bluuebunny/crossref_metadata_2025_split huggingface dataset:
NIMG-87. CHARACTERIZING IMMUNE PROFILES OF PEDIATRIC MEDULLOBLASTOMA AND THEIR RADIOLOGICAL CORRELATES
Authors: Familiar Ariana , Zhao Chao , Kim Meen Chul , Khalili Nastaran , Madhogarhia Rachel , Arif Sherjeel , Bagheri Sina , Anderson Hannah , Haldar Debanjan , Ware Jeffrey B , Vossough Arastoo , Storm Philip B , Resnick Adam C , Kazerooni Anahita Fathi , Nabavizadeh Ali 
Published: November 2022

Abstract
Recent studies have shown preliminary evidence for differentiation of the tumor microenvironment (TME) and immune landscape between molecularly-defined medulloblastoma (MB) subtypes. Identifying radiological correlates of these TME patterns could establish a non-invasive method of immune profile characterization for guiding patient-centered therapies. Here, we examine immune profiles between MB subtypes using data from Open Pediatric Brain Tumor Atlas (OpenPBTA), and their relationship to tumor measurements from pre-operative MRIs. We identified a retrospective cohort of 94 pediatric MB patients with available molecular subtyping and immune profiles (36 cell types) from bulk gene expression data. A random forest analysis was used to classify the four MB subtypes based on immune profiles. Four cell types had high impact on classification performance: plasmacytoid dendritic cells (PDC; 25.8% accuracy decrease when randomized), hematopoietic stem cells (HSC; 21.9%), plasma B cells (20.3%), and cancer associated fibroblasts (18.8%). Pairwise comparisons revealed SHH and WNT tumors had significantly higher numbers of fibroblasts and HSCs compared to Group3/Group4. We also found novel evidence for significantly lower amounts of plasma B cells in the SHH group, and high PDC levels in Group4, followed by Group3, and low PDC in SHH/WNT. Multi-parametric MRI scans for 39 patients were used to segment tumor volumes. Overall tumor volume was significantly correlated with composite stroma scores (R = 0.34, p = 0.036). Additionally, patients with higher volumes of gadolinium contrast-enhancing compared to non-enhancing components had higher immune (R = 0.42, p = 0.009) and microenvironment (summed immune and stromal cell types; R = 0.44, p = 0.006) scores, regardless of their molecular subtype. Together, our results demonstrate: (1) the use of rich immune profiles for differentiating molecular subtypes of MB and their unique TME characterization; and (2) initial evidence for radiological correlates of these profiles based on pre-operative imaging collected through standard practices.
NIMG-96. SPINAL MENINGEAL MASS LESION: A RARE PRESENTATION OF FOLLICULAR LYMPHOMA
Authors: White Jessica , Clarke Michelle , Paludo Jonas , Sener Ugur 
Published: November 2022

Abstract

OBJECTIVE
We aim to describe a case of follicular lymphoma that presented as a durally-based thoracic spine lesion manifested as rapidly progressive back pain and meningismus.

BACKGROUND
Follicular lymphoma is one of the most common forms of non-Hodgkin’s lymphoma; however, it is rare for follicular lymphoma to present as a spinal meningeal mass lesion.

METHODS
This is a case report and review of literature.

RESULTS
A 38-year-old man developed thoracic back pain that progressed over one month with associated severe focal tenderness over his mid to lower thoracic spine. He developed intermittent numbness of the bilateral lower extremities, nuchal rigidity, difficulty sleeping, and night sweats. An MRI of the thoracic spine demonstrated a dorsal intradural, extramedullary enhancing lesion from T6-T9 extending outside the spinal canal. Dural thickening across the entire circumference of the spinal cord was noted. CT-guided biopsy of the thoracic lesion was performed, and pathology was consistent with follicular lymphoma. FDG PET: CT demonstrated no systemic disease. Bone marrow biopsy was negative for malignancy. Symptoms resolved with dexamethasone therapy. He was treated with bendamustine and rituximab with follow up PET: CT two months later demonstrating a complete response.

DISCUSSION
This case illustrates an unusual presentation of follicular lymphoma as a spinal meningeal mass lesion. Though rare, lymphoma should be included in the differential diagnosis of a dural mass lesion. Prompt diagnosis and initiation of treatment can lead to complete response and resolution of symptoms.
NIMG-99. REAL-TIME DELINEATION OF THE CENTRAL SULCUS WITH THE SPATIAL PROFILE OF SSEPS CAPTURED WITH HIGH-DENSITY ECOG GRID
Authors: Priscella Priscella , Prabhu Sujit , Bhavsar Shreyas , Sudhakar Tummala , Ince Nuri 
Published: November 2022

Abstract

OBJECTIVE
Cortical mapping during tumor resection is critical to reducing the risk of neurological complications. While the somatosensory evoked potential (SSEPs) is widely employed to delineate the central sulcus, the evoked response can be misconstrued from the manual peak interpretation. This is due to the poor spatial resolution of the strip electrode as well as a result of edema or tumor infiltration of the overlying cortex. We present a real-time computer-based visualization system that uses recorded SSEPs with a subdural grid to aid in cortical mapping. Method: The neural data during electrical stimulation of the median nerve at 0.6Hz are picked up with a bio-amplifier. The stimulation artifact recorded from the bipolar electromyogram (EMG) is used as the stimulation onset. The ECoG data are assessed online with MATLAB Simulink to process and visualize the SSEPs waveform. The visualization system is programmed to display the SSEP's peak activation as a heat map on a 2D grid and projected onto a screen, showcasing the nature of the cortical activities over the contact surface area in real-time.

RESULTS
SSEPs were recorded from 3 patients during their awake craniotomies. The ECoG grid occupied a large cortical surface where the heatmap delineated the central sulcus. The color-coding of the heatmap revealed the anterior and posterior channels, providing a consistently high separation accuracy in each patient (accuracy = 98%). The map could be viewed at any time point along the SSEP trace without peak interpretation.

CONCLUSION
We believe that this visualization system will aid in the rapid definition of the sensorimotor area during surgical planning to provide additional information during cortical mapping and facilitate interpreting ECoG grid data.
NIMG-102. RAPNO-DEFINED SEGMENTATION AND VOLUMETRIC ASSESSMENT OF PEDIATRIC BRAIN TUMORS ON MULTI-PARAMETRIC MRI SCANS USING DEEP LEARNING; A ROBUST TOOL WITH POTENTIAL APPLICATION IN TUMOR RESPONSE ASSESSMENT
Authors: Kazerooni Anahita Fathi , Madhogarhia Rachel , Arif Sherjeel , Ware Jeffrey B , Bagheri Sina , Haldar Debanjan , Anderson Hannah , Familiar Ariana , Vidal Lorenna , Aboian Mariam , Storm Philip B , Resnick Adam C , Vossough Arastoo , Davatzikos Christos , Nabavizadeh Ali 
Published: November 2022

Abstract
Volumetric measurements of whole tumor and its components on MRI scans, facilitated by automatic segmentation tools, are essential to reduce inter-observer variability in monitoring tumor progression and response assessment for pediatric brain tumors. Here, we present a fully automatic segmentation model based on deep learning that reliably delineates the tumor components recommended by the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group for evaluation of treatment response. Multi-parametric MRI (mpMRI) scans (T1-pre, T1-post, T2, and T2-FLAIR), acquired on multiple MRI scanners with different field strengths and vendors, for a cohort of 218 pediatric patients with a variety of histologically confirmed brain tumor subtypes were collected. The mpMRI scans were co-registered and manually segmented by experienced neuroradiologists in consensus to identify the tumor subregions including the enhancing tumor (ET), non-enhancing tumor (NET), cystic components (CC), and peritumoral edema (ED) regions. A convolutional neural network model based on DeepMedic architecture was trained using mpMRI scans as the inputs for segmentation of the whole tumor and subregions. The trained model showed excellent performance in segmentation of the whole tumor, as suggested by median dice of 0.90/0.85 for validation (n = 44)/independent test (n = 22) sets. ET and non-enhancing components (union of NET, CC, and ED) were segmented with median dice scores of 0.78/0.84 and 0.76/0.74 for validation/test sets, respectively. The automated and manual segmentations demonstrated strong agreement in estimating VASARI (Visually AcceSAble Rembrandt Images) MRI features with Pearson’s correlation coefficient R &gt; 0.75 (p &lt; 0.0001) for ET, NET, CC, and ED components. Our proposed automated segmentation method developed based on MRI scans acquired with different protocols, equipment, and from a variety of brain tumor subtypes, shows potential application for reliable and generalizable volumetric measurements which can be used for treatment response assessment in clinical trials.
NIMG-105. DEUTERIUM METABOLIC IMAGING (DMI) DETECTS A LARGER WARBURG EFFECT IN HIGH-GRADE BRAIN TUMORS AND IN IDH WILD TYPE GLIOMAS
Authors: Kim Lauren , De Feyter Henk , de Graaf Robin , Fulbright Robert , Liu Yanning , Rothman Douglas , Baehring Joachim , Blondin Nicholas , Kim Peter , Omuro Antonio , Chiang Veronica , Moliterno Jennifer , Omay Sacit Bulent , Piepmeier Joseph , Corbin Zachary 
Published: November 2022

Abstract

BACKGROUND
The Warburg Effect (WE) is a metabolic change in which tumors favor glycolysis over oxidative phosphorylation and has been linked to cancer aggressiveness. Mutations in the isocitrate dehydrogenase (IDH) genes in gliomas are associated with improved outcomes. We deployed a magnetic resonance (MR) spectroscopic imaging technique coined Deuterium Metabolic Imaging (DMI) to measure the WE in multiple brain tumor types.

METHODS
Twenty-one patients underwent DMI, acquired on a Bruker 4T MR scanner after oral administration of 0.75g/kg of deuterated glucose. The WE was defined as the ratio of deuterated lactate, representing glycolysis, over deuterated glutamate and glutamine, representing oxidative phosphorylation. We devised an interval scale from 0 to 2 for the WE results. The Wilcoxon rank sum test was performed to detect differences between groups.

RESULTS
The WE measurements for the largest groups, by diagnosis, showed: glioblastoma (n= 9, mean= 1.67); astrocytoma, IDH-mutant, WHO grade 3 (n= 2, mean= 0.25); oligodendroglioma, WHO grade 3 (n= 3, mean= 0.5); low grade glioma, IDH-mutant (n= 2, mean= 0); and meningioma, WHO grade 2 (n= 2, mean= 0). The WE for high-grade tumors (n= 15, mean= 1.27) was significantly different from the WE for low-grade tumors (n= 5, mean= 0), with p= 0.010. The WE for IDH wild type gliomas (n= 9, mean= 1.67) was significantly different from the WE for IDH-mutant gliomas (n= 9, mean= 0.44), with p= 0.007. Analysis is ongoing.

CONCLUSIONS
DMI successfully and non-invasively detects the WE in many types of brain tumors. The WE was larger in high-grade tumors as compared to low-grade tumors, and the WE was larger in IDH wild type gliomas as compared to IDH-mutant gliomas. If validated with future studies, our results suggest that DMI is a useful tool to measure differences in the metabolism of brain tumors with different clinical behaviors.
NIMG-107. THE LANDSCAPE OF BRAIN TUMOR MIMICS IN NEURO-ONCOLOGY PRACTICE
Authors: Yogendran Lalanthica , Kalelioglu Tuba , Donahue Joseph , Ahmed Haroon , Phillips Kester , Calautti Nicole , Lopes Maria-Beatriz , Asthagiri Ashok , Purow Benjamin , Schiff David , Patel Sohil , Fadul Camilo 
Published: November 2022

Abstract

BACKGROUND
Differentiating neoplastic and non-neoplastic brain lesions is essential to make management recommendations and convey prognosis, but the distinction between brain tumors and their mimics in practice may prove challenging. The aim of this study is to provide the incidence of brain tumor mimics in the neuro-oncology setting and describe this patient subset.

METHODS
Retrospective study of adult patients referred to the Division of Neuro-oncology for a presumed diagnosis of brain tumor from January 1, 2005 through December 31, 2017, who later satisfied the diagnosis of a non-neoplastic entity based on neuroimaging, clinical course, and/or histopathology evaluation. We classified tumor mimic entities according to clinical, radiologic, and laboratory characteristics that correlated with the diagnosis.

RESULTS
The incidence of brain tumor mimics was 3.4% (132/3897). The etiologies of the non-neoplastic entities were vascular (35%), inflammatory non-demyelinating (26%), demyelinating (15%), cysts (10%), infectious (9%), and miscellaneous (5%). In our study, 38% of patients underwent biopsy to determine diagnosis, but in 26%, the biopsy was inconclusive.

DISCUSSION
Brain tumor mimics represent a small but important subset of the neuro-oncology referrals. Vascular, inflammatory, and demyelinating etiologies represent two-thirds of cases. Recognizing the clinical, radiologic and laboratory characteristics of such entities may improve resource utilization and prevent unnecessary as well as potentially harmful diagnostic and therapeutic interventions.
NIMG-108. PHYSICAL STRESSES IN BRAIN TUMORS
Authors: Nia Hadi , Kumar Ashwin , Datta Meenal , Siri Saeed , McHugh Jeffrey , Ferraro Gino , Chatterjee Sampurna , Rapalino Otto , Choi Bryan , Nahed Brian , Jain Rakesh 
Published: November 2022

Abstract
Solid stress, distinct from fluid pressure, is a physical force contained in and transmitted by solid components of the brain tumor, including cells and the matrix they produce. Solid stress has been shown to promote tumor progression, and decrease anticancer therapy efficacy. This is especially relevant in brain tumors, as the rigid skull results in these trapped forces, increasing intracranial pressure, and potentially leading to other complications, including neuronal cell death. Here we present a novel method of quantifying these physical stresses in situ in both mice (glioblastoma [U87], brain metastasis [BT474], and ependymoma models) and patients. Briefly, following a craniotomy, mechanical forces that include solid stress are released, which causes the tissue to deform in peaks (areas under compression) and valleys (areas originally under tension). This tissue deformation is imaged via high-resolution ultrasound and analysed via custom MATLAB code to produce an accurate 3D model of the entire mouse brain, including the tumour region. For human samples, a pre-operative MRI is used to generate a detailed 3D model of the human brain. During surgery, the trapped physical stresses results in a bulge of the dura post craniotomy. We use BrainLab to measure the craniotomy induced brain deformation, which is then registered to the pre-operation MRI before being analysed in an identical fashion to the murine models using SolidWorks and Abaqus. We further show that in the brain metastases model, chemotherapy reduces compression stresses by 51%. Further, our technique results in fast processing time (~ 15 minutes), and has the potential to prevent the need for intraoperative MRI based on position simulations. As such, solid stress measurements provide a new class of mechanical biomarkers that can be correlated to clinical outcomes for predictive and prognostic value.
NCMP-12. SECONDARY VERSUS RECURRENT CENTRAL NERVOUS SYSTEM LYMPHOMA - SIMILAR OR DIFFERENT?
Authors: Bazer Danielle , Zabrocka Ewa , Orwitz Matthew , Kowalska Agnieszka 
Published: November 2022

Abstract

BACKGROUND
Although rare, primary central nervous system lymphoma (PCNSL) affects 0.5 per 100,000 individuals. It is estimated that 5% of cases will develop into secondary central nervous system lymphoma (SCNSL) and 2-5% will evolve into recurrent CNS lymphoma (RPCNSL) with the diffuse large B-cell lymphoma (DLBCL) variant of RPCNSL.

METHODS
This is a retrospective study; data obtained via chart review.

RESULTS
We compared 3 patients with RPCNSL to 3 patients with SCNSL. All patients were EBV and HIV negative, DLBCL variant. The average age of diagnosis with the first malignancy with RCNSL was 62.7 years old and age at recurrence was 66.7. With SCNSL, the initial age of diagnosis averaged to 72.7 years old and with secondary presentation at an average age of 76. Initial PCNSL treatments for RPCSNL were steroids, RCHOP with radiation, and DeAngelis Protocol. Initial malignancies for patients with SCNSL were renal cell carcinoma in 2 patients and atypical chronic lymphocytic leukemia variant with 17p deletion. All patients with RPCNSL presented with altered mental status and 2/3 SCNSL patients were altered upon presentation; 1 SCNSL patient was asymptomatic. The lesions within the RPCNSL cohort were all single lesions, localized to the frontal and temporal lobes. Within the SCNSL cohort, 2/3 patients had multiple lesions, whereas 1 patient had single lesions. All of the RPCNSL patients were ultimately on palliative care. SCNSL 2/3 were lost to follow-up and 1/3 elected to proceed with further treatment.

CONCLUSION
Although differing in etiology, there are shared features among SCNSL and RPCNSL. Most relapses are in the central nervous system, a small number of relapses are isolated systemic relapses, and clinical symptoms occur early and vary. Treatment is similar for both, although the prognosis for RPCNSL is very poor.
NCMP-13. TOLERANCE OF HIGH-DOSE METHOTREXATE TREATMENT OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA (PCNSL) PATIENTS WITH RENAL IMPAIRMENT, CASE SERIES AND REVIEW OF LITERATURE
Authors: Zhu Jay-Jiguang , Chinea Luis , Quintero Juan Carlos Rodriguez , Ware Cornelius 
Published: November 2022

Abstract
PCNSL in immune competent patients is a rare extra-nodal non-Hodgkin lymphoma that accounts for 3–4% of newly diagnosed CNS tumors. Treatment consists of high-dose methotrexate (HD-MTX) based polychemotherapy regimen with or without brain radiation. There are few reported cases supporting the use of HD-MTX as a treatment option in such patients with impaired renal function. The objective of this study was to analyze outcomes and tolerance of HD-MTX based chemotherapy regimen (HD-MTX, rituximab and temozolomide, MRT) in patients with PCNSL and renal impairment. We present five patients with median age 63 (range 40 – 67) at diagnosis, with varying degrees of renal impairments, were all treated with and tolerated well of MRT. They are all alive and have been on observation. Cases 2 & 3 had a one functioning kidney and achieved complete responses (CR) without toxicities. Case 1, with history of grade 3 renal insufficiency during his initial HD-MTX and received carboxypeptidase G2 rescue, tolerated re-treatment with MRT at PCNSL recurrence and achieved a partial response (PR) that has been stable for 44 months. Case 4, who had a cadaver-transplanted kidney, was able to get a CR after 8 treatment with MRT. Case 5, with grade 3 chronic kidney disease from type II diabetes mellitus, achieved CR with MRT with slowing down of his MTX clearance. Literature review for reports with PCNSL and renal impairment treated with HD-MTX through March 31, 2022 identified eight cases and their responses and adverse effects summarized. Due to the low number of published cases and limitation of a retrospective analysis, it is impossible to draw a conclusion on the impact of impaired renal function on the tolerance of HD-MTX treatment of PCNSL. However, our findings indicate that a subset of the patients may still benefit from treatment with HD-MTX based chemotherapy.
NCMP-15. A CASE OF SYSTEMIC METASTATIC DIFFUSE LEPTOMENINGEAL GLIONEURAL TUMOR
Authors: Battini Sahithi , Horta Erika , Gokden Murat , Palys Viktoras 
Published: November 2022

Abstract

INTRODUCTION
Diffuse leptomeningeal glioneural tumor (DLGT) is a very rare central nervous tumor that has no standard of care for its treatment. This report illustrates a case of DLGT with a unique presentation and a first description of multiple systemic metastasis. Case: 19 year-old male with personal history of hereditary multiple osteochondromas and recent covid-19 infection who on investigation of headaches, progressive cranio-neuropathies, and right-sided weakness was found to have vasospasms resulting in acute infarcts in multiple vascular areas, and diffuse leptomeningeal enhancement in the thoracic spine and cauda equina. Patient underwent meningeal biopsy, after 2 months of first symptoms, which revealed DLGT per two different neuro-oncology centers. Course of disease was complicated with hydrocephalus needing shunt placement soon after diagnosis. Craniospinal radiation concurrent with temozolomide was started one month from diagnosis. Patient developed pancytopenia and chemotherapy was stop in the first weeks during radiation therapy. Metastatic disease to bone marrow was diagnosed in the second adjuvant temozolomide cycle through biopsy. One week after, on investigation of pleural effusion, lung metastasis were discovered on pleural cytology and thoracic computer tomography. Liquid biopsy showed non-actionable mutations on PIK3CA, BRAF and KRAS. Chemotherapy with carboplatin and vincristine was started with markedly improvement of pancytopenia and pleural effusions leading to cessation of frequent transfusions and auxiliary oxygen. Vincristine dose was decreased due to painful neuropathy and tinnitus. At the end of endovenous chemotherapy, worsening of disease was found with metastasis to muscles of the face and brain parenchyma. Patient was then enrolled in hospice, dying weeks after.

CONCLUSION
DLGT should be considered in the differential diagnosis of vasospasm. DLGT is a primary central nervous system that can metastasize to other organs. Although no standard of care is yet identified, chemotherapy with vincristine and carboplatin can be offered to systemic metastatic disease.
NCMP-21. PEMBROLIZUMAB-ASSOCIATED MYOSITIS, MYASTHENIC CRISIS, AND MYOCARDITIS IN A PATIENT WITH METASTATIC UROTHELIAL CARCINOMA
Authors: Hein Laura , Narayan Anisha , Lia Franco , Barata Pedro , Trevino Christopher 
Published: November 2022

Abstract
Although immune checkpoint inhibitors (ICIs) have improved systemic cancer care, in rare cases, patients develop neuromuscular immune related adverse events (irAEs), which carry high morbidity and mortality. This case study describes an 85-year-old male who developed the triad of myositis, myasthenic crisis, and myocarditis in association with ICI treatment for metastatic urothelial carcinoma (T3N0M1). The patient developed progressive weakness and gait impairment five weeks after initiating treatment with pembrolizumab. Later, he developed reduced ambulation, fatigue, shortness of breath, and orthopnea with concomitant ECG changes. Clinical exam demonstrated dysphagia, ptosis, proximal muscle weakness, fatigable weakness, and areflexia, ultimately resulting in respiratory failure, intubation, and inability to stand. Lab workup revealed elevated creatinine kinase, myoglobin, lactate dehydrogenase, and aldolase, but was notably negative for acetylcholine receptor and muscle specific kinase antibodies. Labs, clinical timeline, and clinical features supported his diagnoses. Interestingly, the cytokine panel demonstrated a high-normal soluble IL-2 receptor alpha which supports autoimmune pathology and elevated IL-10. The patient was treated with pyridostigmine, prednisone, and plasma exchange (PLEX) for 10 exchanges. EMG 10 days into treatment supported evidence of inflammatory myositis. After methylprednisone and PLEX treatment, the patient’s symptoms improved to ambulation with a walker and occasional BiPap support. His metastatic disease remained stable for several weeks while holding pembrolizumab due to toxicity. This case illustrates how early intervention and aggressive treatment for neuromuscular ICI-induced triad can stabilize patients and improve neurologic recovery. Due to the high morbidity and mortality for these irAEs, the authors support increased clinical scrutiny when evaluating these rare conditions and consideration of investigating the acute inflammatory processes. With improved pathophysiologic understanding of these rare conditions, the community can improve outcomes and refine treatments.