFT compared with that in meningioma, indicating the difference in capillary permeability between the tumors. Comparing the hyperintensity on T1WI of the solid components with that of the cerebral cortex was a simple and useful characteristic to differentiate SFT from meningioma.
NIMG-98. IDENTIFYING PATTERNS OF FAILURE AFTER INITIAL THERAPY IN PRIMARY CNS LYMPHOMA IN A LARGE PATIENT COHORT
Authors: Tringale Kathryn , Yahalom Joachim , Scordo Michael , Vachha Behroze , Schaff Lauren , Grommes Christian , Imber Brandon 
Published: November 2022

Abstract

INTRODUCTION
Treatment of primary CNS lymphoma (PCNSL) has rapidly evolved, emphasizing improved efficacy while reducing neurotoxicity. PCNSL has historically been considered a multifocal disease and many patients relapse after first-line therapy. We evaluated relapse patterns in a large cohort of contemporarily treated patients.

METHODS
Consecutive PCNSL patients treated at MSKCC between 1983-2020 were analyzed. T1 post-contrast-enhancing disease on baseline MRI was characterized. Site of initial relapse was characterized as purely local (involving/adjacent to initial site) vs distant intraparenchymal, or other (e.g., both local and distant, systemic, ocular). Progression-free survival (PFS) was evaluated using Kaplan Meier methods.

RESULTS
Of 645 patients, 564 were eligible for analysis (diffuse large B-cell histology, sufficient data, ≥ 1 MRI response assessment). Median follow-up was 2.7 years (IQR 1.2-5.6). Median age was 63 years (range 19-90). Baseline disease was often supratentorial (420, 74%), multifocal (274, 49%), and bilateral (224, 40%). Fewer had leptomeningeal disease (94/430 CSF+, 22%; 117/559 radiographically positive, 21%). Most received methotrexate (MTX)-based induction (534, 96%), most commonly rituximab, MTX, procarbazine, vincristine (R-MVP; 257, 46%) or MVP (144, 26%). Overall, 286 (51%) patients relapsed with a median PFS of 2.1 years (95% CI 1.8-2.5). Of 275 characterizable relapses, 75 (27%) were exclusively local intraparenchymal, 91 (33%) were distant intraparenchymal, and 109 (40%) were other. Baseline unifocal disease often relapsed unifocally (66/118 baseline unifocal; 56%). Of 126 unifocal relapses, 45 (36%) were local. Of 202 patients with baseline supratentorial disease, 152 (75%) relapsed supratentorially. Unilateral relapses often remain ipsilateral (49% left- and 54% right-hemispheric lesions at baseline and relapse).

CONCLUSIONS
In a large PCNSL cohort, relapses often maintained baseline characteristics. For a disease historically considered multifocal, a substantial proportion of relapses were local. Future analyses will evaluate predictors of relapse, which can further efforts in informing personalization of treatment in the era of cellular therapies.
NIMG-103. VOLUMETRIC CHANGES IN GRAY MATTER AFTER RADIOTHERAPY DETECTED WITH LONGITUDINAL MAGNETIC RESONANCE IMAGING IN GLIOMA PATIENTS
Authors: Lee Hye In , Jang Bum-Sup , Kang Min Kyoung , Hwang Kihwan , Kim Chae-Yong , Kim Yu Jung , Suh Koung Jin , Choi Byung Se , Choe Gheeyoung , Kim In Ah 
Published: November 2022

Abstract

PURPOSE
We evaluated volumetric changes in the gray matter (GM) after radiotherapy (RT) and identified factors that were strongly associated with GM volumetric reduction.

METHODS
A total of 461 magnetic resonance imagings (MRI) from 105 glioma patients treated with postoperative radiotherapy (RT) was retrospectively analyzed. Study patients’ MRIs were collected at five time points: before RT and 1 month, 6 months, 1 year, and 2 years after RT. Using the ‘FastSurfer’ platform, a deep learning-based neuroimaging pipeline, a total of 73 subsites was automatically segmented from longitudinal MRIs and their volumetric changes were calculated. Each subsite was grouped into 10 functional fields. A multivariable linear mixed-effects model was established to identify the potential predictors of volumetric changes.

RESULTS
The median volumetric changes in the overall, ipsilateral, and contralateral GM were -3.5%, -4.5%, and -2.4% at 2 years after RT. The functional fields of cognition and execution of movement showed the greatest volumetric reductions. In the multivariable linear mixed model, female and the interaction between age and days after RT were significantly associated with GM volume reduction. The GM volume was significantly reduced in patients older than the subsite-specific threshold age at RT (e.g., 45, 50, and 60 years for hippocampus, Broca area, and Wernicke area, respectively). However, there was no significant GM volumetric reduction in patients younger than the threshold age at RT.

CONCLUSIONS
GM volumetric changes were identified after RT that could lead to long-term treatment sequelae. Particularly for susceptible patients, individualized treatment and prevention strategies are needed.
NIMG-109. A PILOT STUDY OF LYMPHOSCINTIGRAPHY WITH TRACER INJECTION IN THE HUMAN BRAIN
Authors: Coxon Andrew , Desai Rupen , Patel Pujan , Vellimana Ananth , Willie Jon , Dowling Joshua , Leuthardt Eric , Kim Albert , Johanns Tanner , Siegel Barry , Dunn Gavin 
Published: November 2022

Abstract

INTRODUCTION
Many groups have reported lymphatic and glymphatic structures in animal and human brains, but tracer injection into the human brain to demonstrate real-time lymphatic drainage and mapping has not been reported. Technetium (99mTc) tilmanocept is a radiopharmaceutical agent that binds CD206 and maps draining lymph nodes. We hypothesized that peritumoral 99mTc-tilmanocept injection into the brain parenchyma would map drainage to cervical lymph nodes. Here we show a paucity of tracer movement after injection due to a presumed inefficiency of glymphatic and lymphatic drainage.

METHODS
We enrolled 14 patients undergoing resection or stereotactic biopsy of suspected benign or malignant intracranial tumors. Patients received peritumoral injections of 99mTc-tilmanocept followed by planar or tomographic imaging. One patient was excluded from analysis because of tracer leakage during injection.

RESULTS
No patients showed drainage of 99mTc-tilmanocept to regional lymph nodes. On average, after correcting for radioactive decay, 70.1% (95% CI: 60.0%, 81.6%) of the tracer in the injection site and 78.1% (95% CI: 71.1%, 85.1%) in the whole-head on the day of surgery remained the morning after, with variable radioactivity in the subarachnoid space. The remaining fraction at the injection site was much larger than the expected fraction of 1.12% (95% CI: 1.07%, 1.17%) based on previously reported clearance rates from non-brain injections. We determined that this lack of drainage was not due to sequestration by a large population of CD206+ cells via immunohistochemistry of peritumoral tissue sections. Patients with benign or malignant tumors and a patient who underwent or minimally invasive stereotactic biopsy all showed no drainage.

DISCUSSION
In this pilot study, the lymphatic tracer 99mTc-tilmanocept was injected into the brain parenchyma, and there was an absence of drainage to the cervical lymph nodes. Our work demonstrates an inefficiency of drainage from the brain parenchyma and highlights an opportunity to improve brain immunosurveillance.
NCMP-03. HEADACHE IN PATIENTS WITH NON-CNS CANCER
Authors: Cacho-Diaz Bernardo , Arrieta Oscar 
Published: November 2022

Abstract

BACKGROUND
Almost everybody will experience at least one headache episode and almost 40% of the world-population will be diagnosed with some sort of cancer during their life; nevertheless, their association has scantly been measured. Aim: To identify if headache characteristics and/or accompanying signs were associated with brain metastases (BM) in patients with non-CNS cancer.

METHODS
Patients with systemic cancer and headache sent for evaluation between June 2012 and June 2018 were included. Hematologic or primary CNS tumors were excluded. Magnetic resonance imaging (MRI) was performed in most; the remaining were followed for at least a year. Logistic regression analyses were used to measure associations.

RESULTS
From 572 patients with cancer and headache, 216 (38%) were diagnosed with BM. Variables significantly (P &lt; 0.05) associated with BM after multivariable analysis were male gender (OR 1.97), headache starting after cancer diagnosis (OR 21), oppressive type (OR 1.9), presence of vomiting (OR 5.78), not increased by changes in position (OR 2.2), and generalized location (OR 0.34). Having another symptom/sign other than headache was seen in 73% of patients with BM and was significantly associated with a higher risk of BM [OR 6.08 (9%%CI 2.1-17.3)], especially if patients presented with altered mental status (OR 15), visual complaint (OR 15), focal motor weakness (OR 11), seizures (OR 15), ataxia (OR 19), and/or vertigo (OR 3.8).

CONCLUSION
Headache in patients with cancer should be considered a warning sign, it′s characteristics and accompanying signs should be considered to assess individually the risk of being diagnosed with BM.
NCMP-05. RARE CASE OF INTRAMEDULLARY SPINAL CORD METASTASIS AND CANCER-RELATED STROKE SECONDARY TO NASOPHARYNGEAL CARCINOMA
Authors: Alonto Anisah Hayaminnah , Mondia Mark Willy , Planilla Cyril Jonas , Mendoza Marvin Jonne , Urquiza Sheen , King Rich Ericson , Bagnas Marjorie Anne 
Published: November 2022

Abstract

INTRODUCTION
Central nervous system (CNS) metastasis from nasopharyngeal carcinoma (NPC) is rare and presents with high morbidity and mortality. As a rare entity, a few patients with CNS metastasis from NPC have been reported, and no studies were available on treatment and prognosis. Based on our clinical experience, early diagnosis with incorporation of a clear palliative plan is imperative in providing holistic care for patients with locally-invasive and metastatic nasopharyngeal carcinoma.

CASE REPORT
Our study reports a case of a 48-year-old Filipino male with known NPC Stage IVB who developed acute symptoms of constipation, urinary retention, and bilateral lower limb weakness and numbness. Magnetic resonance imaging (MRI) showed intramedullary lesions in multiple segments of the spinal cord. Steroid and radiotherapy of the spine were initiated with noted transient improvement of the motor strength. Subsequently, he developed cancer-related stroke. The patient progressively deteriorated despite best medical care. To our knowledge, this is the fourth case of intramedullary spinal cord metastasis from NPC reported worldwide but the first one in the Philippines.
NCMP-08. THE EFFECTIVENESS OF ANTISEIZURE MEDICATION TRIPLETHERAPY IN GLIOMA PATIENTS WITH REFRACTORY EPILEPSY: A MULTICENTER OBSERVATIONAL COHORT STUDY
Authors: van der Meer Pim , Dirven Linda , Fiocco Marta , Vos Maaike , Kouwenhoven Mathilde , van den Bent Martin , Taphoorn Martin , Koekkoek Johan 
Published: November 2022

Abstract

BACKGROUND
About 10% of glioma patients with epilepsy need antiseizure medication (ASM) tripletherapy due to refractory epilepsy. This study aimed to determine whether levetiracetam combined with valproic acid and clobazam (LEV+VPA+CLB), a commonly prescribed tripletherapy, has favorable effectiveness compared to other tripletherapy combinations in glioma patients.

METHODS
In this multicenter retrospective observational cohort study, the primary outcome was to estimate the cumulative incidence of treatment failure for any reason, from initiation of ASM tripletherapy. Secondary outcomes included cumulative incidences of: 1) treatment failure due to uncontrolled seizures; 2) treatment failure due to adverse effects; and 3) recurrent seizure. Maximum duration of follow-up was 36 months.

RESULTS
Out of n=1435 patients in the original cohort, n=90 patients received ASM tripletherapy after second-line ASM treatment failure due to uncontrolled seizures. LEV+VPA+CLB was prescribed to 48% (43/90) and other ASM tripletherapy to 52% (47/90) patients. The cumulative incidence of treatment failure for any reason of LEV+VPA+CLB did not significantly differ from other tripletherapy (12 months: 47% [95%CI, 31-62%] versus 42% [95%CI, 27-56%], p=0.892). No statistical significant differences for treatment failure due to uncontrolled seizures (12 months: 12% [95%CI, 4-25%] versus 18% [95%CI, 8-30%], p=0.445), due to adverse effects (12 months: 22% [95%CI, 11-36%] versus 15% [95%CI, 7-27%], p=0.446), or recurrent seizure (1 month: 65% [95%CI, 48-78%] versus 63% [95%CI, 47-75%], p=0.911) were found.

CONCLUSIONS
LEV+VPA+CLB showed equivalent effectiveness compared to other ASM tripletherapy combinations in glioma patients.
NCMP-10. NEURO-OPHTHALMOLOGICAL FINDINGS IN CHILDREN AND ADOLESCENTS WITH MEDULLOBLASTOMA - A RETROSPECTIVE ANALYSIS
Authors: Lippolis Maria Aliotti , Koinig Sabine , Azizi Amedeo , Dorfer Christian , Pemp Berthold 
Published: November 2022

Abstract

BACKGROUND
Medulloblastoma represents the most common malignant pediatric brain tumor. Ophthalmic complications are possible sequelae.

METHODS
Pediatric medulloblastoma (MB) patients treated at the Medical University of Vienna from January 2012 to August 2021 were analyzed and their last ophthalmic assessment was reviewed.

RESULTS
Fifty-six MB patients could be included (71.4% non-WNT/non-SHH, 16.1% SHH-activated, 8.9% WNT-activated, 3.6% non-specified). Mean age at diagnosis was 7.2 years (range 0-19). Median follow-up to last ophthalmological assessment was 19.7 months (range 0.1-93.2). Thirty-four children underwent tumor resection at our hospital, their tumor localizations were: vermis (55.9%), floor of the 4th ventricle (26.5%), cerebellar hemispheres (11.8%), lateral recess (5.9%). Symptoms at presentation were evaluable for 51 children: 92.2% had symptoms of elevated intracranial pressure, 76.5% ataxia and 21.6% visual disturbances. Postoperative posterior fossa syndrome was observed in 11.1% of 54 children. 98.2% had chemotherapy as part of their initial treatment and all children older than four years (85.7%) received postoperative irradiation of the posterior fossa. In 13 (23.2%) intraventricular chemotherapy was applied. At the last follow-up 21 patients experienced relapse after primary treatment. At the final assessment, frequent neuro-ophthalmological abnormalities included: oculomotor disturbance (75%), esotropia (35.7%) including abducens palsy (12.5%), other cranial nerve palsies (21.4%), horizontal gaze-evoked nystagmus (51.8%), spontaneous nystagmus (16.1%), ocular tilt reaction (21.4%), and optic disc abnormalities (14.3%). Good visual acuity (≥20/25) was maintained in 62.5% patients. Visual field and optical coherence tomography was successfully performed in 75% and 66.1% of patients, respectively. Optic pathway lesions were detected in 4 patients (7.1%), including two cases with occipital metastases, one with optic nerve metastasis and one with leptomeningeal carcinomatosis. Orthoptic treatment with prisms and strabismus surgery was required in 14.3% and 7.7% of children, respectively.

CONCLUSION
Children with MB frequently suffer from neuro-ophthalmological late-effects. Regular monitoring is warranted to initiate appropriate management.