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Duong MT, Rudie JD, Mohan S. Neuroimaging Patterns of Intracranial Infections: Meningitis, Cerebritis, and Their Complications. Neuroimaging Clin N Am 2023; 33:11-41. [PMID: 36404039 PMCID: PMC10904173 DOI: 10.1016/j.nic.2022.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic imaging patterns help radiologists distinguish different types of intracranial infections including meningitis and cerebritis from a variety of bacterial, viral, fungal, and/or parasitic causes. Here, we describe key radiologic patterns of meningeal enhancement and diffusion restriction through profiles of meningitis, cerebritis, abscess, and ventriculitis. We discuss various imaging modalities and recent diagnostic advances such as deep learning through a survey of intracranial pathogens and their radiographic findings. Moreover, we explore critical complications and differential diagnoses of intracranial infections.
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Affiliation(s)
- Michael Tran Duong
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Jeffrey D Rudie
- Department of Radiology, Scripps Clinic and University of California San Diego, 10666 Torrey Pines Road, La Jolla, CA 92037, USA
| | - Suyash Mohan
- Division of Neuroradiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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2
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Mollica L, Leli C, Puglisi S, Sardi S, Sottotetti F. Leptomeningeal carcinomatosis and breast cancer: a systematic review of current evidence on diagnosis, treatment and prognosis. Drugs Context 2021; 10:dic-2021-6-6. [PMID: 34745272 PMCID: PMC8552906 DOI: 10.7573/dic.2021-6-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/14/2021] [Indexed: 02/02/2023] Open
Abstract
Leptomeningeal carcinomatosis (LC) is a rare but challenging manifestation of advanced breast cancer with a severe impact on morbidity and mortality. We performed a systematic review of the evidence published over the last two decades, focusing on recent advances in the diagnostic and therapeutic options of LC. Lobular histology and a triple-negative intrinsic subtype are well-known risk factors for LC. Clinical manifestations are diverse and often aspecific. There is no gold standard for LC diagnosis: MRI and cerebrospinal fluid cytology are the most frequently used modalities despite the low accuracy. Current standard of care involves a multimodal strategy including systemic and intrathecal chemotherapy in combination with brain radiotherapy. Intrathecal chemotherapy has been widely used through the years despite the lack of data from randomized controlled trials and conflicting evidence on patient outcomes. No specific chemotherapeutic agent has shown superiority over others for both intrathecal and systemic treatment. Although endocrine therapy was heuristically considered unable to exert significant control on central nervous system metastatic disease, retrospective data suggest a favourable toxicity profile and even a possible positive impact on survival. In recent years, encouraging data on the use of targeted agents has emerged but further research in this field is required. Palliative treatment in the form of whole brain or stereotactic radiotherapy is associated with improvement in clinical manifestations and quality of life, with no proven impact on survival. The most investigated prognostic factors include performance status, non-triple-negative disease and multimodal treatment. Validation of prognostic scores is necessary to aid clinicians in the identification of patient subgroups that are most likely to benefit from an intensive therapeutic approach.
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Affiliation(s)
| | - Claudia Leli
- Division of Medical Oncology, IRCCS-ICS Maugeri, Pavia, Italy
| | - Silvia Puglisi
- Division of Medical Oncology, Ospedale Policlinico San Martino, Genova, Italy
| | - Silvia Sardi
- Department of Anaesthesia and Intensive Care Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Federico Sottotetti
- Division of Medical Oncology, IRCCS-ICS Maugeri, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy
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3
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Schmidt T, Kebir S, Livingstone E, Junker A, Zülow S, Lazaridis L, Oster C, Chorti E, Pierscianek D, Pul R, Keyvani K, Sure U, Stuschke M, Kleinschnitz C, Scheffler B, Zimmer L, Glas M. Case Report: Pseudomeningeosis and Demyelinating Metastasis-Like Lesions From Checkpoint Inhibitor Therapy in Malignant Melanoma. Front Oncol 2021; 11:637185. [PMID: 33937037 PMCID: PMC8081911 DOI: 10.3389/fonc.2021.637185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/22/2021] [Indexed: 11/13/2022] Open
Abstract
Immune checkpoint inhibitors (ICIs) have considerably expanded the effective treatment options for malignant melanoma. ICIs revert tumor-associated immunosuppression and potentiate T-cell mediated tumor clearance. Immune-related neurologic adverse events (irNAEs) manifest in the central (CNS) or peripheral nervous system (PNS) and most frequently present as encephalitis or myasthenia gravis respectively. We report on a 47-year old male patient with metastatic melanoma who developed signs of cerebellar disease five weeks after the start of ICI treatment (ipilimumab and nivolumab). Magnetic resonance imaging (MRI) of the brain and spine revealed multiple new contrast enhancements suggestive of parenchymal and leptomeningeal metastasis. Cerebral spinal fluid (CSF) evaluation showed a lymphomononuclear pleocytosis in the absence of tumor cells. Subsequent stereotactic brain biopsy confirmed demyelinating disease. High-dose corticosteroid treatment resulted in immediate improvement of the clinical symptoms. MRI scans and CSF re-evaluation were conducted six weeks later and showed a near-complete remission. The strong resemblance to neoplastic CNS dissemination and irNAEs is a particularly difficult diagnostic challenge. Treating physicians should be aware of irNAEs as those can be effectively treated with high-dose steroids.
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Affiliation(s)
- Teresa Schmidt
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,German Cancer Research Center (DKFZ)-Division of Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
| | - Sied Kebir
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,German Cancer Research Center (DKFZ)-Division of Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
| | | | - Andreas Junker
- Institute of Neuropathology, University Hospital Essen, Essen, Germany
| | - Stefan Zülow
- Centre of Neurology-Radiology, University Hospital Bonn, Bonn, Germany
| | - Lazaros Lazaridis
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,German Cancer Research Center (DKFZ)-Division of Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
| | - Christoph Oster
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,German Cancer Research Center (DKFZ)-Division of Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
| | - Eleftheria Chorti
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Daniela Pierscianek
- West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Refik Pul
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,Department of Radiotherapy, University Hospital Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany
| | - Björn Scheffler
- German Cancer Research Center (DKFZ)-Division of Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, University Hospital Essen, Essen, Germany
| | - Martin Glas
- Department of Neurology, Division of Clinical Neurooncology, University Hospital Essen, Essen, Germany.,West German Cancer Center (WTZ), University Hospital Essen, University Duisburg-Essen and German Cancer Consortium (DKTK), Partner Site University Hospital Essen, Essen, Germany.,German Cancer Research Center (DKFZ)-Division of Translational Neurooncology at the WTZ, DKTK Partner Site, University Hospital Essen, Essen, Germany
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4
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Wu CS, Wang HP, Sung SF. Idiopathic hypertrophic pachymeningitis with anticardiolipin antibody: A case report. Medicine (Baltimore) 2021; 100:e24387. [PMID: 33466222 PMCID: PMC7808507 DOI: 10.1097/md.0000000000024387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/29/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies. PATIENT CONCERNS A 41-year-old male patient presented with insidious onset headache of 3-month duration. DIAGNOSES Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made. INTERVENTIONS Oral prednisolone and azathioprine followed by methotrexate were administered. OUTCOMES During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement. LESSONS Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy.
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Affiliation(s)
| | - Hung-Ping Wang
- Division of Rheumatology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Taiwan
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Ogawa T, Kojima I, Wakamori S, Yoshida T, Murata T, Sakamoto M, Ohkoshi A, Nakanome A, Endo H, Endo T, Usubuchi H, Katori Y. Clinical utility of apparent diffusion coefficient and diffusion-weighted magnetic resonance imaging for resectability assessment of head and neck tumors with skull base invasion. Head Neck 2020; 42:2896-2904. [PMID: 32608548 DOI: 10.1002/hed.26336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/28/2020] [Accepted: 05/30/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The usefulness of apparent diffusion coefficient (ADC) and diffusion-weighted magnetic resonance imaging (DWI) in the detection of malignant tumors has been reported. The purpose of this study is to clarify the role of ADC and DWI for diagnosis of skull base tumors. METHODS A total of 27 patients with head and neck tumors with skull base invasions undergoing skull base surgery were enrolled in this study. Pathological findings of dural invasion and bone invasion were compared with the diagnostic imaging. RESULTS Advanced magnetic resonance imaging techniques revealed that ADC values in regions of pathological bone and dural invasions were significantly lower than in regions of no invasion. The area under the curve of ADC in bone invasions and dural invasions were 0.957 and 0.894, respectively. CONCLUSIONS Our findings indicate that ADC and DWI are useful tools for the diagnosis of head and neck tumors with skull base invasion.
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Affiliation(s)
- Takenori Ogawa
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Ikuho Kojima
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Oral Diagnosis, Tohoku University Hospital, Sendai, Japan
| | - Shun Wakamori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Takuya Yoshida
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Takaki Murata
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Maya Sakamoto
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Oral Diagnosis, Tohoku University Hospital, Sendai, Japan
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Ayako Nakanome
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
| | - Hidenori Endo
- Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan.,Department of Neurosurgery, Tohoku University Hospital, Sendai, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku University Hospital, Sendai, Japan
| | - Hajime Usubuchi
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Hospital, Sendai, Japan.,Head and Neck Cancer Center, Tohoku University Hospital, Sendai, Japan
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6
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Sindeeva OA, Verkhovskii RA, Sarimollaoglu M, Afanaseva GA, Fedonnikov AS, Osintsev EY, Kurochkina EN, Gorin DA, Deyev SM, Zharov VP, Galanzha EI. New Frontiers in Diagnosis and Therapy of Circulating Tumor Markers in Cerebrospinal Fluid In Vitro and In Vivo. Cells 2019; 8:E1195. [PMID: 31581745 PMCID: PMC6830088 DOI: 10.3390/cells8101195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/21/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023] Open
Abstract
One of the greatest challenges in neuro-oncology is diagnosis and therapy (theranostics) of leptomeningeal metastasis (LM), brain metastasis (BM) and brain tumors (BT), which are associated with poor prognosis in patients. Retrospective analyses suggest that cerebrospinal fluid (CSF) is one of the promising diagnostic targets because CSF passes through central nervous system, harvests tumor-related markers from brain tissue and, then, delivers them into peripheral parts of the human body where CSF can be sampled using minimally invasive and routine clinical procedure. However, limited sensitivity of the established clinical diagnostic cytology in vitro and MRI in vivo together with minimal therapeutic options do not provide patient care at early, potentially treatable, stages of LM, BM and BT. Novel technologies are in demand. This review outlines the advantages, limitations and clinical utility of emerging liquid biopsy in vitro and photoacoustic flow cytometry (PAFC) in vivo for assessment of CSF markers including circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), microRNA (miRNA), proteins, exosomes and emboli. The integration of in vitro and in vivo methods, PAFC-guided theranostics of single CTCs and targeted drug delivery are discussed as future perspectives.
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Affiliation(s)
- Olga A. Sindeeva
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
| | - Roman A. Verkhovskii
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
| | - Mustafa Sarimollaoglu
- Arkansas Nanomedicine Center & Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Galina A. Afanaseva
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
- Saratov State Medical University, 112 Bolshaya Kazachia St., 410012 Saratov, Russia
| | - Alexander S. Fedonnikov
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
- Saratov State Medical University, 112 Bolshaya Kazachia St., 410012 Saratov, Russia
| | - Evgeny Yu. Osintsev
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
- Saratov State Medical University, 112 Bolshaya Kazachia St., 410012 Saratov, Russia
| | - Elena N. Kurochkina
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
- Saratov State Medical University, 112 Bolshaya Kazachia St., 410012 Saratov, Russia
| | - Dmitry A. Gorin
- Laboratory of Biophotonics, Skolkovo Institute of Science and Technology, 3 Nobelya Str., 121205 Moscow, Russia;
| | - Sergey M. Deyev
- Shemyakin-Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Miklukho-Maklaya St., 16/10, Moscow 117997, Russia;
| | - Vladimir P. Zharov
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
- Arkansas Nanomedicine Center & Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Ekaterina I. Galanzha
- Laboratory of Biomedical Photoacoustics, Saratov State University, 83 Astrakhanskaya St, 410012 Saratov, Russia; (O.A.S.); (R.A.V.); (G.A.A.); (A.S.F.); (E.Y.O.); (E.N.K.); (V.P.Z.)
- Laboratory of Lymphatic Research, Diagnosis and Therapy (LDT), University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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