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Omid-Fard N, Puac-Polanco P, Torres CH, Hamilton L, Nguyen TB. Imaging Features of Immunodeficiency-Associated Primary CNS Lymphoma: A Review. Can Assoc Radiol J 2024:8465371241259951. [PMID: 38902978 DOI: 10.1177/08465371241259951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
In the immunocompromised setting, there are distinct radiologic findings of primary central nervous system lymphoma (PCNSL), including necrotic ring-enhancing lesions, increased propensity for intralesional haemorrhage, and multiplicity. In this clinical context, advanced imaging with MR perfusion, spectroscopy, and diffusion-weighted imaging can be used to increase accuracy in the diagnosis of lymphoma over mimics such as high-grade glioma, metastases, or infection. This review summarizes the histology and pathophysiology of PCNSL in immunodeficient hosts, which provide a basis for its imaging appearances, prognosis, and treatment. This discussion is important for the general radiologist as the incidence of immunodeficiency-related PCNSL may be increasing.
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Affiliation(s)
- Nima Omid-Fard
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Paulo Puac-Polanco
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Carlos Hernando Torres
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
| | - Leslie Hamilton
- Department of Anatomical Pathology, University of Ottawa, Ottawa, ON, Canada
| | - Thanh Binh Nguyen
- Department of Radiology, Radiation Oncology and Medical Physics, University of Ottawa, Ottawa, ON, Canada
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Chaganti SS, Sidhom G, Chaganti J. Multiparametric imaging in the evaluation of intracerebral abscesses. Pract Neurol 2023; 23:376-385. [PMID: 37248041 DOI: 10.1136/pn-2023-003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Cerebral abscesses are uncommon space occupying lesions; they are associated with high morbidity and mortality, though are potentially treatable. Patients often present with non-specific symptoms and may have few clinical signs. Routine clinical imaging may not give a definite diagnosis, as the findings can be indistinguishable from those of other intracranial mass lesions. We review the role of advanced MR techniques to characterise brain abscesses and discuss the role of imaging in monitoring their response to the treatment.
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Affiliation(s)
- Sai Sivananda Chaganti
- Fellow, Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - George Sidhom
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Joga Chaganti
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- Department of Radiology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
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3
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Solar P, Valekova H, Marcon P, Mikulka J, Barak M, Hendrych M, Stransky M, Siruckova K, Kostial M, Holikova K, Brychta J, Jancalek R. Classification of brain lesions using a machine learning approach with cross-sectional ADC value dynamics. Sci Rep 2023; 13:11459. [PMID: 37454179 PMCID: PMC10349862 DOI: 10.1038/s41598-023-38542-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023] Open
Abstract
Diffusion-weighted imaging (DWI) and its numerical expression via apparent diffusion coefficient (ADC) values are commonly utilized in non-invasive assessment of various brain pathologies. Although numerous studies have confirmed that ADC values could be pathognomic for various ring-enhancing lesions (RELs), their true potential is yet to be exploited in full. The article was designed to introduce an image analysis method allowing REL recognition independently of either absolute ADC values or specifically defined regions of interest within the evaluated image. For this purpose, the line of interest (LOI) was marked on each ADC map to cross all of the RELs' compartments. Using a machine learning approach, we analyzed the LOI between two representatives of the RELs, namely, brain abscess and glioblastoma (GBM). The diagnostic ability of the selected parameters as predictors for the machine learning algorithms was assessed using two models, the k-NN model and the SVM model with a Gaussian kernel. With the k-NN machine learning method, 80% of the abscesses and 100% of the GBM were classified correctly at high accuracy. Similar results were obtained via the SVM method. The proposed assessment of the LOI offers a new approach for evaluating ADC maps obtained from different RELs and contributing to the standardization of the ADC map assessment.
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Affiliation(s)
- Peter Solar
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Hana Valekova
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Marcon
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Jan Mikulka
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Martin Barak
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Michal Hendrych
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- First Department of Pathology, St. Anne's University Hospital, Brno, Czech Republic
| | - Matyas Stransky
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Katerina Siruckova
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Martin Kostial
- Faculty of Electrical Engineering and Communication, Brno University of Technology, Technicka, 12, 616 00, Brno, Czech Republic
| | - Klara Holikova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Medical Imaging, St. Anne's University Hospital, Brno, Czech Republic
| | - Jindrich Brychta
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic
| | - Radim Jancalek
- Department of Neurosurgery, St. Anne's University Hospital, Pekarska 53, 656 91, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Rezk EM, Mokbel E. Stereotactic biopsy for multiple intra-axial brain lesions: impact on consequent treatment Regimen. EGYPTIAN JOURNAL OF NEUROSURGERY 2023. [DOI: 10.1186/s41984-023-00193-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Abstract
Background and objectives
Multiple brain lesions represent a serious challenge in which biopsy is commonly the first step to help overcome patients' mental anxiety and decide the following treatment step. This study presents an effective decisional algorithm that could guide in dealing with such a challenge. We evaluate the feasibility and safety of frame-based stereotactic biopsy to obtain the histopathologic diagnosis of the multiple intra-axial brain lesions and to decide the further treatment.
Patients and methods
Thirty-two patients with multiple intracerebral lesions underwent stereotactic serial biopsies for brain lesions at the Neurosurgery Department, Tanta University Hospital. All the stereotactic biopsies were obtained under local anesthesia using Riechert–Mundinger (RM) system or Cosman–Roberts–Wells (CRW) system.
Results
The histopathological diagnosis revealed multifocal malignant gliomas in 43.75% of patients (18.75% anaplastic astrocytoma and 25% multiform glioblastoma) and metastatic tumor in 37.5% of patients (all were adenocarcinoma). In addition, 12.5% had multiple brain abscesses, and 6.25% had malignant lymphoma. We reported no mortality secondary to the surgical procedure.
Conclusions
Stereotactic biopsy is considered the best choice to allow histopathologic diagnosis of multiple brain lesions with minimal morbidity and no mortality. Histopathologic findings gained with stereotactic procedures guided the choice of proper treatment thus eliminating the hazards associated with blind treatments.
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5
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Wong KT, Tan CT, Lim T. Beyond Pattern Recognition. Neuroimaging Clin N Am 2023; 33:225-233. [DOI: 10.1016/j.nic.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Yogendran LV, Kalelioglu T, Donahue JH, Ahmad H, Phillips KA, Calautti NM, Lopes MB, Asthagiri AR, Purow B, Schiff D, Patel SH, Fadul CE. The landscape of brain tumor mimics in neuro-oncology practice. J Neurooncol 2022; 159:499-508. [PMID: 35857249 DOI: 10.1007/s11060-022-04087-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/02/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE 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.
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Affiliation(s)
- Lalanthica V Yogendran
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Tuba Kalelioglu
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Joseph H Donahue
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Haroon Ahmad
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | - Kester A Phillips
- Department of Neurology, The Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment at Swedish Neuroscience Institute, Seattle, WA, USA
| | - Nicole M Calautti
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Maria-Beatriz Lopes
- Department of Pathology, Divisions of Neuropathology and Molecular Diagnostics, University of Virginia, Charlottesville, VA, USA
| | - Ashok R Asthagiri
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Benjamin Purow
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA
| | - Sohil H Patel
- Department of Radiology & Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Camilo E Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, VA, 22908, USA.
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Carloni A, Bernardini M, Mattei C, De Magistris AV, Llabres-Diaz F, Williams J, Gutierrez-Quintana R, Oevermann A, Schweizer-Gorgas D, Finck C, Masseau I, Lorenzo V, Sabatini A, Contiero B, Specchi S. Can MRI differentiate between ring-enhancing gliomas and intra-axial abscesses? Vet Radiol Ultrasound 2022; 63:563-572. [PMID: 35509117 DOI: 10.1111/vru.13098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022] Open
Abstract
Gliomas of the brain may appear as expansile ring-enhancing masses in MRI studies, mimicking the appearance of intra-axial abscesses. The aims of this study were to compare the MRI features of ring-enhancing gliomas and intra-axial brain abscesses in dogs and cats and to identify the characteristics that might help differentiate them. For this multicenter, retrospective, and observational study, the inclusion criteria were as follows: (a) a definitive diagnosis of glioma or abscess based on cytological or histopathological examination following CSF collection or surgical biopsy/necropsy, respectively; (b) MRI study performed with a high- or low-field MRI scanner, including a same plane T1W pre- and postcontrast, a T2W and a T2 FLAIR sequence in at least one plane. If available, delayed T1W postcontrast, T2*W GE, DWI/ADC, and SWI sequences were also evaluated. Sixteen patients were diagnosed with ring-enhancing gliomas, and 15 were diagnosed with intra-axial abscesses. A homogenous signal on T1W (P = 0.049) and T2W (P = 0.042) sequences, a T2W (P = 0.005) or T2*W GE (P = 0.046) peripheral hypointense halo, and an even enhancing capsule (P = 0.002) were significantly associated with brain abscesses. A progressive central enhancement on delayed T1W postcontrast sequences was correlated with ring-enhancing gliomas (P = 0.009). The combination of the following features was suggestive of brain abscess: homogeneous T1W or T2W signal intensity, a T2W or T2*W GE peripheral hypointense halo and an evenly enhancing capsule. Central progression of enhancement on delayed T1W postcontrast sequences was suggestive of glioma.
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Affiliation(s)
- Andrea Carloni
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
| | - Marco Bernardini
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy.,Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Padua, Legnaro, Italy
| | - Chiara Mattei
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
| | - Angela Vittoria De Magistris
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
| | | | - Jonathan Williams
- Pathobiology and Population Sciences, Royal Veterinary College, Hatfield, UK
| | - Rodrigo Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, UK
| | - Anna Oevermann
- Division of Neurological Sciences, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Cyrielle Finck
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | | | | | - Barbara Contiero
- Department of Animal Medicine, Production and Health, Clinical Section, University of Padua, Padua, Legnaro, Italy
| | - Swan Specchi
- Diagnostic Imaging Department, Veterinary Hospital "I Portoni Rossi" Anicura Italy, Zola Predosa, Bologna, Italy
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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9
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Chawla S, Asadollahi S, Gupta PK, Nath K, Brem S, Mohan S. Advanced magnetic resonance imaging and spectroscopy in a case of neurocysticercosis from North America. Neuroradiol J 2022; 35:119-125. [PMID: 34167362 PMCID: PMC8826293 DOI: 10.1177/19714009211026889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Neurocysticercosis (NCC) is a parasitic infection caused by Cysticercus cellulosae, the metacestode of pork tapeworm (Taenia solium). NCC is one of the most common public health problems worldwide. We present a patient harboring a bilobed ring-enhancing lesion with a presumed diagnosis of brain metastasis, who returned to the USA after traveling to an endemic region. The diagnosis of NCC was established based on a characteristic resonance of succinate on proton magnetic resonance spectroscopy. Also, higher mean diffusivity and lower fractional anisotropy along with relative cerebral blood volume were observed from the lesion compared to contralateral normal brain regions. Multiparametric analysis may improve the differential diagnosis of ring-enhancing intracranial lesions such as NCC.
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA,Sanjeev Chawla, Department of Radiology, Division
of Neuroradiology, 219 Dulles Building, 3400 Spruce Street, Perelman School of Medicine at
the University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Shadi Asadollahi
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
| | - Pradeep Kumar Gupta
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
| | - Kavindra Nath
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
| | - Steven Brem
- Department of Neurosurgery, Perelman School
of Medicine at the University of Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of
Medicine at the University of Pennsylvania, USA
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The role of "penumbra sign" and diffusion-weighted imaging in adnexal masses: do they provide a clue in differentiating tubo-ovarian abscess from ovarian malignancy? Pol J Radiol 2022; 86:e661-e671. [PMID: 35059059 PMCID: PMC8757038 DOI: 10.5114/pjr.2021.111986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the role of “penumbra sign”, diffusion-weighted imaging (DWI), and the apparent diffusion coefficient (ADC) value in differentiating tubo-ovarian abscess (TOA) from ovarian malignancy. Material and methods Thirty-six patients with 50 adnexal masses (tubo-ovarian abscess, n = 24; ovarian malignancy, n = 26), who underwent magnetic resonance imaging (MRI) with DWI, were retrospectively evaluated. “Penumbra sign” (hyperintense rim on T1W images), diffusion restriction, and mean apparent diffusion coefficient (ADC) values from cystic (c-ADC) and solid (s-ADC) components were evaluated for all the masses. Results “Penumbra sign” on T1W images was significantly more common in the TOA group (n = 21, 87.5%) than in the ovarian malignancy group (n = 2, 7.7%) (p < 0.001). Similarly, diffusion restriction in the cystic component was more frequent in the TOA group (n = 24, 100% vs. n = 2, 10.5%; p < 0.001). In contrast, diffusion restriction in the solid component was more common in the ovarian malignancy group (n = 5, 20.8% vs. n = 26, 100%; p < 0.001). The mean c-ADC value was significantly lower in TOAs (p < 0.001). A c-ADC value of 1.31 × 10-3 mm2/s may be an optimal cut-off in distinguishing TOAs from ovarian malignancies. Conversely, the mean s-ADC value was significantly lower in the ovarian malignancy group (p < 0.001). An s-ADC value of 0.869 × 10-3 mm2/s may be an optimal cut-off in differentiating ovarian malignancies from TOAs (p < 0.001). ROC curve analysis showed that c-ADC values had a higher diagnostic accuracy than s-ADC values. Conclusions “Penumbra sign” on T1W images, diffusion characteristics, and ADC values provide important clues in addition to conventional MR imaging features in differentiating TOA from ovarian malignancy.
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Beucler N, Farah K, Choucha A, Meyer M, Fuentes S, Seng P, Dufour H. Nocardia farcinica cerebral abscess: A systematic review of treatment strategies. Neurochirurgie 2021; 68:94-101. [PMID: 33989644 DOI: 10.1016/j.neuchi.2021.04.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Nocardia farcinica is an opportunistic pathogen causing mainly pneumonia in immunocompromised patients, complicated in almost one-third of the cases by a thick-walled multiloculated cerebral abscess which induces significant morbidity and mortality. This review aims to assess the optimal treatment strategy for N. farcinica cerebral abscess. METHODS Report of a case. Medline database was used to conduct a systematic review from inception to January 2020 looking for English-language articles focused on N. farcinica cerebral abscess, in accordance with the PRISMA guidelines. RESULTS The research yielded 54 articles for a total of 58 patients. N. farcinica cerebral abscess displayed three different neuroimaging patterns: a single multiloculated abscess in half of the cases, multiple cerebral abscesses, or a small paraventricular abscess with meningitis. The patients who benefited from surgical excision of the abscess showed a trend towards a lower risk of surgical revision (8% versus 31%, P=0.06) and a lower mortality rate (8% versus 23%, P=0.18) than patients who benefited from needle aspiration. Twenty-two percent of the patients benefited from microbiological documentation from another site with a mortality rate of 23%. CONCLUSION Urgent multimodal MRI is necessary in face with clinical suspicion of cerebral nocardiosis. In case of single or multiple small cerebral abscesses, microbiological documentation can be obtained with puncture of pseudotumoral visceral lesions. In case of large or symptomatic cerebral abscess, an aggressive surgical excision seems a reliable option and can be preferred over needle aspiration. Long-term antibiotic therapy with cotrimoxazole is necessary thereafter.
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Affiliation(s)
- N Beucler
- Neurosurgery department, Sainte-Anne Military teaching Hospital, 2, boulevard Sainte-Anne, 83800 Toulon cedex 9, France; École du Val-de-Grâce, French Military Health Service Academy, 1, place Alphonse-Laveran, 75230 Paris cedex 5, France.
| | - K Farah
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - A Choucha
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - M Meyer
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - S Fuentes
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France
| | - P Seng
- Unité microbes, évolution, phylogenie et infection (MEPHI), IHU - méditerranée infection, Service de maladies infectieuses tropicales et infections chroniques (MITIC), Aix-Marseille Université, APHM, 19-21, boulevard Jean-Moulin, 13005 Marseille, France
| | - H Dufour
- Neurosurgery department, Timone University Hospital, APHM, 264, rue Saint-Pierre, 13005 Marseille, France; Inserm, MMG, Aix-Marseille Université, Marseille, France
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Sartoretti E, Sartoretti T, Gutzwiller A, Karrer U, Binkert C, Najafi A, Czell D, Beyeler S, Sartoretti-Schefer S. Advanced multimodality MR imaging of a cerebral nocardiosis abscess in an immunocompetent patient with a focus on Amide Proton Transfer weighted imaging. BJR Case Rep 2020; 6:20190122. [PMID: 33029379 PMCID: PMC7527004 DOI: 10.1259/bjrcr.20190122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/03/2020] [Accepted: 02/17/2020] [Indexed: 01/27/2023] Open
Abstract
Cerebral nocardiosis abscess is a very rare entity in an immunocompetent patient. In this case report multiparametric and multimodality MR imaging characteristics of a pyogenic brain abscess caused by Nocardia Farcinica are discussed with a specific focus on amide proton transfer weighted imaging as a modern non-invasive, molecular MR imaging method which detects endogenous mobile protein and peptide concentration and tissue pH changes in pathologic brain lesions. The imaging characteristics are reviewed and discussed in respect to possible differential diagnoses, especially malignant tumorous lesions.
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Affiliation(s)
- Elisabeth Sartoretti
- Institut für Radiologie, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Thomas Sartoretti
- Institut für Radiologie, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Annina Gutzwiller
- Klinik für Innere Medizin, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Urs Karrer
- Klinik für Innere Medizin, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Christoph Binkert
- Institut für Radiologie, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - Arash Najafi
- Institut für Radiologie, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
| | - David Czell
- Klinik für Innere Medizin, Zuger Kantonsspital, Landhausstrasse 11, 6340 Baar, Switzerland
| | - Simon Beyeler
- Institut für Radiologie, Kantonsspital Winterthur, Brauerstrasse 15, 8401 Winterthur, Switzerland
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Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e28-e34. [DOI: 10.15586/jptcp.v27i3.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 11/18/2022]
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Cerebral abscesses imaging: A practical approach. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2020; 27:e11-e24. [PMID: 32757543 DOI: 10.15586/jptcp.v27i3.688] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
Brain abscesses (BAs) are focal infections of the central nervous system (CNS) that start as a localised area of weakening of the brain parenchyma (cerebritis) and develops into a collection of pus surrounded by a capsule. Pyogenic (bacterial) BAs represent the majority of all BAs; in some cases, the diagnostic and therapeutic management can be challenging. Imaging has a primary role in differentiating BAs from other lesions. Conventional magnetic resonance imaging (cMRI) is essential for the identification of the lesion, its localisation and its morphological features. However, cMRI does not allow to reliably differentiate BAs from other intracranial mass lesions such as necrotic tumours. Advanced sequences, such as diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI) and proton MR spectroscopy (1H-MRS) are very useful in the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumours, and provide essential information on structural, vascular and metabolic characteristics allowing greater neuroradiological confidence. The aim of this pictorial review is to provide a practical approach showing the added value of more advanced MRI techniques in their diagnostic management.
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Kweh BTS, Lee HQ, Tee JW. Intracranial peripherally enhancing lesions in cardiac transplant recipients: A rare case series and literature review. J Clin Neurosci 2020; 78:284-290. [PMID: 32331940 DOI: 10.1016/j.jocn.2020.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/05/2020] [Indexed: 12/26/2022]
Abstract
Intracranial peripherally enhancing lesions in immunosuppressed solid organ transplant recipients represent a unique diagnostic and management dilemma due to the vast array of differentials that demand consideration. Diagnosis of the underlying pathology is often guided by the use of magnetic resonance imaging (MRI). We present the first published case series of three cardiac transplant recipients with significantly atypical neuroradiological findings contrary to the tenets of contemporary literature. Our rare case series consists of: (1) A sterile Mycobacterium pyogenic abscess mimicking glioblastoma multiforme due to an immunosuppressed state (2) Epstein Barr Virus encephalitis masquerading as Central Nervous System Post-Transplant Lymphoproliferative Disorder (3) An unusual case of partially treated disseminated Nocardiosis warning of the need to consider the immunosuppressed state and partial treatment response obfuscating classical MRI appearances. We utilise these unprecedented cases as the basis of a literature review to understand the pathophysiology behind the peculiar imaging findings in this rarefied cohort of transplant recipients, and rationalise why the MRI findings in each instance contradicts the accepted imaging patterns. In the setting of potential unreliability of neuroradiology in this immunosuppressed unique subgroup, we hope to impart to clinicians that definitive diagnosis obtained by emergent neurosurgical intervention may be necessary to accurately and expediently guide further medical management.
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Affiliation(s)
- Barry Ting Sheen Kweh
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Hui Qing Lee
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Jin Wee Tee
- National Trauma Research Institute, Melbourne, Victoria 3004, Australia; Department of Neurosurgery, Level 1, Old Baker Building, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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Borghei-Razavi H, Sharma M, Emch T, Krivosheya D, Lee B, Muhsen B, Prayson R, Obuchowski N, Barnett GH, Vogelbaum MA, Chao ST, Suh JH, Mohammadi AM, Angelov L. Pathologic Correlation of Cellular Imaging Using Apparent Diffusion Coefficient Quantification in Patients with Brain Metastases After Gamma Knife Radiosurgery. World Neurosurg 2019; 134:e903-e912. [PMID: 31733389 DOI: 10.1016/j.wneu.2019.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/05/2019] [Accepted: 11/06/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the role of apparent diffusion coefficient (ADC) in differentiating radiation necrosis (RN) from recurrent tumor after Gamma Knife radiosurgery (GKRS) for brain metastases (BMs). METHODS Forty-one patients with BM who underwent surgical intervention after GKRS at Cleveland Clinic (2006-2017) were included in this retrospective study. The ADC values of the growing lesions and the contralateral hemisphere were calculated using picture archiving and communication system. These values were correlated to the percentage of RN identified on pathologic evaluation of the surgical specimen. RESULTS The median age of the patients was 59 years (range, 25-86 years), and lung cancer (63.4%) was the most common malignancy. Median initial (pre-GKRS) target volume of the lesions was 5.4 cc (range, 0.135-45.6 cc), and median GKRS dose was 18.0 Gy. Surgical resection or biopsy was performed at a median of 176 days after GKRS. Two variables were statistically significant predictors of predominate RN (75%-100%) in the surgical specimen: 1) ADC of the lesion on the preresection magnetic resonance imaging (MRI) and 2) initial pre-GKRS target volume. ADC >1.5 × 10-3 mm2/s within the lesion on MRI predicted significant RN on pathologic evaluation of the lesion (P < 0.05). Similarly, when the target volume before GKRS was large (>10 cc), the risk of identifying significant necrosis in the pathologic specimen was elevated (P < 0.05). CONCLUSIONS Our data suggest that the combination of lesion ADC on MRI prior to surgical intervention and the initial target volume can predict RN with reasonable accuracy.
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Affiliation(s)
- Hamid Borghei-Razavi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mayur Sharma
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Todd Emch
- Department of Neuroradiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daria Krivosheya
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bryan Lee
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Baha'eddin Muhsen
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Richard Prayson
- Department of Neuropathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gene H Barnett
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Vogelbaum
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - John H Suh
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alireza M Mohammadi
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lilyana Angelov
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, USA; Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, Ohio, USA.
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17
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Siddiqui H, Vakil S, Hassan M. Diagnostic Accuracy of Echo-planar Diffusion-weighted Imaging in the Diagnosis of Intra-cerebral Abscess by Taking Histopathological Findings as the Gold Standard. Cureus 2019; 11:e4677. [PMID: 31328068 PMCID: PMC6634348 DOI: 10.7759/cureus.4677] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 11/05/2022] Open
Abstract
Objective To determine the diagnostic accuracy of echo-planar diffusion-weighted imaging (DWI) in the diagnosis of intra-cerebral abscesses by taking histopathological findings as the gold standard. Subject and methods A retrospective cross-sectional study was performed from July 2014 to June 2015 at a tertiary care hospital in Karachi. A total of 462 patients, who were referred for magnetic resonance imaging (MRI) brain, presenting with clinical suspicion of an intra-cerebral abscess on the basis of clinical signs and symptoms, were included in this study. MR imaging was performed. All patients subsequently underwent surgery. The histopathological findings of these patients were collected and compared with echo-planar diffusion-weighted MRI findings. A proforma was used to record the findings. Results The mean age of the patients was 47.39±13.54 years. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of echo-planar diffusion-weighted MRI in the diagnosis of intra-cerebral abscesses was 85.64%, 95.88%, 93.82%, 90.14%, and 91.56%, respectively. Conclusion Brain abscesses and necrotic tumors are, most of the time, difficult to differentiate on routine conventional imaging, and prompt diagnosis is important, as an untreated brain abscess could be lethal. Diffusion imaging can aid in the diagnosis and further management plan so as to help in improved patient care. Although this sequence has high sensitivity and specificity, it should be used in addition to conventional imaging and not as a replacement of histopathology.
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Affiliation(s)
- Hina Siddiqui
- Radiology, Dow University of Health Sciences (DUHS), Karachi, PAK
| | - Sameera Vakil
- Radiology, Dow University of Health Sciences (DUHS), Karachi, PAK
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White ML, Moore DW, Zhang Y, Mark KD, Greiner TC, Bierman PJ. Primary central nervous system post-transplant lymphoproliferative disorders: the spectrum of imaging appearances and differential. Insights Imaging 2019; 10:46. [PMID: 30972513 PMCID: PMC6458224 DOI: 10.1186/s13244-019-0726-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/25/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Central nervous system post-transplant lymphoproliferative disorder (CNS-PTLD) is a rare disease that presents with non-specific signs and symptoms. The purpose of this article is to present the imaging appearances of CNS-PTLD by magnetic resonance imaging. We highlight the differential diagnostic considerations including primary central nervous system lymphoma, glioblastoma, cerebral abscess, and metastatic disease. This is an important topic to review since in daily practice the diagnosis of CNS-PTLD is often not initially considered when present due to its rarity and the lack of radiologists' familiarity with the disease. CONCLUSION Knowing the unique imaging features of CNS-PTLD narrows the differential diagnosis, facilitates the diagnostic work-up, and optimizes making the diagnosis. Advanced MRI data for CNS PTLD is limited but is promising for helping with narrowing the differential diagnosis.
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Affiliation(s)
- Matthew L White
- Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198-1045, USA.
| | - Drew W Moore
- Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198-1045, USA
| | - Yan Zhang
- Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198-1045, USA
| | - Keiper D Mark
- Radiology, University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE, 68198-1045, USA
| | - Timothy C Greiner
- Pathology, University of Nebraska Medical Center, 983135 Nebraska Medical Center, Omaha, NE, 68198-3135, USA
| | - Philip J Bierman
- Oncology, University of Nebraska Medical Center, 986840 Nebraska Medical Center, Omaha, NE, 68198-6840, USA
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Thurnher MM. Neuroimaging in Bacterial and Mycobacterial Infections of the Brain. Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-68536-6_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Differentiation of brain infection from necrotic glioblastoma using combined analysis of diffusion and perfusion MRI. J Magn Reson Imaging 2018; 49:184-194. [DOI: 10.1002/jmri.26053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
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21
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Neuroimaging in Bacterial and Mycobacterial Infections of the Brain. Clin Neuroradiol 2018. [DOI: 10.1007/978-3-319-61423-6_46-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Magnetic Resonance Spectroscopy and its Clinical Applications: A Review. J Med Imaging Radiat Sci 2017; 48:233-253. [PMID: 31047406 DOI: 10.1016/j.jmir.2017.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 04/30/2017] [Accepted: 06/22/2017] [Indexed: 12/25/2022]
Abstract
In vivo NMR spectroscopy is known as magnetic resonance spectroscopy (MRS). MRS has been applied as both a research and a clinical tool in order to detect visible or nonvisible abnormalities. The adaptability of MRS allows a technique that can probe a wide variety of metabolic uses across different tissues. Although MRS is mostly applied for brain tissue, it can be used for detection, localization, staging, tumour aggressiveness evaluation, and tumour response assessment of breast, prostate, hepatic, and other cancers. In this article, the medical applications of MRS in the brain, including tumours, neural and psychiatric disorder studies, breast, prostate, hepatic, gastrointestinal, and genitourinary investigations have been reviewed.
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Yang Z, Du L, Liu R, Jian Z, Wan Y. Evaluation of Continuous Irrigation and Drainage with a Double-Cavity Sleeve Tube to Treat Brain Abscess. World Neurosurg 2017; 106:231-239. [PMID: 28663048 DOI: 10.1016/j.wneu.2017.05.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Brain abscesses carries a high morbidity and mortality, and despite medical advances, it continues to pose diagnostic and therapeutic challenges worldwide. The traditional surgical approaches to treating brain abscess (burr hole aspiration and craniotomy) have both advantages and disadvantages and remain controversial. Here we report a single institution's experience with a new surgical approach for brain abscess. METHODS We retrospectively analyzed 46 patients with intracranial abscess who underwent continuous irrigation and drainage through a double-cavity sleeve tube placed surgically in conjunction with a 4-week course of intravenous cefotaxime and metronidazole at Renmin Hospital of Wuhan University between January 2008 and December 2016. The patients' medical records were analyzed for demographic data, clinical presentation, predisposing factors, imaging findings, microbiological test results, treatments, surgical techniques, and outcomes. RESULTS The 46 patients included 29 males and 17 females, ranging in age from 22 to 74 years. A single abscess was detected in 34 patients, whereas 12 patients had multiple abscesses. The average duration of hospitalization was 12.6 days. After treatment, 38 of the 46 patients resumed a normal life despite minor deficits (Glasgow Outcome Score [GOS] 5), 6 patients exhibited slight neurologic deficits (GOS 4), and 2 patients died of severe systemic infection and multiorgan failure. In particular, a patient with a brain abscess broken into the ventricle recovered well (GOS 5). No patient required repeat aspiration or surgical excision. CONCLUSIONS Continuous brain abscess cavity irrigation and drainage with a double-cavity sleeve tube is an effective treatment for brain abscess and produces excellent results, especially for an abscess broken into the ventricle. It combines the advantages of burr hole aspiration and open craniotomy excision. It is easy to perform and reduces costs and damage to the patient, and also shortens hospitalization time and antibiotic treatment time, greatly reducing the likelihood of reoperation. This approach may be the optimal choice to treat brain abscess.
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Affiliation(s)
- Zhenxing Yang
- Department of Physiology, Wuhan University School of Medicine, Wuhan, China; Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Du
- Department of Anesthesia, Renmin Hospital of Wuhan University, Wuhan, China
| | - Renzhong Liu
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhihong Jian
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Wan
- Department of Physiology, Wuhan University School of Medicine, Wuhan, China.
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De Simone M, Brogna B, Sessa G, Oliva G, Guida B, Magliulo M. Valuable contribution of magnetic resonance spectroscopy in differentiation of brain abscess from glioma. Infect Dis (Lond) 2017; 49:871-873. [PMID: 28574298 DOI: 10.1080/23744235.2017.1331464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Marta De Simone
- a Neuroradiology Unit , "San Giuseppe Moscati" Hospital , Avellino , Italy
| | - Barbara Brogna
- b Department of Internal and Experimental Medicine "Magrassi-Lanzara", Institute of Radiology , Second University of Naples , Naples , Italy
| | - Giovanni Sessa
- c Neurosurgery Unit , "San Giuseppe Moscati" Hospital , Avellino , Italy
| | - Giovanni Oliva
- c Neurosurgery Unit , "San Giuseppe Moscati" Hospital , Avellino , Italy
| | - Bruno Guida
- a Neuroradiology Unit , "San Giuseppe Moscati" Hospital , Avellino , Italy
| | - Maurizio Magliulo
- d Neurosurgery Unit , "San Giuseppe Moscati" Hospital Avellino , Italy
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Dibble EH, Boxerman JL, Baird GL, Donahue JE, Rogg JM. Toxoplasmosis versus lymphoma: Cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosurg 2016; 152:84-89. [PMID: 27940418 DOI: 10.1016/j.clineuro.2016.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE CNS toxoplasmosis and lymphoma are often indistinguishable by conventional contrast-enhanced MRI. There is limited literature on the diagnostic efficacy of dynamic susceptibility contrast (DSC) MRI for differentiating these entities. This study assesses the clinical utility of relative cerebral blood volume (rCBV) for making a diagnosis and determines rCBV thresholds for differentiation using contemporary DSC-MRI. PATIENTS AND METHODS Thirteen patients with 25 lesions (13 toxoplasmosis and 12 lymphoma) and pre-treatment DSC-MRI were identified retrospectively. Volumetric regions of interest of segmented enhancement were used to extract mean rCBV normalized to normal-appearing white matter for each lesion. We compared average mean rCBV between all toxoplasmosis and lymphoma lesions using a general mixed model. Three models were also compared for evaluating rCBV-based disease status in each patient: 1) mean rCBV of each lesion using a generalized estimating equation, 2) volume-weighted mean rCBV, and 3) maximum mean rCBV of all lesions using logistic regression. RESULTS The average mean rCBV for all toxoplasmosis lesions was 0.98 (95% CI 0.55-1.41) compared to 2.07 (95% CI 1.71-2.43) for all lymphoma lesions, a significant difference (1.09, 95% CI 0.53-1.65, p=0.0013). For the three models used to evaluate rCBV-based disease status in each patient, a significant relationship was observed, with an optimal rCBV threshold of approximately 1.5 for distinguishing lymphoma from toxoplasmosis in each model. CONCLUSION RCBV derived from contemporary DSC-MRI is helpful for distinguishing between cerebral toxoplasmosis and cerebral lymphoma on an individual patient basis and may facilitate more timely initiation of appropriate directed therapy.
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Affiliation(s)
- Elizabeth H Dibble
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jerrold L Boxerman
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Grayson L Baird
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - John E Donahue
- Rhode Island Hospital, Department of Neuropathology, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jeffrey M Rogg
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
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An interesting case of intracerebral MRSA. JAAPA 2016; 29:33-6. [DOI: 10.1097/01.jaa.0000491220.49520.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Salice S, Esposito R, Ciavardelli D, delli Pizzi S, di Bastiano R, Tartaro A. Combined 3 Tesla MRI Biomarkers Improve the Differentiation between Benign vs Malignant Single Ring Enhancing Brain Masses. PLoS One 2016; 11:e0159047. [PMID: 27410226 PMCID: PMC4943588 DOI: 10.1371/journal.pone.0159047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 06/27/2016] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To evaluate whether the combination of imaging biomarkers obtained by means of different 3 Tesla (3T) Magnetic Resonance Imaging (MRI) advanced techniques can improve the diagnostic accuracy in the differentiation between benign and malignant single ring-enhancing brain masses. MATERIALS AND METHODS 14 patients presenting at conventional 3T MRI single brain mass with similar appearance as regard ring enhancement, presence of peri-lesional edema and absence of hemorrhage signs were included in the study. All lesions were histologically proven: 5 pyogenic abscesses, 6 glioblastomas, and 3 metastases. MRI was performed at 3 Tesla and included Diffusion Weighted Imaging (DWI), Dynamic Susceptibility Contrast -Perfusion Weighted Imaging (DSC-PWI), Magnetic Resonance Spectroscopy (MRS), and Diffusion Tensor Imaging (DTI). Imaging biomarkers derived by those advanced techniques [Cerebral Blood Flow (CBF), relative Cerebral Blood Volume (rCBV), relative Main Transit Time (rMTT), Choline (Cho), Creatine (Cr), Succinate, N-Acetyl Aspartate (NAA), Lactate (Lac), Lipids, relative Apparent Diffusion Coefficient (rADC), and Fractional Anisotropy (FA)] were detected by two experienced neuroradiologists in joint session in 4 areas: Internal Cavity (IC), Ring Enhancement (RE), Peri-Lesional edema (PL), and Contralateral Normal Appearing White Matter (CNAWM). Significant differences between benign (n = 5) and malignant (n = 9) ring enhancing lesions were tested with Mann-Withney U test. The diagnostic accuracy of MRI biomarkers taken alone and MRI biomarkers ratios were tested with Receiver Operating Characteristic (ROC) analysis with an Area Under the Curve (AUC) ≥ 0.9 indicating a very good diagnostic accuracy of the variable. RESULTS Five MRI biomarker ratios achieved excellent accuracy: IC-rADC/PL-NAA (AUC = 1), IC-rADC/IC-FA (AUC = 0.978), RE-rCBV/RE-FA (AUC = 0.933), IC-rADC/RE-FA (AUC = 0.911), and IC-rADC/PL-FA (AUC = 0.911). Only IC-rADC achieved a very good diagnostic accuracy (AUC = 0.909) among MRI biomarkers taken alone. CONCLUSION Although the major limitation of the study was the small sample size, preliminary results seem to suggest that combination of multiple 3T MRI biomarkers is a feasible approach to MRI biomarkers in order to improve diagnostic accuracy in the differentiation between benign and malignant single ring enhancing brain masses. Further studies in larger cohorts are needed to reach definitive conclusions.
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Affiliation(s)
- Simone Salice
- Department of Neurosciences, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Roberto Esposito
- Department of Neurosciences, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- AO Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Domenico Ciavardelli
- School of Human and Social Science, “Kore” University of Enna, Enna, Italy
- Molecular Neurology Unit, Center of Excellence on Aging and Translational Medicine (Ce.S.I.-MeT), University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Stefano delli Pizzi
- Department of Neurosciences, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Rossella di Bastiano
- Department of Neurosciences, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Armando Tartaro
- Department of Neurosciences, Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
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Wu CJ, Wang Q, Zhang J, Wang XN, Liu XS, Zhang YD, Shi HB. Readout-segmented echo-planar imaging in diffusion-weighted imaging of the kidney: comparison with single-shot echo-planar imaging in image quality. Abdom Radiol (NY) 2016; 41:100-8. [PMID: 26830616 DOI: 10.1007/s00261-015-0615-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the image quality of readout-segmented echo-planar imaging (RS-EPI) and that of standard single-shot echo-planar imaging (SS-EPI) in the kidney in a rat model. MATERIALS AND METHODS Twelve Wistar rats undergoing MRI examinations were imaged with two diffusion-weighted (DW) imaging protocols: a standard SS-EPI and a new RS-EPI protocol, both with a 1.0 × 1.0 × 3.0 mm voxel. The two groups of diffusion-weighted images were independently scored on geometric distortion, image blurring, signal dropout, and the overall image quality by two radiologists. Signal-to-noise ratio (SNR) and apparent diffusion coefficient (ADC) were measured on both sequences. Inter-rater agreement (IRA) was evaluated by Fleiss kappa (κ) and inter-class correlation coefficient (ICC) statistics. Comparisons of image qualities were made by Wilcoxon signed-rank test and paired-sample t test. RESULTS Both RS-EPI and SS-EPI had good IRAs in scoring image qualities (κ = 0.607-0.833) and measuring renal ADCs (ICC = 0.828-0.945). Compared to SS-EPI, RS-EPI produced less geometric distortion (median score 1.5 versus 2.5, p < 0.0001), less image blurring (1.75 versus 2.0, p = 0.0003), less signal dropout (1.0 versus 3.0, p = 0.0001), and a lower score in overall image artifacts (4.25 versus 7.25; p < 0.0001). RS-EPI had higher SNR of renal DW images than SS-EPI (p < 0.001). The intra-variability of ADCs in cortex, outer medulla, and inner medulla ranged from 9.6% to 11.1% (Pearson correlation coefficient ρ = 0.675-0.729; p < 0.001) between the two protocols. CONCLUSION We showed that for DWI of the kidney at 1.0 × 1.0 × 3.0 mm(3) voxel sizes, the new protocol provided better image quality than standard SS-EPI protocol.
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Affiliation(s)
- Chen-Jiang Wu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Qing Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xiao-Ning Wang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Xi-Sheng Liu
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital with Nanjing Medical University, No. 300, Guangzhou Road, Nanjing, 210000, China.
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Copen WA, Lev MH, Rapalino O. Brain perfusion: computed tomography and magnetic resonance techniques. HANDBOOK OF CLINICAL NEUROLOGY 2016; 135:117-135. [PMID: 27432662 DOI: 10.1016/b978-0-444-53485-9.00006-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral perfusion imaging provides assessment of regional microvascular hemodynamics in the living brain, enabling in vivo measurement of a variety of different hemodynamic parameters. Perfusion imaging techniques that are used in the clinical setting usually rely upon X-ray computed tomography (CT) or magnetic resonance imaging (MRI). This chapter reviews CT- and MRI-based perfusion imaging techniques, with attention to image acquisition, clinically relevant aspects of image postprocessing, and fundamental differences between CT- and MRI-based techniques. Correlations with cerebrovascular physiology and potential clinical applications of perfusion imaging are reviewed, focusing upon the two major classes of neurologic disease in which perfusion imaging is most often performed: primary perfusion disorders (including ischemic stroke, transient ischemic attack, and reperfusion syndrome), and brain tumors.
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Affiliation(s)
- William A Copen
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Michael H Lev
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Ramírez Mejía AR, Fuertes MY, Moya MJ. Brain Abscess in a Patient with Rendu-Osler-Weber Syndrome: Value of Proton Magnetic Resonance Spectroscopy. NMC Case Rep J 2016; 3:35-37. [PMID: 28663994 PMCID: PMC5386148 DOI: 10.2176/nmccrj.cr.2015-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/20/2015] [Indexed: 12/04/2022] Open
Abstract
The diagnosis of intracranial focal lesions based on imaging studies is a challenge. In brain abscess, proton magnetic resonance spectroscopy (1H-MRS) is useful to define etiology, differentiating anaerobic from aerobic pathogens and inclusive sterile abscess based on the behavior of certain metabolites. We report a patient with Rendu-Osler-Weber syndrome, pulmonary arteriovenous fistulas, and brain abscesses characterized by brain magnetic resonance imaging (MRI), with a spectroscopy pattern compatible with anaerobic infection.
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13N-ammonia combined with 18F-FDG could discriminate between necrotic high-grade gliomas and brain abscess. Clin Nucl Med 2015; 40:195-9. [PMID: 25546194 DOI: 10.1097/rlu.0000000000000649] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Accurate prediction of brain abscess is beneficial for timely management. In this study, we investigated the utility of 13N-ammonia and its combination with 18F-FDG in differentiating brain abscess from necrotic high-grade gliomas. PATIENTS AND METHODS Thirteen patients with ring-like enhancement high-grade gliomas and 11 patients with brain abscess were recruited in our study. All of them underwent both 18F-FDG and 13N-ammonia PET imaging. Lesion uptake was evaluated by lesion to normal gray matter ratio (L/N). Histopathology diagnosis was obtained for all the patients after PET imaging. RESULTS The L/N values of 18F-FDG were not significantly different between brain abscess and necrotic high-grade gliomas (P = 0.35). The uptake of 13N-ammonia in gliomas was higher than that in abscess lesions (L/N: 1.38 ± 0.31 vs 0.84 ± 0.18, P < 0.001). The receiver operating characteristic curve analysis determined the optimal L/N cutoff value (13N-ammonia) of 1.0 with the area under the curve of 0.94 and the overall accuracy of 87.5%. Discriminant analysis demonstrated that the combination of 18F-FDG and 13N-ammonia could distinguish the 2 clinical entities with higher accuracy of 95%, and only 1 necrotic glioma lesion was misclassified into the abscess group. CONCLUSIONS 13N-ammonia is effective in distinguishing brain abscess from necrotic high-grade gliomas, and its combination with 18F-FDG could further elevate the diagnostic accuracy.
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Abstract
Infections of the central nervous system (CNS) are a very common worldwide health problem in childhood with significant morbidity and mortality. In children, viruses are the most common cause of CNS infections, followed by bacterial etiology, and less frequent due to mycosis and other causes. Noncomplicated meningitis is easier to recognize clinically; however, complications of meningitis such as abscesses, infarcts, venous thrombosis, or extra-axial empyemas are difficult to recognize clinically, and imaging plays a very important role on this setting. In addition, it is important to keep in mind that infectious process adjacent to the CNS such as mastoiditis can develop by contiguity in an infectious process within the CNS. We display the most common causes of meningitis and their complications.
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Fu JH, Chuang TC, Chung HW, Chang HC, Lin HS, Hsu SS, Wang PC, Hsu SH, Pan HB, Lai PH. Discriminating pyogenic brain abscesses, necrotic glioblastomas, and necrotic metastatic brain tumors by means of susceptibility-weighted imaging. Eur Radiol 2014; 25:1413-20. [DOI: 10.1007/s00330-014-3518-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 11/06/2014] [Accepted: 11/18/2014] [Indexed: 01/14/2023]
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Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction. PLoS One 2014; 9:e109172. [PMID: 25330386 PMCID: PMC4201450 DOI: 10.1371/journal.pone.0109172] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/09/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MRI before and after mathematic contrast leakage correction in differentiating pyogenic brain abscesses from glioblastomas and/or metastatic brain tumors. Materials and Methods Cerebral blood volume (CBV), leakage-corrected CBV and leakage coefficient K2 were measured in enhancing rims, perifocal edema and contralateral normal appearing white matter (NAWM) of 17 abscesses, 19 glioblastomas and 20 metastases, respectively. The CBV and corrected CBV were normalized by dividing the values in the enhancing rims or edema to those of contralateral NAWM. For each study group, a paired t test was used to compare the K2 of the enhancing rims or edema with those of NAWM, as well as between CBV and corrected CBV of the enhancing rims or edema. ANOVA was used to compare CBV, corrected CBV and K2 among three lesion types. The diagnostic performance of CBV and corrected CBV was assessed with receiver operating characteristic (ROC) curve analysis. Results The CBV and correction CBV of enhancing rim were 1.45±1.17 and 1.97±1.01 for abscesses, 3.85±2.19 and 4.39±2.33 for glioblastomas, and 2.39±0.90 and 2.97±0.78 for metastases, respectively. The CBV and corrected CBV in the enhancing rim of abscesses were significantly lower than those of glioblastomas and metastases (P = 0.001 and P = 0.007, respectively). In differentiating abscesses from glioblastomas and metastases, the AUC values of corrected CBV (0.822) were slightly higher than those of CBV (0.792). Conclusions Mathematic leakage correction slightly increases the diagnostic performance of CBV in differentiating pyogenic abscesses from necrotic glioblastomas and cystic metastases. Clinically, DSC perfusion MRI may not need mathematic leakage correction in differentiating abscesses from glioblastomas and/or metastases.
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ABO-Sheisha DM, Amin MA, Soliman AY. Role of diffusion weighted imaging and proton magnetic resonance spectroscopy in ring enhancing brain lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Elshafey R, Hassanein O, Shakal A, Mokbel E. 1H proton MR spectroscopy and diffusion-weighted imaging in discrimination between pyogenic brain abscesses and necrotic brain tumors. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Treister D, Kingston S, Hoque KE, Law M, Shiroishi MS. Multimodal Magnetic Resonance Imaging Evaluation of Primary Brain Tumors. Semin Oncol 2014; 41:478-495. [DOI: 10.1053/j.seminoncol.2014.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Muccio CF, Caranci F, D'Arco F, Cerase A, De Lipsis L, Esposito G, Tedeschi E, Andreula C. Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol 2014; 41:153-67. [PMID: 24957685 DOI: 10.1016/j.neurad.2014.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
The aim of this paper is to illustrate the potential of magnetic resonance imaging (MRI) in diagnosis, differential diagnosis, treatment planning and evaluation of therapy effectiveness of pyogenic brain abscesses, through the use of morphological (or conventional) and functional (or advanced) sequences. Conventional MRI study is useful for the identification of lesions, to determine the location and morphology and allows a correct hypothesis of nature in the most typical cases. However, the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumors (high-grade gliomas and metastases) is often only possible through the use of functional sequences, as the measurement of diffusion with apparent diffusion coefficient (DWI-ADC), proton magnetic resonance spectroscopy ((1)H-MRS) and perfusion weighted imaging (PWI), which complement the morphological sequences and provide essential information on structural, metabolic and hemodynamic characteristics allowing greater neuroradiological confidence. Modern diagnostic MRI of pyogenic brain abscesses cannot be separated from knowledge, integration and proper use of the morphological and functional sequences.
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Affiliation(s)
- Carmine Franco Muccio
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Ferdinando Caranci
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Felice D'Arco
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Alfonso Cerase
- Unit of Neuroradiology, Department of Neuroscience, University "Santa Maria alle Scotte", Siena, Italy
| | - Luca De Lipsis
- Department of Critical Care Medicine, Hospital "Fatebenefratelli", Benevento, Italy
| | - Gennaro Esposito
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Enrico Tedeschi
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Cosma Andreula
- Unit of Radiology and Neuroradiology, Anthea Hospital, Bari, Italy
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Warrington CD, Feeney DA, Ober CP, Jessen CR, Steward SM, Armién AG, Fletcher TF. Relative metabolite concentrations and ratios determined by use of 3-T region-specific proton magnetic resonance spectroscopy of the brain of healthy Beagles. Am J Vet Res 2014; 74:1291-303. [PMID: 24066913 DOI: 10.2460/ajvr.74.10.1291] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine relative concentrations of selected major brain tissue metabolites and their ratios and lobar variations by use of 3-T proton (hydrogen 1 [(1)H]) magnetic resonance spectroscopy (MRS) of the brain of healthy dogs. ANIMALS 10 healthy Beagles. PROCEDURES 3-T (1)H MRS at echo times of 144 and 35 milliseconds was performed on 5 transverse slices and 1 sagittal slice of representative brain lobe regions. Intravoxel parenchyma was classified as white matter, gray matter, or mixed (gray and white) and analyzed for relative concentrations (in arbitrary units) of N-acetylaspartate (NAA), choline, and creatine (ie, height at position of peak on MRS graph) as well as their ratios (NAA-to-choline, NAA-to-creatine, and choline-to-creatine ratios). Peak heights for metabolites were compared between echo times. Peak heights for metabolites and their ratios were correlated and evaluated among matter types. Yield was calculated as interpretable voxels divided by available lobar voxels. RESULTS Reference ranges of the metabolite concentration ratios were determined at an echo time of 35 milliseconds (NAA-to-choline ratio, 1.055 to 2.224; NAA-to-creatine ratio, 1.103 to 2.161; choline-to-creatine ratio, 0.759 to 1.332) and 144 milliseconds (NAA-to-choline ratio, 0.687 to 1.788; NAA-to-creatine ratio, 0.984 to 2.044; choline-to-creatine ratio, 0.828 to 1.853). Metabolite concentration ratios were greater in white matter than in gray matter. Voxel yields ranged from 43% for the temporal lobe to 100% for the thalamus. CONCLUSIONS AND CLINICAL RELEVANCE Metabolite concentrations and concentration ratios determined with 3-T (1)H MRS were not identical to those in humans and were determined for clinical and research investigations of canine brain disease.
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Affiliation(s)
- Christopher D Warrington
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108
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High extracellular concentration of excitatory amino acids glutamate and aspartate in human brain abscess. Neurochem Int 2014; 69:41-7. [DOI: 10.1016/j.neuint.2014.03.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 11/17/2022]
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Lo WB, Cahill J, Carey M, Mehta H, Shad A. Infected Intracranial Meningiomas. World Neurosurg 2014; 81:651.e9-13. [DOI: 10.1016/j.wneu.2013.07.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 07/26/2013] [Indexed: 11/24/2022]
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Hosainey SAM, Rydning PN, Rezai M, Herrman H. En kvinne i 60-årene med vedvarende hodepine. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:2058-61. [DOI: 10.4045/tidsskr.14.0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Wang JH, Sun GF, Zhang J, Shao CW, Zuo CJ, Hao J, Zheng JM, Feng XY. Infective severe acute pancreatitis: A comparison of 99mTc-ciprofloxacin scintigraphy and computed tomography. World J Gastroenterol 2013; 19:4897-4906. [PMID: 23946594 PMCID: PMC3740419 DOI: 10.3748/wjg.v19.i30.4897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/12/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate 99mTc-ciprofloxacin scintigraphy compared with computed tomography (CT) for detecting secondary infections associated with severe acute pancreatitis (SAP) in swine.
METHODS: Six healthy swine were assigned to a normal control group (group A, n = 6). SAP was induced in group B (n = 9) and C (n = 18), followed by inoculation of the resulting pancreatic necroses with inactive Escherichia coli (E. coli) (group B) and active E. coli (group C), respectively. At 7 d after inoculation, a CT scan and a series of analyses using infecton imaging (at 0.5, 1, 2, 3, 4 and 6 h after the administration of 370 MBq of intravenous infecton) were performed. The scintigrams were visually evaluated and semi-quantitatively analyzed using region of interest assignments. The differences in infecton uptake and changes in the lesion-background radioactive count ratios (L/B) in the 3 groups were recorded and compared. After imaging detection, histopathology and bacterial examinations were performed, and infected SAP was regarded as positive. The imaging findings were compared with histopathological and bacteriological results.
RESULTS: In group A, 6 animals survived without infection in the pancreas. In group B, 7/9 swine survived and one suffered from infection. In group C, 15/18 animals survived with infection. Hence, the number of normal, non-infected and infected SAP swine was 6, 6 and 16, respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the infecton method were 93.8% (15/16), 91.7% (11/12), 92.9% (26/28), 93.8% (15/16) and 91.7% (11/12), whereas these values for CT were 12.5% (2/16), 100.0% (12/12), 50.0% (14/28), 100.0% (2/2) and 46.2% (12/26), respectively. The changes in L/B for the infected SAP were significantly different from those of the non-infected and normal swine (P < 0.001). The mean L/B of the infectious foci at 0.5, 1, 2, 3, 4 and 6 h was 1.17 ± 0.10, 1.71 ± 0.30, 2.46 ± 0.45, 3.36 ± 0.33, 2.04 ± 0.37 and 1.1988 ± 0.09, respectively. At 3 h, the radioactive counts (2350.25 ± 602.35 k) and the mean L/B of the infectious foci were significantly higher than that at 0.5 h (P = 0.000), 1 h (P = 0.000), 2 h (P = 0.04), 4 h (P = 0.000) and 6 h (P = 0.000).
CONCLUSION: 99mTc-ciprofloxacin scintigraphy may be an effective procedure for detecting SAP secondary infections with higher sensitivity and accuracy than CT.
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Grand S, Tahon F, Attye A, Lefournier V, Le Bas JF, Krainik A. Perfusion imaging in brain disease. Diagn Interv Imaging 2013; 94:1241-57. [PMID: 23876408 DOI: 10.1016/j.diii.2013.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Perfusion CT or MRI have been extensively developed over the last years and are accessible on most imaging machines. Perfusion CT has taken a major place in the assessment of a stroke. Its role has to be specified for the diagnosis and treatment of the vasospasm, complicating a subarachnoid hemorrhage. Perfusion MRI should be included in the assessment of any brain tumor, both at the time of the diagnosis as well as in the post-treatment monitoring. It is included in the multimodal approach required for the optimum treatment of this disease. The applications in epilepsy and the neurodegenerative diseases are in the evaluation process.
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Affiliation(s)
- S Grand
- CHU de Grenoble, Cluni BP 217, 38043 Grenoble cedex 9, France; Grenoble institut des neurosciences, chemin Fortuné-Ferrini, 38042 Grenoble cedex 9, France.
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Advanced MR imaging of gliomas: an update. BIOMED RESEARCH INTERNATIONAL 2013; 2013:970586. [PMID: 23862163 PMCID: PMC3686060 DOI: 10.1155/2013/970586] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/12/2013] [Accepted: 05/13/2013] [Indexed: 02/07/2023]
Abstract
Recent advances in the treatment of cerebral gliomas have increased the demands on noninvasive neuroimaging for the diagnosis, therapeutic planning, tumor monitoring, and patient outcome prediction. In the meantime, improved magnetic resonance (MR) imaging techniques have shown much potentials in evaluating the key pathological features of the gliomas, including cellularity, invasiveness, mitotic activity, angiogenesis, and necrosis, hence, further shedding light on glioma grading before treatment. In this paper, an update of advanced MR imaging techniques is reviewed, and their potential roles as biomarkers of tumor grading are discussed.
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Abstract
This article presents an overview of advanced magnetic resonance (MR) imaging techniques using contrast media in neuroimaging, focusing on T2*-weighted dynamic susceptibility contrast MR imaging and T1-weighted dynamic contrast-enhanced MR imaging. Image acquisition and data processing methods and their clinical application in brain tumors, stroke, dementia, and multiple sclerosis are discussed.
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Affiliation(s)
- Jean-Christophe Ferré
- Department of Radiology, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, USA.
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Rath TJ, Hughes M, Arabi M, Shah GV. Imaging of Cerebritis, Encephalitis, and Brain Abscess. Neuroimaging Clin N Am 2012; 22:585-607. [DOI: 10.1016/j.nic.2012.04.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Mills SJ, Thompson G, Jackson A. Advanced magnetic resonance imaging biomarkers of cerebral metastases. Cancer Imaging 2012; 12:245-52. [PMID: 22935843 PMCID: PMC3458786 DOI: 10.1102/1470-7330.2012.0012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There are a number of magnetic resonance imaging techniques available for use in the diagnosis and management of patients with cerebral metastases. This article reviews these techniques, in particular, the advanced imaging methodologies from which quantitative parameters can be derived, the role of these imaging biomarkers have in distinguishing metastases from primary central nervous system tumours and tumour mimics, and metrics that may be of value in predicting the origin of the primary tumour.
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Affiliation(s)
- S J Mills
- Department of Neuroradiology, Salford Royal Foundation Trust Hospital, Salford, Greater Manchester, UK.
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Vermoolen MA, Kwee TC, Nievelstein RAJ. Apparent diffusion coefficient measurements in the differentiation between benign and malignant lesions: a systematic review. Insights Imaging 2012; 3:395-409. [PMID: 22695951 PMCID: PMC3481080 DOI: 10.1007/s13244-012-0175-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 03/16/2012] [Accepted: 04/13/2012] [Indexed: 12/11/2022] Open
Abstract
Objectives To systematically review the value of apparent diffusion coefficient (ADC) measurement in the differentiation between benign and malignant lesions. Methods A systematic search of the Medline/Pubmed and Embase databases revealed 109 relevant studies. Quality of these articles was assessed using the Quality Assessment of the Studies of Diagnostic Accuracy Included in Systematic Reviews (QUADAS) criteria. Reported ADC values of benign and malignant lesions were compared per organ. Results The mean quality score of the reviewed articles was 50%. Comparison of ADC values showed marked variation among studies and between benign and malignant lesions in various organs. In several organs, such as breast, liver, and uterus, ADC values discriminated well between benign and malignant lesions. In other organs, such as the salivary glands, thyroid, and pancreas, ADCs were not significantly different between benign and malignant lesions. Conclusion The potential utility of ADC measurement for the characterisation of tumours differs per organ. Future well-designed studies are required before ADC measurements can be recommended for the differentiation of benign and malignant lesions. These future studies should use standardised acquisition protocols and provide complete reporting of study methods, to facilitate comparison of results and clinical implementation of ADC measurement for tumour characterisation. Electronic supplementary material The online version of this article (doi:10.1007/s13244-012-0175-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M A Vermoolen
- Department of Radiology, University Medical Center, Heidelberglaan 100 HP. E.01.132, PO Box 85500, 3508 GA, Utrecht, The Netherlands,
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Mong S, Ellingson BM, Nghiemphu PL, Kim HJ, Mirsadraei L, Lai A, Yong W, Zaw TM, Cloughesy TF, Pope WB. Persistent diffusion-restricted lesions in bevacizumab-treated malignant gliomas are associated with improved survival compared with matched controls. AJNR Am J Neuroradiol 2012; 33:1763-70. [PMID: 22538078 DOI: 10.3174/ajnr.a3053] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE A subset of patients with malignant glioma develops conspicuous lesions characterized by persistent restricted diffusion during treatment with bevacizumab. The purpose of the current study was to characterize the evolution of these lesions and to determine their relationship to patient outcome. MATERIALS AND METHODS Twenty patients with malignant glioma with persistent restricted-diffusion lesions undergoing treatment with bevacizumab were included in the current study. Mean ADC and the volume of restricted diffusion were computed for each patient during serial follow-up. Differences in TTP, TTS, and OS were compared between patients with restricted diffusion and matched controls by using Kaplan-Meier analysis with the logrank test and Cox hazard models. RESULTS Mean ADC values were generally stable with time (mean, 5.2 ± 12.6% change from baseline). The volume of restricted diffusion increased a median of 23% from baseline by 6 months. Patients with restricted-diffusion lesions had significantly greater TTP (logrank, P = .013), TTS (logrank, P = .008), and OS (logrank, P = .010) than matched controls. When available, advanced physiologic imaging of restricted-diffusion lesions showed hypovascularity on perfusion MR imaging and decreased amino acid uptake on (18)F-FDOPA PET scans. Atypical gelatinous necrotic tissue was confirmed in the area of restricted diffusion in 1 patient. CONCLUSIONS Restricted-diffusion lesions in malignant gliomas treated with bevacizumab are generally stable with time and are associated with improved outcomes. These results combined with physiologic imaging and histopathologic data suggest that these lesions are not consistent with aggressive tumor.
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Affiliation(s)
- S Mong
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095-1721, USA
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