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Benson JC, Trejo-Lopez JA, Cormier JL, Parney IF, Mark IT, Madhavan AA, Kotsenas AL, Rydberg CH, Luetmer PH, Eckel LJ, Johnson DR. Radiology-pathology correlation: Giant tumefactive perivascular spaces. Neuroradiol J 2024:19714009241247459. [PMID: 38613202 DOI: 10.1177/19714009241247459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Dilated perivascular spaces (PVSs) are common and easily recognized on imaging. However, rarer giant tumefactive PVSs (GTPVSs) can have unusual multilocular cystic configurations, and are often confused for other pathologic entities, including neoplasms, cystic infarctions, and neuroepithelial cysts. Because GTPVSs are scarcely encountered and even more infrequently operated upon, many radiologists are unaware of the imaging and pathologic features of these lesions. Here, a case of a resected GTPVS is presented, highlighting both its radiologic and histologic characteristics, and discussing how such lesions can be differentiated from their closest mimickers on imaging.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Jason L Cormier
- Department of Neurosurgery, Acadiana Neurosurgery, Lafayette, LA, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, LA, USA
| | - Ian T Mark
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Amy L Kotsenas
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Mark IT, Van Gompel J, Bancos I, Nagelschneider AA, Johnson DR, Bathla G, Madhavan AA, Weber NM, Yu L. Back to the Future: Dynamic Contrast-Enhanced Photon-Counting Detector CT for the Detection of Pituitary Adenoma in Cushing Disease. AJNR Am J Neuroradiol 2024:ajnr.A8171. [PMID: 38290737 DOI: 10.3174/ajnr.a8171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
Historically, MR imaging has been unable to detect a pituitary adenoma in up to one-half of patients with Cushing disease. This issue is problematic because the standard-of-care treatment is surgical resection, and its success is correlated with finding the tumor on imaging. Photon-counting detector CT is a recent advancement that has multiple benefits over conventional energy-integrating detector CT. We present the use of dynamic contrast-enhanced imaging using photon-counting detector CT for the detection of pituitary adenomas in patients with Cushing disease.
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Affiliation(s)
- Ian T Mark
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - Jamie Van Gompel
- Department of Neurosurgery (J.V.G.), Mayo Clinic, Rochester, Minnesota
| | - Irina Bancos
- Department of Endocrinology (I.B.), Mayo Clinic, Rochester, Minnesota
| | - Alex A Nagelschneider
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - Derek R Johnson
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - Girish Bathla
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - Ajay A Madhavan
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - Nikkole M Weber
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
| | - Lifeng Yu
- From the Department of Radiology (I.T.M. A.A.N., D.R.J., G.B., A.A.M., N.M.W., L.Y.), Mayo Clinic, Rochester, Minnesota
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Nabavizadeh A, Galldiks N, Veronesi M, Lohmann P, McConathy JE, Johnson DR, Aboian MS, Barajas RF, Ivanidze J. Introducing the American Society of Neuroradiology PET-Guided Diagnosis and Management in Neuro-Oncology Study Group. AJNR Am J Neuroradiol 2024:ajnr.A8243. [PMID: 38548306 DOI: 10.3174/ajnr.a8243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
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Mark IT, Welker K, Erickson D, Johnson DR, Bathla G, Messina S, Farnsworth PJ, Gompel JV. 7T MRI for Cushing's Disease: A Single Institutional Experience and Literature Review. AJNR Am J Neuroradiol 2024:ajnr.A8209. [PMID: 38365424 DOI: 10.3174/ajnr.a8209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/15/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND AND PURPOSE Cushing disease is typically caused by a pituitary adenoma that frequently is small and challenging to detect on conventional MRI. High field strength 7T MRI can leverage increased signal-to-noise and contrast-to-noise ratios compared to lower-field strength MRI to help identify small pituitary lesions. We aim to describe our institutional experience with 7T MRI in patients with Cushing disease and perform a review of the literature. MATERIALS AND METHODS A retrospective analysis of 7T MRI findings in patients with pathology proven cases of Cushing disease from a single institution, followed by a review of the literature on 7T MRI for Cushing disease. RESULTS Our institutional experience identified Cushing adenomas in 10/13 (76.9%) patients on 7T, however only 5/13 (38.5%) lesions were discrete. Overall, the imaging protocols used were heterogeneous in terms of contrast dose as well as type of post-contrast T1-weighted sequences (Dynamic, 2D vs 3D, and type of 3D sequence). From our institutional data, specific post-gadolinium T1-weighted sequences were helpful in identifying a surgical lesion as follows: Dynamic Contrast Enhanced 2/7 (28.6%), 2D FSE 4/8 (50%), 3D SPACE 5/6 (83.3%), and 3D MPRAGE 8/11 (72.7%). The literature review identified Cushing adenomas in 31/33 (93.9%) patients on 7T. CONCLUSIONS 7T MRI for pituitary lesion localization in Cushing disease is a new technique with imaging protocols that varied widely. Further comparative research is needed to identify the optimal imaging technique as well as to assess the benefit of 7T over lower-field strength MRI. ABBREVIATIONS MRI = Magnetic Resonance Imaging, CT = Computed Tomography, 7T = 7 Tesla, DCE = Dynamic Contrast Enhanced.
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Affiliation(s)
- Ian T Mark
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Kirk Welker
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Dana Erickson
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Derek R Johnson
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Girish Bathla
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Steven Messina
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Paul J Farnsworth
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
| | - Jamie Van Gompel
- From the Department of Radiology (ITM, KW, DRJ, GB, SM, PJF), Department of Endocrinology (DE), and Department of Neurosurgery (JVG, May Clinic, Rochester, MN, USA
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Mendoza MA, Hass RM, Vaillant J, Johnson DR, Theel ES, Toledano M, Abu Saleh O. Powassan Virus Encephalitis: A Tertiary Center Experience. Clin Infect Dis 2024; 78:80-89. [PMID: 37540989 PMCID: PMC10810704 DOI: 10.1093/cid/ciad454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Powassan virus (POWV) is an emerging arthropod-borne flavivirus, transmitted by Ixodes spp. ticks, which has been associated with neuroinvasive disease and poor outcomes. METHODS A retrospective study was conducted at Mayo Clinic from 2013 to 2022. We included clinical and epidemiologic data of probable and confirmed neuroinvasive POWV cases. RESULTS Sixteen patients with neuroinvasive POWV were identified; their median age was 63.2 years, and 62.5% were male. Six patients presented with rhombencephalitis, 4 with isolated meningitis, 3 with meningoencephalitis, 2 with meningoencephalomyelitis, and 1 with opsoclonus myoclonus syndrome. A median time of 18 days was observed between symptom onset and diagnosis. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with elevated protein and normal glucose in the majority of patients. Death occurred within 90 days in 3 patients (18.8%), and residual neurologic deficits were seen in 8 survivors (72.7%). CONCLUSIONS To our knowledge, this is the largest case series of patients with neuroinvasive POWV infection. We highlight the importance of a high clinical suspicion among patients who live in or travel to high-risk areas during the spring to fall months. Our data show high morbidity and mortality rates among patients with neuroinvasive disease.
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Affiliation(s)
- Maria Alejandra Mendoza
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Reece M Hass
- Departement of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James Vaillant
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Departement of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elitza S Theel
- Division of Clinical Microbiology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michel Toledano
- Departement of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Omar Abu Saleh
- Division of Public Health, Infectious Diseases, and Occupational Medicine News, Mayo Clinic, Rochester, Minnesota, USA
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Galanis E, Dooley KE, Keith Anderson S, Kurokawa CB, Carrero XW, Uhm JH, Federspiel MJ, Leontovich AA, Aderca I, Viker KB, Hammack JE, Marks RS, Robinson SI, Johnson DR, Kaufmann TJ, Buckner JC, Lachance DH, Burns TC, Giannini C, Raghunathan A, Iankov ID, Parney IF. Carcinoembryonic antigen-expressing oncolytic measles virus derivative in recurrent glioblastoma: a phase 1 trial. Nat Commun 2024; 15:493. [PMID: 38216554 PMCID: PMC10786937 DOI: 10.1038/s41467-023-43076-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 10/31/2023] [Indexed: 01/14/2024] Open
Abstract
Measles virus (MV) vaccine strains have shown significant preclinical antitumor activity against glioblastoma (GBM), the most lethal glioma histology. In this first in human trial (NCT00390299), a carcinoembryonic antigen-expressing oncolytic measles virus derivative (MV-CEA), was administered in recurrent GBM patients either at the resection cavity (Group A), or, intratumorally on day 1, followed by a second dose administered in the resection cavity after tumor resection on day 5 (Group B). A total of 22 patients received study treatment, 9 in Group A and 13 in Group B. Primary endpoint was safety and toxicity: treatment was well tolerated with no dose-limiting toxicity being observed up to the maximum feasible dose (2×107 TCID50). Median OS, a secondary endpoint, was 11.6 mo and one year survival was 45.5% comparing favorably with contemporary controls. Other secondary endpoints included assessment of viremia, MV replication and shedding, humoral and cellular immune response to the injected virus. A 22 interferon stimulated gene (ISG) diagonal linear discriminate analysis (DLDA) classification algorithm in a post-hoc analysis was found to be inversely (R = -0.6, p = 0.04) correlated with viral replication and tumor microenvironment remodeling including proinflammatory changes and CD8 + T cell infiltration in post treatment samples. This data supports that oncolytic MV derivatives warrant further clinical investigation and that an ISG-based DLDA algorithm can provide the basis for treatment personalization.
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Affiliation(s)
- Evanthia Galanis
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Joon H Uhm
- Department of Neurology, Division of Neuro-Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ileana Aderca
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kimberly B Viker
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Julie E Hammack
- Department of Neurology, Division of Neuro-Oncology, Mayo Clinic, Rochester, MN, USA
| | - Randolph S Marks
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Steven I Robinson
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jan C Buckner
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Daniel H Lachance
- Department of Neurology, Division of Neuro-Oncology, Mayo Clinic, Rochester, MN, USA
| | - Terry C Burns
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ianko D Iankov
- Department of Molecular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ian F Parney
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Burkett BJ, Johnson DR, Hunt CH, Messina SA, Broski SM. Anti-LGI1 Autoimmune Epilepsy. Clin Nucl Med 2023; 48:956-957. [PMID: 37703448 DOI: 10.1097/rlu.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
ABSTRACT Leucine-rich glioma inactivated 1 autoimmune encephalitis is a treatable cause of autoimmune epilepsy associated with faciobrachial dystonic seizures-a rare form of epilepsy with frequent brief seizures primarily affecting the arm and face. We report a case with characteristic imaging findings. 18 F-FDG PET/CT demonstrated severe hypometabolism in the left basal ganglia, a regional abnormality associated with leucine-rich glioma inactivated 1 encephalitis.
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Affiliation(s)
- Brian J Burkett
- From the Department of Radiology, Mayo Clinic, Rochester, MN
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Neth BJ, Raghunathan A, Kizilbash SH, Uhm JH, Breen WG, Johnson DR, Daniels DJ, Sener U, Carabenciov ID, Campian JL, Khatua S, Mahajan A, Ruff MW. Management and Long-term Outcomes of Adults With Medulloblastoma: A Single-Center Experience. Neurology 2023; 101:e1256-e1271. [PMID: 37524533 PMCID: PMC10516280 DOI: 10.1212/wnl.0000000000207631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/30/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Medulloblastomas are embryonal tumors predominantly affecting children. Recognition of molecularly defined subgroups has advanced management. Factors influencing the management and prognosis of adult patients with medulloblastoma remains poorly understood. METHODS We examined the management, prognostic factors, and, when possible, molecular subgroup differences (subset) in adult patients (aged 18 years or older) with medulloblastoma from our center (specialty Neuro-Oncology clinic within a large academic practice) diagnosed between 1992 and 2020. Molecular subtyping corresponding to the 2021 WHO Classification was performed. Kaplan-Meier estimates (with log-rank test) were performed for univariate survival analysis with Cox regression used for multivariate analyses. RESULTS We included 76 adult patients with medulloblastoma (62% male), with a median age of 32 years at diagnosis (range: 18-66) and median follow-up of 7.7 years (range: 0.6-27). A subset of 58 patients had molecular subgroup characterization-37 SHH-activated, 12 non-WNT/non-SHH, and 9 WNT-activated. Approximately 67% underwent gross total resection, 75% received chemotherapy at diagnosis, and 97% received craniospinal irradiation with boost. The median overall survival (OS) for the whole cohort was 14.8 years. The 2-, 5-, and 10-year OS rates were 93% (95% CI 88-99), 86% (78-94), and 64% (53-78), respectively. Survival was longer for younger patients (aged 30 years or older: 9.9 years; younger than 30 years: estimated >15.4 years; log-rank p < 0.001). There was no survival difference by molecular subgroup or extent of resection. Only age at diagnosis remained significant in multivariate survival analyses. DISCUSSION We report one of the largest retrospective cohorts in adult patients with medulloblastoma with molecular subtyping. Survival and molecular subgroup frequencies were similar to prior reports. Survival was better for adult patients younger than 30 years at diagnosis and was not significantly different by molecular subgroup or management characteristics (extent of resection, RT characteristics, or chemotherapy timing or regimen).
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Affiliation(s)
- Bryan J Neth
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Aditya Raghunathan
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Sani H Kizilbash
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Joon H Uhm
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - William G Breen
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Derek R Johnson
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - David J Daniels
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Ugur Sener
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Ivan D Carabenciov
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Jian L Campian
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Soumen Khatua
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Anita Mahajan
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN
| | - Michael W Ruff
- From the Departments of Neurology (B.J.N., J.H.U., D.R.J., U.S., I.D.C., M.W.R.), Pathology (A.R.), Medical Oncology (S.H.K., J.H.U., U.S., I.D.C., J.L.C., M.W.R.), Radiation Oncology (W.G.B., A.M.), Radiology (D.R.J.), Neurosurgery (D.J.D.), and Pediatrics (S.K.), Mayo Clinic, Rochester, MN.
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Mark IT, Black D, Benson JC, Campeau NG, Johnson DR, Messina SA, Giannini C, Parney I, Morris PP. Benign Enhancing Foramen Magnum Lesions. AJNR Am J Neuroradiol 2023; 44:999-1001. [PMID: 37536735 PMCID: PMC10494948 DOI: 10.3174/ajnr.a7955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/27/2023] [Indexed: 08/05/2023]
Abstract
Benign enhancing foramen magnum lesions have been previously described as T2-hyperintense small, enhancing lesions located posterior to the intradural vertebral artery. We present the first case with pathologic correlation. These lesions are fibrotic nodules adhering to the spinal accessory nerve. While they can enlarge with time on subsequent examinations, on the basis of the imaging characteristics and location, they do not necessitate surgical resection.
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Affiliation(s)
- I T Mark
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - D Black
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - J C Benson
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - N G Campeau
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - D R Johnson
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - S A Messina
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
| | - C Giannini
- Department of Laboratory Medicine and Pathology (C.G.), Mayo Clinic, Rochester, Minnesota
| | - I Parney
- Department of Neurosurgery (I.P.), Mayo Clinic, Rochester, Minnesota
| | - P P Morris
- From the Department of Radiology (I.T.M., D.B., J.B., N.G.C., D.R.J., S.A.M., P.P.M.), Mayo Clinic, Rochester, Minnesotta
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10
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Burkett BJ, Bartlett DJ, McGarrah PW, Lewis AR, Johnson DR, Berberoğlu K, Pandey MK, Packard AT, Halfdanarson TR, Hruska CB, Johnson GB, Kendi AT. A Review of Theranostics: Perspectives on Emerging Approaches and Clinical Advancements. Radiol Imaging Cancer 2023; 5:e220157. [PMID: 37477566 PMCID: PMC10413300 DOI: 10.1148/rycan.220157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/06/2023] [Accepted: 05/31/2023] [Indexed: 07/22/2023]
Abstract
Theranostics is the combination of two approaches-diagnostics and therapeutics-applied for decades in cancer imaging using radiopharmaceuticals or paired radiopharmaceuticals to image and selectively treat various cancers. The clinical use of theranostics has increased in recent years, with U.S. Food and Drug Administration (FDA) approval of lutetium 177 (177Lu) tetraazacyclododecane tetraacetic acid octreotate (DOTATATE) and 177Lu-prostate-specific membrane antigen vector-based radionuclide therapies. The field of theranostics has imminent potential for emerging clinical applications. This article reviews critical areas of active clinical advancement in theranostics, including forthcoming clinical trials advancing FDA-approved and emerging radiopharmaceuticals, approaches to dosimetry calculations, imaging of different radionuclide therapies, expanded indications for currently used theranostic agents to treat a broader array of cancers, and emerging ideas in the field. Keywords: Molecular Imaging, Molecular Imaging-Cancer, Molecular Imaging-Clinical Translation, Molecular Imaging-Target Development, PET/CT, SPECT/CT, Radionuclide Therapy, Dosimetry, Oncology, Radiobiology © RSNA, 2023.
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Affiliation(s)
- Brian J. Burkett
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - David J. Bartlett
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Patrick W. McGarrah
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Akeem R. Lewis
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Derek R. Johnson
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Kezban Berberoğlu
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Mukesh K. Pandey
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Annie T. Packard
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Thorvardur R. Halfdanarson
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Carrie B. Hruska
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - Geoffrey B. Johnson
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
| | - A. Tuba Kendi
- From the Department of Radiology (B.J.B., D.J.B., D.R.J., M.K.P.,
A.T.P., C.B.H., G.B.J., A.T.K.) and Division of Medical Oncology (P.W.M.,
A.R.L., T.R.H.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and
Department of Nuclear Medicine, Anadolu Medical Center, Gebze/Kocaeli, Turkey
(K.B.)
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11
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Ensign SF, Agarwal M, Klanderman M, Badawy M, Halfdanarson TR, Johnson DR, Sonbol MB, Kendi AT. Clinical utility of somatostatin receptor positron emission tomography imaging biomarkers for characterization of meningioma among incidental central nervous system lesions. Nucl Med Commun 2023; 44:663-670. [PMID: 37158225 DOI: 10.1097/mnm.0000000000001706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Somatostatin receptor (SSTR) PET imaging is utilized with increasing frequency in the clinical management of neuroendocrine tumors. Incidental PET-avid CNS lesions are commonly noted and presumed to be meningiomas. However, SSTR PET lacks specificity for meningioma identification. This study aimed to clarify the role of SSTR-based imaging in the classification of incidental CNS lesions based on current clinical practice. METHODS Patients who underwent both Ga-68-DOTATATE PET and brain MRI and had an incidental CNS lesion identified with a radiographic prediction of meningioma via one (discordant prediction) or both (concordant prediction) imaging modalities were retrospectively analyzed. Imaging indication, semiquantitative measures, and clinical history were recorded. RESULTS Among 48 patients with a CNS lesion identified on both imaging modalities, most scans were performed for a history of neuroendocrine tumor (64.6%). Cases with concordant lesion-type prediction of meningioma between imaging modalities ( N = 24) displayed a significantly higher SUV max (median 7.9 vs. 4.0; P = 0.008) and Krenning score (median 3.0 vs. 2.0; P = 0.005) on Ga-68-DOTATATE PET compared with cases with a discordant prediction of meningioma ( N = 24). In cases with lower SUV max values, Ga-68-DOTATATE was more likely to discordantly predict meningioma without agreement by the corresponding MRI. Prior cranial radiation or use of somatostatin mimetics did not affect quantitative radiographic measures, and MRI-based tumor size was similar across groups. CONCLUSION Lesions with increased avidity may be more confidently predicted as meningioma in Ga-68-DOTATATE PET scans, whereas there is more discrepancy in prediction among low SUV cases.
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Affiliation(s)
| | | | - Molly Klanderman
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | - Mohamed Badawy
- Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center
| | | | - Derek R Johnson
- Department of Radiology
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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12
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Bauman MMJ, Graves JP, Harrison DJ, Hassett LC, Bancos I, Johnson DR, Van Gompel JJ. The utility of PET for detecting corticotropinomas in Cushing disease: a scoping review. Neurosurg Rev 2023; 46:160. [PMID: 37393399 DOI: 10.1007/s10143-023-02077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
While magnetic resonance imaging (MRI) is the current standard imaging method for diagnosing and localizing corticotropinomas in Cushing disease, it can fail to detect adenomas in up to 40% of cases. Recently, positron emission tomography (PET) has shown promise as a diagnostic tool to detect pituitary adenomas in Cushing disease. We perform a scoping review to characterize the uses of PET in diagnosing Cushing disease, with a focus on describing the types of PET investigated and defining PET-positive disease. A scoping review was conducted following the PRISMA-ScR guidelines. Thirty-one studies fulfilled our inclusion criteria, consisting of 10 prospective studies, 8 retrospective studies, 11 case reports, and 2 illustrative cases with a total of 262 patients identified. The most commonly utilized PET modalities in prospective/retrospective studies were FDG PET (n = 5), MET PET (n = 5), 68 Ga-DOTATATE PET (n = 2), 13N-ammonia PET (n = 2), and 68 Ga-DOTA-CRH PET (n = 2). MRI positivity ranged from 13 to 100%, while PET positivity ranged from 36 to 100%. In MRI-negative disease, PET positivity ranged from 0 to 100%. Five studies reported the sensitivity and specificity of PET, which ranged from 36 to 100% and 50 to 100%, respectively. PET shows promise in detecting corticotropinomas in Cushing disease, including MRI-negative disease. MET PET has been highly investigated and has demonstrated excellent sensitivity and specificity. However, preliminary studies with FET PET and 68 Ga-DOTA-CRH PET show promise for achieving high sensitivity and specificity and warrant further investigation.
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Affiliation(s)
- Megan M J Bauman
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, MN, Rochester, USA
| | - Jeffrey P Graves
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel Jeremiah Harrison
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, MN, Rochester, USA
| | | | - Irina Bancos
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, MN, Rochester, USA.
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA.
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13
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Guerin JB, Kaufmann TJ, Eckel LJ, Morris JM, Vaubel RA, Giannini C, Johnson DR. A Radiologist's Guide to the 2021 WHO Central Nervous System Tumor Classification: Part 2-Newly Described and Revised Tumor Types. Radiology 2023; 307:e221885. [PMID: 37191486 DOI: 10.1148/radiol.221885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
The fifth edition of the World Health Organization classification of tumors of the central nervous system (CNS), published in 2021, introduces major shifts in the classification of brain and spine tumors. These changes were necessitated by rapidly increasing knowledge of CNS tumor biology and therapies, much of which is based on molecular methods in tumor diagnosis. The growing complexity of CNS tumor genetics has required reorganization of tumor groups and acknowledgment of new tumor entities. For radiologists interpreting neuroimaging studies, proficiency with these updates is critical in providing excellent patient care. This review will focus on new or revised CNS tumor types and subtypes, beyond infiltrating glioma (described in part 1 of this series), with an emphasis on imaging features.
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Affiliation(s)
- Julie B Guerin
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Timothy J Kaufmann
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Laurence J Eckel
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Jonathan M Morris
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Rachael A Vaubel
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Caterina Giannini
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Derek R Johnson
- From the Departments of Radiology (J.B.G., T.J.K., L.J.E., J.M.M., D.R.J.), Laboratory Medicine and Pathology (R.A.V., C.G.), and Neurology (D.R.J.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
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14
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Moawad AW, Janas A, Baid U, Ramakrishnan D, Jekel L, Krantchev K, Moy H, Saluja R, Osenberg K, Wilms K, Kaur M, Avesta A, Pedersen GC, Maleki N, Salimi M, Merkaj S, von Reppert M, Tillmans N, Lost J, Bousabarah K, Holler W, Lin M, Westerhoff M, Maresca R, Link KE, Tahon NH, Marcus D, Sotiras A, LaMontagne P, Chakrabarty S, Teytelboym O, Youssef A, Nada A, Velichko YS, Gennaro N, Cramer J, Johnson DR, Kwan BY, Petrovic B, Patro SN, Wu L, So T, Thompson G, Kam A, Perez-Carrillo GG, Lall N, Albrecht J, Anazodo U, Lingaru MG, Menze BH, Wiestler B, Adewole M, Anwar SM, Labella D, Li HB, Iglesias JE, Farahani K, Eddy J, Bergquist T, Chung V, Shinohara RT, Dako F, Wiggins W, Reitman Z, Wang C, Liu X, Jiang Z, Van Leemput K, Piraud M, Ezhov I, Johanson E, Meier Z, Familiar A, Kazerooni AF, Kofler F, Calabrese E, Aneja S, Chiang V, Ikuta I, Shafique U, Memon F, Conte GM, Bakas S, Rudie J, Aboian M. The Brain Tumor Segmentation (BraTS-METS) Challenge 2023: Brain Metastasis Segmentation on Pre-treatment MRI. ArXiv 2023:arXiv:2306.00838v1. [PMID: 37396600 PMCID: PMC10312806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Clinical monitoring of metastatic disease to the brain can be a laborious and timeconsuming process, especially in cases involving multiple metastases when the assessment is performed manually. The Response Assessment in Neuro-Oncology Brain Metastases (RANO-BM) guideline, which utilizes the unidimensional longest diameter, is commonly used in clinical and research settings to evaluate response to therapy in patients with brain metastases. However, accurate volumetric assessment of the lesion and surrounding peri-lesional edema holds significant importance in clinical decision-making and can greatly enhance outcome prediction. The unique challenge in performing segmentations of brain metastases lies in their common occurrence as small lesions. Detection and segmentation of lesions that are smaller than 10 mm in size has not demonstrated high accuracy in prior publications. The brain metastases challenge sets itself apart from previously conducted MICCAI challenges on glioma segmentation due to the significant variability in lesion size. Unlike gliomas, which tend to be larger on presentation scans, brain metastases exhibit a wide range of sizes and tend to include small lesions. We hope that the BraTS-METS dataset and challenge will advance the field of automated brain metastasis detection and segmentation.
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Affiliation(s)
| | - Anastasia Janas
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- Charité - Universitatsmedizin, Berlin, Germany
| | - Ujjwal Baid
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Divya Ramakrishnan
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
| | - Leon Jekel
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- DKFZ Division of Translational Neurooncology at the WTZ, German Cancer Consortium, DKTK Partner Site, University Hospital Essen, Essen, Germany
- German Cancer Research Center, Heidelberg, Germany
- University of Ulm, Ulm, Germany
| | - Kiril Krantchev
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- Charité - Universitatsmedizin, Berlin, Germany
| | - Harrison Moy
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
| | | | - Klara Osenberg
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- University of Leipzig, Leipzig, Germany
| | - Klara Wilms
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- University of Leipzig, Leipzig, Germany
| | - Manpreet Kaur
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- Ludwig Maximillian University, Munich, Germany
| | - Arman Avesta
- Yale University School of Medicine, Department of Radiology, New Haven, CT
| | - Gabriel Cassinelli Pedersen
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
| | - Nazanin Maleki
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
| | - Mahdi Salimi
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
| | - Sarah Merkaj
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- University of Ulm, Ulm, Germany
| | - Marc von Reppert
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- University of Leipzig, Leipzig, Germany
| | - Niklas Tillmans
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- University of Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
| | - Jan Lost
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
- University of Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany
| | | | | | - MingDe Lin
- Visage Imaging, Inc, San Diego, California, USA
| | | | - Ryan Maresca
- Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, CT
| | | | | | | | | | | | | | | | - Ayda Youssef
- Yale University School of Medicine, Department of Radiology, New Haven, CT
| | | | - Yuri S. Velichko
- Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL
| | - Nicolo Gennaro
- Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL
| | - Connectome Students
- Connectome – Student Association for Neurosurgery, Neurology and Neurosciences E.V
| | | | | | | | - Benjamin Y.M. Kwan
- Queen’s University, Department of Diagnostic Radiology, Kingston, Canada
| | | | - Satya N. Patro
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lei Wu
- University of Washington Department of Radiology, Seattle, WA
| | - Tiffany So
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong
| | | | - Anthony Kam
- Loyola University Medical Center, Chicago, IL
| | | | - Neil Lall
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Group of Approvers
- Connectome – Student Association for Neurosurgery, Neurology and Neurosciences E.V
| | | | - Udunna Anazodo
- Montreal Neurological Institute (MNI), McGill University, Montreal, CA
| | | | - Bjoern H Menze
- Biomedical Image Analysis & Machine Learning, Department of Quantitative Biomedicine, University of Zurich, Switzerland
| | - Benedikt Wiestler
- Department of Neuroradiology, Technical University of Munich, Munich, Germany
| | - Maruf Adewole
- Medical Artificial Intelligence (MAI) Lab, Crestview Radiology, Lagos, Nigeria
| | | | | | - Hongwei Bran Li
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA
| | - Juan Eugenio Iglesias
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA
| | - Keyvan Farahani
- Cancer Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | - Russel Takeshi Shinohara
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Farouk Dako
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Xinyang Liu
- Children’s National Hospital, Washington DC, USA
| | - Zhifan Jiang
- Children’s National Hospital, Washington DC, USA
| | - Koen Van Leemput
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Denmark
| | | | - Ivan Ezhov
- Department of Informatics, Technical University Munich, Germany
| | - Elaine Johanson
- PrecisionFDA, U.S. Food and Drug Administration, Silver Spring, MD
| | | | - Ariana Familiar
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Sanjay Aneja
- Yale University School of Medicine, Department of Therapeutic Radiology, New Haven, CT
| | - Veronica Chiang
- Yale University School of Medicine, Department of Neurosurgery, New Haven, CT
| | | | | | - Fatima Memon
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
| | | | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania School of Medicine, Philadelphia, PA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jeffrey Rudie
- University of California San Diego, San Diego, CA
- University of California San Francisco, San Francisco, CA
| | - Mariam Aboian
- Yale University School of Medicine, Department of Radiology, New Haven, CT
- ImagineQuant, Yale University School of Medicine, Department of Radiology, New Haven, CT
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15
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Johnson DR. Unraveling bias in survival of patients with incidentally discovered low-grade gliomas. Neurooncol Pract 2023; 10:109-110. [PMID: 36970178 PMCID: PMC10037934 DOI: 10.1093/nop/npad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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16
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Farnsworth PJ, Madhavan AA, Verdoorn JT, Shlapak DP, Johnson DR, Cutsforth-Gregory JK, Brinjikji W, Lehman VT. Spontaneous intracranial hypotension: updates from diagnosis to treatment. Neuroradiology 2023; 65:233-243. [PMID: 36336758 DOI: 10.1007/s00234-022-03079-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is caused by spinal cerebrospinal fluid (CSF) leaks, which result in continued loss of CSF volume and multiple debilitating clinical manifestations. The estimated annual incidence of SIH is 5/100,000. Diagnostic methods have evolved in recent years due to improved understanding of pathophysiology and implementation of advanced myelographic techniques. Here, we synthesize recent updates and contextualize them in an algorithm for diagnosis and treatment of SIH, highlighting basic principles and points of practice variability or continued debate. This discussion includes finer points of SIH diagnosis, CSF leak classification systems, less common types and variants of CSF leaks, brain MRI Bern scoring, potential SIH complications, key technical considerations, and positioning strategies for different types of dynamic myelography. The roles of conservative measures, non-targeted or targeted blood patches, surgery, and recently developed endovascular techniques are presented.
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Affiliation(s)
- Paul J Farnsworth
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| | - Ajay A Madhavan
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Jared T Verdoorn
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Darya P Shlapak
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
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Johnson DR, Giannini C, Vaubel RA, Morris JM, Eckel LJ, Kaufmann TJ, Guerin JB. A Radiologist's Guide to the 2021 WHO Central Nervous System Tumor Classification: Part I-Key Concepts and the Spectrum of Diffuse Gliomas. Radiology 2023; 306:e229036. [PMID: 36689347 DOI: 10.1148/radiol.229036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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18
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Benson JC, Madhavan AA, Cutsforth-Gregory JK, Johnson DR, Carr CM. The Monro-Kellie Doctrine: A Review and Call for Revision. AJNR Am J Neuroradiol 2023; 44:2-6. [PMID: 36456084 PMCID: PMC9835920 DOI: 10.3174/ajnr.a7721] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022]
Abstract
The Monro-Kellie doctrine is a well-accepted principle of intracranial hemodynamics. It has undergone few consequential revisions since it was established. Its principle is straightforward: The combined volume of neuronal tissue, blood, and CSF is constant. To maintain homeostatic intracranial pressure, any increase or decrease in one of these elements leads to a reciprocal and opposite change in the others. The Monro-Kellie doctrine assumes a rigid, unadaptable calvaria. Recent studies have disproven this assumption. The skull expands and grows in response to pathologic changes in intracranial pressure. In this review, we outline what is known about calvarial changes in the setting of pressure dysregulation and suggest a revision to the Monro-Kellie doctrine that includes an adaptable skull as a fourth component.
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Affiliation(s)
- J C Benson
- From the Departments of Radiology (J.C.B., A.A.M., D.R.J., C.M.C.)
| | - A A Madhavan
- From the Departments of Radiology (J.C.B., A.A.M., D.R.J., C.M.C.)
| | | | - D R Johnson
- From the Departments of Radiology (J.C.B., A.A.M., D.R.J., C.M.C.)
| | - C M Carr
- From the Departments of Radiology (J.C.B., A.A.M., D.R.J., C.M.C.)
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19
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Vaubel RA, Kumar R, Weiskittel TM, Jenkins S, Dasari S, Uhm JH, Lachance DH, Brown PD, Van Gompel JJ, Jenkins RB, Kipp BR, Sukov WR, Giannini C, Johnson DR, Raghunathan A. Genomic markers of recurrence risk in atypical meningioma following gross total resection. Neurooncol Adv 2023; 5:vdad004. [PMID: 36845294 PMCID: PMC9950854 DOI: 10.1093/noajnl/vdad004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background Meningiomas are the most common primary central nervous system (CNS) tumor in adults and CNS World Health Organization grade 2 (atypical) meningiomas show an intermediate risk of recurrence/progression. Molecular parameters are needed to better inform management following gross total resection (GTR). Methods We performed comprehensive genomic analysis of tumor tissue from 63 patients who underwent radiologically confirmed GTR of a primary grade 2 meningioma, including a CLIA-certified target next-generation sequencing panel (n = 61), chromosomal microarray (n = 63), genome-wide methylation profiling (n = 62), H3K27me3 immunohistochemistry (n = 62), and RNA-sequencing (n = 19). Genomic features were correlated with long-term clinical outcomes (median follow-up: 10 years) using Cox proportional hazards regression modeling and published molecular prognostic signatures were evaluated. Results The presence of specific copy number variants (CNVs), including -1p, -10q, -7p, and -4p, was the strongest predictor of decreased recurrence-free survival (RFS) within our cohort (P < .05). NF2 mutations were frequent (51%) but did not show a significant association with RFS. DNA methylation-based classification assigned tumors to DKFZ Heidelberg benign (52%) or intermediate (47%) meningioma subclasses and was not associated with RFS. H3K27 trimethylation (H3K27me3) was unequivocally lost in 4 tumors, insufficient for RFS analysis. Application of published integrated histologic/molecular grading systems did not improve prediction of recurrence risk over the presence of -1p or -10q alone. Conclusions CNVs are strong predictors of RFS in grade 2 meningiomas following GTR. Our study supports incorporation of CNV profiling into clinical evaluation to better guide postoperative patient management, which can be readily implemented using existing, clinically validated technologies.
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Affiliation(s)
- Rachael A Vaubel
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rahul Kumar
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Taylor M Weiskittel
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarah Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Surendra Dasari
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Joon H Uhm
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie J Van Gompel
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - William R Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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20
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Heltzel RS, Johnson DR, Zaki MT, Gebreslase AK, Abdul-Aziz OI. Machine learning techniques to increase the performance of indirect methane quantification from a single, stationary sensor. Heliyon 2022; 8:e11962. [PMID: 36578421 PMCID: PMC9791841 DOI: 10.1016/j.heliyon.2022.e11962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/12/2022] [Accepted: 11/21/2022] [Indexed: 12/03/2022] Open
Abstract
Researchers are searching for ways to better quantify methane emissions from natural gas infrastructure. Current indirect quantification techniques (IQTs) allow for more frequent or continuous measurements with fewer personnel resources than direct methods but lack accuracy and repeatability. Two IQTs are Other Test Method (OTM) 33A and Eddy Covariance (EC). We examined a novel approach to improve the accuracy of single sensor IQT whereby the results from both OTM and EC were combined with two machine learning (ML) models, a random forest (RF) and a neural network (NN). Then, models were enhanced with feature reduction and hyper-parameter tuning and compared to traditional quantification methods. The NN and RF improved upon the default OTM by an average of 44% and 78%, respectively. When compared to traditional OTM estimates with low Data Quality Indicators (DQIs), RF and NN models reduced 1σ errors from ±66% to ±13% and ±34%, respectively. Models also reduced the standard deviation of estimates with 93% and 85% of estimates falling within ±50% of the known release rate. This approach can be deployed with single sensor systems at well sites to improve confidence in reported emissions, reducing the number of anomalous overestimates that would trigger unnecessary site evaluations. Additional improvements could be realized by expanding training datasets with more methane release rates. Further, deployment of such models in a variety of situations could enhance their ability help close the gap between bottom-up inventory and top-down studies by enabling continuous monitoring of temporal emissions that could identify with improved confidence, atypically higher emissions. Accurate remote single sensor systems are key in developing an improved understanding of methane emissions to enable industry to identify and reduce methane emissions.
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21
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Vizcaino MA, Giannini C, King RL, Johnson DR, Yang T, Raghunathan A. Primary Leptomeningeal Lymphoma: Clinicopathologic Features of 2 Rare Phenotypes. J Neuropathol Exp Neurol 2022; 81:1002-1007. [PMID: 36102830 DOI: 10.1093/jnen/nlac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Primary leptomeningeal lymphoma is exceedingly rare. We describe 2 rare lymphoma cases with exclusive leptomeningeal disease: 1 ALK-positive (ALK+) anaplastic large cell lymphoma (ALCL) and 1 primary effusion lymphoma (PEL). Case 1: A 19-year-old man presented with symptoms concerning for leptomeningitis. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis. Spine MRI demonstrated pial enhancement from T10 through the conus medullaris and cauda equina enhancement/thickening. A biopsy showed leptomeningeal involvement by large lymphoma cells with hallmark cells and brisk mitotic activity. By immunohistochemistry, cells were CD7/CD30-positive with cytoplasmic ALK staining. No systemic disease was identified. The diagnosis of primary leptomeningeal ALK+ ALCL was made. Despite 2 CSF relapses requiring systemic therapy and autologous bone marrow transplant, the patient was in complete clinical remission 9 years after the diagnosis. Case 2: A 60-year-old, human immunodeficiency virus-positive man presented with symptoms suggestive of leptomeningitis. Brain MRIs revealed multifocal, supratentorial, and infratentorial leptomeningeal enhancement. A right frontal biopsy demonstrated leptomeningeal involvement by large lymphoma cells negative for B-cell immunostains, but CD138, MUM-1, and HHV8-positive, with aberrant CD3 expression. EBV-encoded RNA in situ hybridization was positive. In absence of solid lesions/extracranial involvement, the diagnosis of leptomeningeal PEL was rendered. Despite initial complete remission after chemotherapy, the patient died 9 months later.
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Affiliation(s)
- M Adelita Vizcaino
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caterina Giannini
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Rebecca L King
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tong Yang
- Department of Pathology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Aditya Raghunathan
- From the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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22
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Webb M, Johnson DR, Mahajan A, Brown P, Neth B, Kizilbash SH, Sener U. Clinical experience and outcomes in patients with pineal parenchymal tumor of intermediate differentiation (PPTID): a single-institution analysis. J Neurooncol 2022; 160:527-534. [DOI: 10.1007/s11060-022-04174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
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23
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Johnson DR, Giannini C, Vaubel RA, Morris JM, Eckel LJ, Kaufmann TJ, Guerin JB. A Radiologist's Guide to the 2021 WHO Central Nervous System Tumor Classification: Part I-Key Concepts and the Spectrum of Diffuse Gliomas. Radiology 2022; 304:494-508. [PMID: 35880978 DOI: 10.1148/radiol.213063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The fifth edition of the World Health Organization (WHO) classification of tumors of the central nervous system, published in 2021, contains substantial updates in the classification of tumor types. Many of these changes are relevant to radiologists, including "big picture" changes to tumor diagnosis methods, nomenclature, and grading, which apply broadly to many or all central nervous system tumor types, as well as the addition, elimination, and renaming of multiple specific tumor types. Radiologists are integral in interpreting brain tumor imaging studies and have a considerable impact on patient care. Thus, radiologists must be aware of pertinent changes in the field. Staying updated with the most current guidelines allows radiologists to be informed and effective at multidisciplinary tumor boards and in interactions with colleagues in neuro-oncology, neurosurgery, radiation oncology, and neuropathology. This review represents the first of a two-installment review series on the most recent changes to the WHO brain tumor classification system. This first installment focuses on the changes to the classification of adult and pediatric gliomas of greatest relevance for radiologists.
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Affiliation(s)
- Derek R Johnson
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Caterina Giannini
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Rachael A Vaubel
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Jonathan M Morris
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Laurence J Eckel
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Timothy J Kaufmann
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
| | - Julie B Guerin
- From the Departments of Radiology (D.R.J., J.M.M., L.J.E., T.J.K., J.B.G.), Neurology (D.R.J.), and Laboratory Medicine and Pathology (C.G., R.A.V.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; and Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy (C.G.)
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24
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Abstract
ABSTRACT PET imaging plays an essential role in achieving earlier and more specific diagnoses of dementia syndromes, important for clinical prognostication and optimal medical management. This has become especially vital with the recent development of pathology-specific disease-modifying therapy for Alzheimer disease, which will continue to evolve and require methods to select appropriate treatment candidates. Techniques that began as research tools such as amyloid and tau PET have now entered clinical use, making nuclear medicine physicians and radiologists essential members of the care team. This review discusses recent changes in the understanding of dementia and examines the roles of nuclear medicine imaging in clinical practice. Within this framework, multiple cases will be shown to illustrate a systematic approach of FDG PET interpretation and integration of PET imaging of specific molecular pathology including dopamine transporters, amyloid, and tau. The approach presented here incorporates contemporary understanding of both common and uncommon dementia syndromes, intended as an updated practical guide to assist with the sophisticated interpretation of nuclear medicine examinations in the context of this rapidly and continually developing area of imaging.
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25
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Carr CM, Benson JC, DeLone DR, Diehn FE, Kim DK, Ma D, Nagelschneider AA, Madhavan AA, Johnson DR. Manifestations of radiation toxicity in the head, neck, and spine: An image-based review. Neuroradiol J 2022; 35:427-436. [PMID: 35499087 PMCID: PMC9437506 DOI: 10.1177/19714009221096824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Radiation therapy is an important component of treatment in patients with malignancies of the head, neck, and spine. However, radiation to these regions has well-known potential side effects, many of which can be encountered on imaging. In this manuscript, we review selected radiographic manifestations of therapeutic radiation to the head, neck, and spine that may be encountered in the practice of radiology. METHODS We conducted an extensive literature review of known complications of radiation therapy in the head, neck, and spine. We excluded intracranial and pulmonary radiation effects from our search. We selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications. RESULTS Based on our initial literature search and imaging database review, we selected cases of radiation-induced tumors, radiation tissue necrosis (osteoradionecrosis and soft tissue necrosis), carotid stenosis and blowout secondary to radiation, enlarging thyroglossal duct cysts, radiation myelopathy, and radiation-induced vertebral compression fractures. CONCLUSIONS We describe the clinical and imaging features of selected sequelae of radiation therapy to the head, neck, and spine, with a focus on those with characteristic imaging findings that can be instrumental in helping to make the diagnosis. Knowledge of these entities and their imaging findings is crucial for accurate diagnosis. Not only do radiologists play a key role in early detection of these entities, but many of these entities can be misinterpreted if one is not familiar with them.
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Affiliation(s)
- Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David R DeLone
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Dong K Kim
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Daniel Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
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26
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Camerucci E, Graff-Radford J, Jones DT, Elder BD, Gunter JL, Cutsforth-Gregory JK, Botha H, Murphy MC, Johnson DR, Davidge-Pitts C, Jack CR, Huston J, Cogswell PM. Change in Morphological Features of Enlarged Subarachnoid Spaces Following Treatment in Idiopathic Normal Pressure Hydrocephalus. J Magn Reson Imaging 2022; 57:1443-1450. [PMID: 35894392 DOI: 10.1002/jmri.28340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Focally enlarged sulci (FES) are areas of proposed extraventricular fluid entrapment that may occur within idiopathic normal pressure hydrocephalus (iNPH) with radiographic evidence of disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and should be differentiated from atrophy. PURPOSE To evaluate for change in FES size and pituitary height after shunt placement in iNPH. STUDY TYPE Retrospective. SUBJECTS A total of 125 iNPH patients who underwent shunt surgery and 40 age-matched controls. FIELD STRENGTH/SEQUENCE 1.5 T and 3 T. Axial T2w FLAIR, 3D T1w MPRAGE, 2D sagittal T1w. ASSESSMENT FES were measured in three dimensions and volume was estimated by assuming an ellipsoid shape. Pituitary gland height was measured in the mid third of the gland in iNPH patients and controls. STATISTICAL TESTS Wilcoxon signed-rank test for comparisons between MRI measurements; Wilcoxon rank sum test for comparison of cases/controls. Significance level was P < 0.05. RESULTS Fifty percent of the patients had FES. FES volume significantly decreased between the pre and first postshunt MRI by a median of 303 mm3 or 30.0%. Pituitary gland size significantly increased by 0.48 mm or 14.4%. FES decreased significantly by 190 mm3 or 23.1% and pituitary gland size increased significantly by 0.25 mm or 6% between the first and last postshunt MRI. DATA CONCLUSION Decrease in size of FES after shunt placement provides further evidence that these regions are due to disordered cerebrospinal fluid (CSF) dynamics and should not be misinterpreted as atrophy. A relatively smaller pituitary gland in iNPH patients that normalizes after shunt is a less-well recognized feature of altered CSF dynamics. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | | | - David T Jones
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Caroline Davidge-Pitts
- Department of Medicine, Division of Endocrinology, Diabetes, Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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27
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Babcock JC, Johnson DR, Benson JC, Kim DK, Luetmer PH, Shlapak DP, Cross CP, Johnson MP, Cutsforth-Gregory JK, Carr CM. Diffuse Calvarial Hyperostosis and Spontaneous Intracranial Hypotension: A Case-Control Study. AJNR Am J Neuroradiol 2022; 43:978-983. [PMID: 35772803 DOI: 10.3174/ajnr.a7557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diagnosing spontaneous intracranial hypotension and associated CSF leaks can be challenging, and additional supportive imaging findings would be useful to direct further evaluation. This retrospective study evaluated whether there was a difference in the prevalence of calvarial hyperostosis in a cohort of patients with spontaneous intracranial hypotension compared with an age- and sex-matched control population. MATERIALS AND METHODS Cross-sectional imaging (CT of the head or brain MR imaging examinations) for 166 patients with spontaneous intracranial hypotension and 321 matched controls was assessed by neuroradiologists blinded to the patient's clinical status. The readers qualitatively evaluated the presence of diffuse or layered calvarial hyperostosis and measured calvarial thickness in the axial and coronal planes. RESULTS A significant difference in the frequency of layered hyperostosis (31.9%, 53/166 subjects versus 5.0%, 16/321 controls, P < .001, OR = 11.58) as well as the frequency of overall (layered and diffuse) hyperostosis (38.6%, 64/166 subjects versus 13.2%, 42/321 controls, P < .001, OR = 4.66) was observed between groups. There was no significant difference in the frequency of diffuse hyperostosis between groups (6.6%, 11/166 subjects versus 8.2%, 26/321 controls, P = .465). A significant difference was also found between groups for calvarial thickness measured in the axial (P < .001) and coronal (P < .001) planes. CONCLUSIONS Layered calvarial hyperostosis is more prevalent in spontaneous intracranial hypotension compared with the general population and can be used as an additional noninvasive brain imaging marker of spontaneous intracranial hypotension and an underlying spinal CSF leak.
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Affiliation(s)
- J C Babcock
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D R Johnson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - J C Benson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D K Kim
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - P H Luetmer
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - D P Shlapak
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - C P Cross
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - M P Johnson
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - C M Carr
- From the Department of Radiology, Mayo Clinic, Rochester, Minnesota
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28
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Germano IM, Johnson DR, Patrick HH, Goodman AL, Ziu M, Ormond DR, Olson JJ. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Management of Progressive Glioblastoma in Adults: Update of the 2014 Guidelines. Neurosurgery 2022; 90:e112-e115. [PMID: 35426875 DOI: 10.1227/neu.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Institute of Medicine best practice recommendation to review guidelines every 5 years is followed by the Congress of Neurological Surgeons Guidelines Committee. The aim of this work was to provide an updated literature review and evidence-based recommendations on the topic of diagnosis and treatment of patients with progressive glioblastoma (pGBM). OBJECTIVE To review the literature published since the last guidelines on pGBM dated 2014, with literature search ending in June 2012. METHODS PubMed, Embase, and Cochrane were searched for the period July 1, 2012, to March 31, 2019, using search terms and search strategies to identify pertinent abstracts. These were then screened using published exclusion/inclusion criteria to identify full-text review articles. Evidence tables were constructed using data derived from full-text reviews and recommendations made from the evidence derived. RESULTS From the total 8786 abstracts identified by the search, 237 full-text articles met inclusion/exclusion criteria and were included in this update. Two new level II recommendations derived from this work. For the diagnosis of patients with GBM, the use of diffusion-weighted images is recommended to be included in the magnetic resonance images with and without contrast used for surveillance to detect pGBM. For the treatment of patients with pGBM, repeat cytoreductive surgery is recommended to improve overall survival. An additional 21 level III recommendations were provided. CONCLUSION Recent published literature provides new recommendations for the diagnosis and treatment of pGBM. The Central Nervous System Guidelines Committee will continue to pursue timely updates to further improve the care of patients with diagnosis.https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-management-of-progressive-glioblastoma.
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Affiliation(s)
- Isabelle M Germano
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Hayes H Patrick
- Department of Neurological Surgery, George Washington University, Washington, District of Columbia, USA
| | - Abigail L Goodman
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Georgia, USA
| | - Mateo Ziu
- Department of Neurosurgery, Inova Neuroscience and Spine Institute Fairfax, Virginia, USA
| | - D Ryan Ormond
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Neth BJ, Carabenciov ID, Ruff MW, Johnson DR. Temporal Trends in Glioblastoma Survival: Progress then Plateau. Neurologist 2022; 27:119-124. [PMID: 34855660 DOI: 10.1097/nrl.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Survival of patients with glioblastoma (GBM) increased in the 2000s, most prominently after the addition of temozolomide to the standard-of-care treatment protocol. The reason for subsequent improvements in survival in the late 2000s and early 2010s was less clear, with explanations including the introduction of bevacizumab, better surgical methods, and advances in supportive care. It is uncertain whether the trend of improving population-level survival has continued. MATERIALS AND METHODS Data from the Surveillance, Epidemiology, and End Results (SEER) Program was analyzed comparing survival of adult GBM patients diagnosed in consecutive 3-year periods from 2000 to 2017. Kaplan-Meier survival analysis and Cox proportional hazards models were used. RESULTS A total of 38,352 patients diagnosed with GBM between 2000 and 2017 met inclusion criteria. Median survival and percent survival to 12 and 24 months all progressively increased between 2000 and 2011. There were no significant differences in survival comparing 2009-2011 with 2012-2014 or 2015-2017. During the 2015-2017 period, median survival was 11 months, with 12 and 24-month survival proportions of 45.7% (95% confidence interval, 44.5-47.0) and 19.0% (95% confidence interval, 18.6-21.2), respectively. CONCLUSIONS After a period of progressive improvement in GBM survival between 2000 and 2011, survival plateaued. Subsequent advances since 2011 have not yet been translated to improved survival on the population-level as of 2017.
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Affiliation(s)
| | | | | | - Derek R Johnson
- Departments of Neurology
- Radiology, Mayo Clinic, Rochester, MN
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30
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Eschbacher KL, Johnson DR, Orozco-Do SL, Jawaid T, Schuetz AN, Nguyen AT. A 76-year-old male with multiple enhancing brain lesions. Brain Pathol 2022; 32:e13063. [PMID: 35267225 PMCID: PMC9048808 DOI: 10.1111/bpa.13063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kathryn L Eschbacher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sylvia L Orozco-Do
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, Kansas, USA
| | - Tabinda Jawaid
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey N Schuetz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aivi T Nguyen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Badawy M, Johnson G, Jain M, Kendi AT, Johnson DR, Porter A, Yang M, Sonbol MB. Intracranial neuroendocrine tumour simulating meningioma for several years: an overview of diagnosis and treatment. BJR Case Rep 2022; 8:20210222. [PMID: 36101727 PMCID: PMC9461727 DOI: 10.1259/bjrcr.20210222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/24/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
Metastatic neuroendocrine tumour (NET) to brain has been reported in 1.5–5% of patients with NETs. Differentiation between intracranial NET metastasis and meningiomas can cause a diagnostic dilemma. We present a symptomatic case of a 66-year-old male with a history of left-sided skull base mass. The diagnosis of a meningioma was made based on the MRI findings and clinical presentation. The patient received radiation and the mass remained stable on serial MRI images at follow-up visits. Five years after his initial presentation, the patient’s mass showed further growth. He also complained of worsening of his recent diagnosis of irritable bowel syndrome and fluctuations in his blood pressure. Surgical resection was performed, and histopathological features were consistent with moderately differentiated neuroendocrine tumour. Further evaluation with 68 Gallium-DOTATATE positron emission-computed tomography (Ga-68 PET/CT) showed metastatic disease involving the bones, lymph nodes, and liver without convincing evidence of the location of primary malignancy within the bowel loops or the pancreas. The patient was started on combination of capecitabine and temozolomide with partial response and significant improvement of his symptoms. This case highlights the clinical and radiological behaviour of intracranial NET that can mimic the diagnosis of meningioma.
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Affiliation(s)
- Mohamed Badawy
- Division of Radiology and Nuclear Medicine, Mayo Clinic, Rochester, MN
| | - Geoffrey Johnson
- Division of Radiology and Nuclear Medicine, Mayo Clinic, Rochester, MN
- Department of Immunology, Mayo Clinic, Rochester, MN
| | - Manoj Jain
- Division of Radiology and Nuclear Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ayse Tuba Kendi
- Division of Radiology and Nuclear Medicine, Mayo Clinic, Rochester, MN
| | - Derek R. Johnson
- Division of Radiology and Nuclear Medicine, Mayo Clinic, Rochester, MN
- Division of Neurology, Mayo Clinic, Rochester, MN
| | - Alyx Porter
- Division of Neurology, Mayo Clinic, Phoenix, Arizona
| | - Ming Yang
- Division of Diagnostic Radiology, Mayo Clinic, Phoenix, Arizona
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Schuelke MR, Gundelach JH, Coffey M, West E, Scott K, Johnson DR, Samson A, Melcher A, Vile RG, Bram RJ. Phase I trial of sargramostim/pelareorep therapy in pediatric patients with recurrent or refractory high-grade brain tumors. Neurooncol Adv 2022; 4:vdac085. [PMID: 35821679 PMCID: PMC9268737 DOI: 10.1093/noajnl/vdac085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Brain tumors are the leading cause of cancer death for pediatric patients. Pelareorep, an immunomodulatory oncolytic reovirus, has intravenous efficacy in preclinical glioma models when preconditioned with GM-CSF (sargramostim). We report a phase I trial with the primary goal of evaluating the safety of sargramostim/pelareorep in pediatric patients with recurrent or refractory high-grade brain tumors and a secondary goal of characterizing immunologic responses. Methods The trial was open to pediatric patients with recurrent or refractory high-grade brain tumors (3 + 3 cohort design). Each cycle included 3 days of subcutaneous sargramostim followed by 2 days of intravenous pelareorep. Laboratory studies and imaging were acquired upon recruitment and periodically thereafter. Results Six patients participated, including three glioblastoma, two diffuse intrinsic pontine glioma, and one medulloblastoma. Two pelareorep dose levels of 3 × 108 and 5 × 108 tissue culture infectious dose 50 (TCID50) were assessed. One patient experienced a dose limiting toxicity of persistent hyponatremia. Common low-grade (1 or 2) adverse events included transient fatigue, hypocalcemia, fever, flu-like symptoms, thrombocytopenia, and leukopenia. High-grade (3 or 4) adverse events included neutropenia, lymphopenia, leukopenia, hypophosphatemia, depressed level of consciousness, and confusion. All patients progressed on therapy after a median of 32.5 days and died a median of 108 days after recruitment. Imaging at progression did not show evidence of pseudoprogression or inflammation. Correlative assays revealed transient but consistent changes in immune cells across patients. Conclusions Sargramostim/pelareorep was administered to pediatric patients with recurrent or refractory high-grade brain tumors. Hyponatremia was the only dose limiting toxicity (DLT), though maximum tolerated dose (MTD) was not determined.
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Affiliation(s)
- Matthew R Schuelke
- Medical Scientist Training Program, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Matt Coffey
- Oncolytics Biotech, Calgary, Alberta, Canada
| | - Emma West
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, St James' University Hospital, Leeds, UK
| | - Karen Scott
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, St James' University Hospital, Leeds, UK
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adel Samson
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, St James' University Hospital, Leeds, UK
| | - Alan Melcher
- The Institute of Cancer Research/Royal Marsden, National Institute for Health Research Biomedical Research Centre, London, UK
| | - Richard G Vile
- Faculty of Medicine and Health, Leeds Institute of Medical Research, University of Leeds, St James' University Hospital, Leeds, UK
| | - Richard J Bram
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
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Chatzopoulos K, Eschbacher KL, Gurram PR, Huang J, Rinaldo L, Milone AA, Johnson DR, Shah AS, Wengenack NL, Schuetz AN, Parney IF, Trejo-Lopez JA. An 82-year-old man with a right frontal lobe rim-enhancing lesion. Brain Pathol 2021; 32:e13021. [PMID: 34608704 PMCID: PMC8877727 DOI: 10.1111/bpa.13021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Kyriakos Chatzopoulos
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn L Eschbacher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pooja R Gurram
- Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeffrey Huang
- Division of Critical Care, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Amber A Milone
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Aditya S Shah
- Department of Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy L Wengenack
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Audrey N Schuetz
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian F Parney
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jorge A Trejo-Lopez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Parent EE, Johnson DR, Gleason T, Villanueva-Meyer JE. Neuro-Oncology Practice Clinical Debate: FDG PET to differentiate glioblastoma recurrence from treatment-related changes. Neurooncol Pract 2021; 8:518-525. [PMID: 34594566 PMCID: PMC8475205 DOI: 10.1093/nop/npab027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The ability to accurately differentiate treatment-related changes (ie, pseudoprogression and radiation necrosis) from recurrent glioma remains a critical diagnostic problem in neuro-oncology. Because these entities are treated differently and have vastly different outcomes, accurate diagnosis is necessary to provide optimal patient care. In current practice, this diagnostic quandary commonly requires either serial imaging or histopathologic tissue confirmation. In this article, experts in the field debate the utility of 2-deoxy-2[18F]fluoro-d-glucose positron emission tomography (FDG PET) as an imaging tool to distinguish tumor recurrence from treatment-related changes in a patient with glioblastoma and progressive contrast enhancement on magnetic resonance (MR) following chemoradiotherapy.
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Affiliation(s)
- Ephraim E Parent
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Tyler Gleason
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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36
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Ida CM, Johnson DR, Nair AA, Davila J, Kollmeyer TM, Minn K, Fadra NM, Balcom JR, Fung KMA, Kim DK, Kaufmann TJ, Kipp BR, Halling KC, Jenkins RB, Giannini C. Polymorphous Low-Grade Neuroepithelial Tumor of the Young (PLNTY): Molecular Profiling Confirms Frequent MAPK Pathway Activation. J Neuropathol Exp Neurol 2021; 80:821-829. [PMID: 34363682 DOI: 10.1093/jnen/nlab075] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently described epileptogenic tumor characterized by oligodendroglioma-like components, aberrant CD34 expression, and frequent mitogen-activated protein kinase (MAPK) pathway activation. We molecularly profiled 13 cases with diagnostic histopathological features of PLNTY (10 female; median age, 16 years; range, 5-52). Patients frequently presented with seizures (9 of 12 with available history) and temporal lobe tumors (9 of 13). MAPK pathway activating alterations were identified in all 13 cases. Fusions were present in the 7 youngest patients: FGFR2-CTNNA3 (n = 2), FGFR2-KIAA1598 (FGFR2-SHTN1) (n = 1), FGFR2-INA (n = 1), FGFR2-MPRIP (n = 1), QKI-NTRK2 (n = 1), and KIAA1549-BRAF (n = 1). BRAF V600E mutation was present in 6 patients (17 years or older). Two fusion-positive cases additionally harbored TP53/RB1 abnormalities suggesting biallelic inactivation. Copy number changes predominantly involving whole chromosomes were observed in all 10 evaluated cases, with losses of chromosome 10q occurring with FGFR2-KIAA1598 (SHTN1)/CTNNA3 fusions. The KIAA1549-BRAF and QKI-NTRK2 fusions were associated respectively with a 7q34 deletion and 9q21 duplication. This study shows that despite its name, PLNTY also occurs in older adults, who frequently show BRAF V600E mutation. It also expands the spectrum of the MAPK pathway activating alterations associated with PLNTY and demonstrates recurrent chromosomal copy number changes consistent with chromosomal instability.
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Affiliation(s)
- Cristiane M Ida
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (DRJ, DKK, TJK)
| | - Asha A Nair
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA (AAN, JD, NMF)
| | - Jaime Davila
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA (AAN, JD, NMF).,Department of Mathematics, Statistics and Computer Science, St Olaf College, Northfield, Minnesota, USA (JD)
| | - Thomas M Kollmeyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Kay Minn
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Numrah M Fadra
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA (AAN, JD, NMF)
| | - Jessica R Balcom
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Kar-Ming A Fung
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA (KMAF)
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (DRJ, DKK, TJK)
| | - Timothy J Kaufmann
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA (DRJ, DKK, TJK)
| | - Benjamin R Kipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Kevin C Halling
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Robert B Jenkins
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
| | - Caterina Giannini
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA (CMI, TMK, KM, JRB, BRK, KCH, RBJ, CG)
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Eschbacher KL, Ida CM, Johnson DR, Alvi MA, Jenkins SM, Ruff MW, Kerezoudis P, Neth BJ, Pasion RM, Daniels DJ, Kizilbash SH, Raghunathan A. Diffuse Gliomas of the Brainstem and Cerebellum in Adults Show Molecular Heterogeneity. Am J Surg Pathol 2021; 45:1082-1090. [PMID: 33606385 DOI: 10.1097/pas.0000000000001690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Posterior fossa (PF) diffuse gliomas in pediatric patients frequently harbor the H3 K27M mutation. Among adults, PF diffuse gliomas are rare, with limited data regarding molecular features and clinical outcomes. We identified 28 adult PF diffuse glioma patients (17 males; median: 50 y, range: 19 to 78 y), with surgery performed at our institution (13 brainstem; 15 cerebellum). Histologic subtypes included anaplastic astrocytoma (n=21), glioblastoma (n=6), and diffuse astrocytoma (n=1). Immunohistochemistry was performed for H3 K27M (n=26), IDH1-R132H (n=28), and ATRX (n=28). A 150-gene neuro-oncology-targeted next-generation sequencing panel was attempted in 24/28, with sufficient informative material in 15 (51.7%). Tumors comprised 4 distinct groups: driver mutations in H3F3A (brainstem=4; cerebellum=2), IDH1 (brainstem=4; cerebellum=4), TERT promotor mutation (brainstem=0; cerebellum=3), and none of these (n=5), with the latter harboring mutations of TP53, PDGFRA, ATRX, NF1, and RB1. All TERT promoter-mutant cases were IDH-wild-type and arose within the cerebellum. To date, 20 patients have died of disease, with a median survival of 16.3 months, 1-year survival of 67.5%. Median survival within the subgroups included: H3F3A=16.4 months, IDH mutant=113.4 months, and TERT promoter mutant=12.9 months. These findings suggest that PF diffuse gliomas affecting adults show molecular heterogeneity, which may be associated with patient outcomes and possible response to therapy, and supports the utility of molecular testing in these tumors.
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Affiliation(s)
| | | | | | | | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
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Zahid A, Mark IT, Gilbertson JR, Johnson DR. Cerebral malaria with extensive subcortical microhemorrhages. Oxf Med Case Reports 2021; 2021:omab028. [PMID: 34055364 PMCID: PMC8143660 DOI: 10.1093/omcr/omab028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anza Zahid
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Ian T Mark
- Department of Radiology, UCSF, San Francisco, CA 94143, USA
| | | | - Derek R Johnson
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
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Johnson DR, Waid MD, Rula EY, Hughes DR, Rosenkrantz AB, Duszak R. Comparison of Radiologists and Other Specialists in the Performance of Lumbar Puncture Procedures Over Time. AJNR Am J Neuroradiol 2021; 42:1174-1181. [PMID: 33664117 DOI: 10.3174/ajnr.a7049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/26/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Lumbar punctures may be performed by many different types of health care providers. We evaluated the percentages of lumbar punctures performed by radiologists-versus-nonradiologist providers, including changes with time and discrepancies between specialties. MATERIALS AND METHODS Lumbar puncture procedure claims were identified in a 5% sample of Medicare beneficiaries from 2004 to 2017 and classified by provider specialty, site of service, day of week, and patient complexity. Compound annual growth rates for 2004 versus 2017 were calculated; t test and χ2 statistical analyses were performed. RESULTS Lumbar puncture use increased from 163.3 to 203.4 procedures per 100,000 Medicare beneficiaries from 2004 to 2017 (overall rate, 190.3). Concurrently, the percentage of lumbar punctures performed by radiologists increased from 37.1% to 54.0%, while proportions performed by other major physician specialty groups either declined (eg, neurologists from 23.5% to 10.0%) or were largely unchanged. While radiologists saw the largest absolute increase in the percentage of procedures, the largest relative increase occurred for nonphysician providers (4.2% in 2004 to 7.5% in 2017; +78.6%). In 2017, radiologists performed most procedures on weekdays (56.2%) and a plurality on weekends (38.2%). Comorbidity was slightly higher in patients undergoing lumbar puncture by radiologists (P < .001). CONCLUSIONS Radiologists now perform most lumbar puncture procedures for Medicare beneficiaries in both the inpatient and outpatient settings. The continuing shift in lumbar puncture responsibility from other specialists to radiologists has implications for clinical workflows, cost, radiation exposure, and postgraduate training.
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Affiliation(s)
- D R Johnson
- From the Department of Radiology (D.R.J.), Mayo Clinic, Rochester, Minnesota
- Department of Neurology (D.R.J.), Mayo Clinic, Rochester, Minnesota
| | - M D Waid
- Harvey L. Neiman Health Policy Institute (M.D.W., E.Y.R., D.R.H.), Reston, Virginia
| | - E Y Rula
- Harvey L. Neiman Health Policy Institute (M.D.W., E.Y.R., D.R.H.), Reston, Virginia
| | - D R Hughes
- Harvey L. Neiman Health Policy Institute (M.D.W., E.Y.R., D.R.H.), Reston, Virginia
- School of Economics (D.R.H.), Georgia Institute of Technology, Atlanta, Georgia
| | - A B Rosenkrantz
- Department of Radiology (A.B.R.), NYU Langone Health, New York, New York
| | - R Duszak
- Department of Radiology and Imaging Sciences (R.D.), Emory University School of Medicine, Atlanta, Georgia
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Jain R, Johnson DR, Patel SH, Castillo M, Smits M, van den Bent MJ, Chi AS, Cahill DP. "Real world" use of a highly reliable imaging sign: "T2-FLAIR mismatch" for identification of IDH mutant astrocytomas. Neuro Oncol 2021; 22:936-943. [PMID: 32064507 DOI: 10.1093/neuonc/noaa041] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AbstractThe T2-FLAIR (fluid attenuated inversion recovery) mismatch sign is an easily detectable imaging sign on routine clinical MRI studies that suggests diagnosis of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted gliomas. Multiple independent studies show that the T2-FLAIR mismatch sign has near-perfect specificity, but low sensitivity for diagnosing IDH-mutant astrocytomas. Thus, the T2-FLAIR mismatch sign represents a non-invasive radiogenomic diagnostic finding with potential clinical impact. Recently, false positive cases have been reported, many related to variable application of the sign's imaging criteria and differences in image acquisition, as well as to differences in the included patient populations. Here we summarize the imaging criteria for the T2-FLAIR mismatch sign, review similarities and differences between the multiple validation studies, outline strategies to optimize its clinical use, and discuss potential opportunities to refine imaging criteria in order to maximize its impact in glioma diagnostics.
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Affiliation(s)
- Rajan Jain
- Departments of Radiology and Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sohil H Patel
- Department of Radiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
A 62-year-old man presented with a history of atypical meningioma (World Health Organization grade II) and recurrent as anaplastic meningioma (World Health Organization grade III). His previous treatments included multiple surgical resections, fractionated radiation therapy, stereotactic radiosurgery, everolimus/octreotide long-acting release, bevacizumab, and hydroxyurea. Magnetic resonance imaging revealed rapid volumetric progression over the prior 9 months, with a near tripling in size from 29.9 cm3 to 80.4 cm3. Indium In 111 octreotide scanning confirmed the presence of somatostatin receptors within the tumor. Lutetium Lu 177 dotatate was administered intravenously at a dose of 200 mCi per dose every 8 weeks for 4 cycles. Treatment was tolerated very well, with no notable adverse events. Tumor volume initially increased to 98.3 cm3 after cycle 1 of treatment and subsequently decreased to 91.2 cm3 after cycle 2. Eight months after treatment onset, the tumor volume remained stable (93.4 cm3).
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Affiliation(s)
- Anza Zahid
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Medical Oncology, Mayo Clinic, Rochester, MN
| | - Derek R. Johnson
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Radiology, Mayo Clinic, Rochester, MN
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Carr CM, Benson JC, DeLone DR, Diehn FE, Kim DK, Merrell KW, Nagelschneider AA, Madhavan AA, Johnson DR. Intracranial long-term complications of radiation therapy: an image-based review. Neuroradiology 2021; 63:471-482. [PMID: 33392738 DOI: 10.1007/s00234-020-02621-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Radiation therapy is commonly utilized in the majority of solid cancers and many hematologic malignancies and other disorders. While it has an undeniably major role in improving cancer survival, radiation therapy has long been recognized to have various negative effects, ranging from mild to severe. In this manuscript, we review several intracranial manifestations of therapeutic radiation, with particular attention to those that may be encountered by radiologists. METHODS We conducted an extensive literature review of known complications of intracranial radiation therapy. Based on this review, we selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications, focusing only on patients who had a history of intracranial radiation therapy. We then selected cases that best exemplified expected imaging findings in these entities. RESULTS Based on our initial literature search and imaging database review, we selected cases of radiation-induced meningioma, radiation-induced glioma, cavernous malformation, enlarging perivascular spaces, leukoencephalopathy, stroke-like migraine after radiation therapy, Moyamoya syndrome, radiation necrosis, radiation-induced labyrinthitis, optic neuropathy, and retinopathy. Although retinopathy is not typically apparent on imaging, it has been included given its clinical overlap with optic neuropathy. CONCLUSIONS We describe the clinical and imaging features of selected sequelae of intracranial radiation therapy, with a focus on those most relevant to practicing radiologists. Knowledge of these complications and their imaging findings is important, because radiologists play a key role in early detection of these entities.
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Affiliation(s)
- Carrie M Carr
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R DeLone
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Alex A Nagelschneider
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ajay A Madhavan
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Stocksdale B, Nagpal S, Hixson JD, Johnson DR, Rai P, Shivaprasad A, Tremont-Lukats IW. Neuro-Oncology Practice Clinical Debate: long-term antiepileptic drug prophylaxis in patients with glioma. Neurooncol Pract 2020; 7:583-588. [PMID: 33312673 DOI: 10.1093/nop/npaa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with primary brain tumors often experience seizures, which can be the presenting symptom or occur for the first time at any point along the illness trajectory. In addition to causing morbidity, seizures negatively affect independence and quality of life in other ways, for example, by leading to loss of driving privileges. Long-term therapy with antiepileptic drugs (AEDs) is the standard of care in brain tumor patients with seizures, but the role of prophylactic AEDs in seizure-naive patients remains controversial. In this article, experts in the field discuss the issues of AED efficacy and toxicity, and explain their differing recommendations for routine use of prophylactic AEDs.
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Affiliation(s)
- Brian Stocksdale
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Seema Nagpal
- Department of Neurology, Stanford University, California
| | - John D Hixson
- Department of Neurology, University of California San Francisco
| | | | - Prashant Rai
- Department of Neurology, The University of Texas Medical Branch at Galveston
| | - Akhil Shivaprasad
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Texas
| | - Ivo W Tremont-Lukats
- Kenneth R. Peak Brain and Pituitary Tumor Center, Houston Methodist Hospital, Texas.,Department of Neurosurgery, Houston Methodist Hospital, Texas
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Johnson DR, Carr CM, Luetmer PH, Diehn FE, Lehman VT, Cutsforth-Gregory JK, Verdoorn JT, Krecke KN. Diffuse Calvarial Hyperostosis in Patients with Spontaneous Intracranial Hypotension. World Neurosurg 2020; 146:e848-e853. [PMID: 33220476 DOI: 10.1016/j.wneu.2020.11.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Diagnosis of spontaneous intracranial hypotension (SIH) may be delayed due to nonspecific symptoms and variable imaging findings. Cases of hyperostosis in children who are overshunted, a process that may be physiologically analogous to adults with SIH, have been reported by others and observed in our practice. The purpose of this retrospective study was to assess the frequency and pattern of calvarial hyperostosis in patients with SIH. METHODS We retrospectively reviewed computed tomography and magnetic resonance imaging examinations from consecutive patients who underwent myelography for the evaluation of SIH to assess for the presence of generalized calvarial thickening or development of a secondary layer of bone. Patients with typical benign hyperostosis frontalis were excluded. Patient demographics and clinical factors were evaluated for association with hyperostosis. RESULTS Among 285 patients with SIH, 40 (14.0%) demonstrated diffuse calvarial hyperostosis on imaging. Most of these patients (32/40; 80.0%) demonstrated a distinct circumferentially layered appearance to the skull, whereas 8 of 40 (20.0%) had generalized calvarial thickening without layering. CONCLUSIONS Diffuse calvarial hyperostosis, particularly the concentrically layered form that we term "layer cake skull," is a relatively common imaging feature in patients with SIH. In the appropriate clinical context, this finding will allow the possibility of SIH to be raised based on computed tomography imaging, which is otherwise of limited utility in the initial diagnosis of this condition.
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Affiliation(s)
- Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
| | - Carrie M Carr
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vance T Lehman
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Cogswell PM, Graff-Radford J, Wurtz LI, Graff-Radford NR, Johnson DR, Hunt CH, Gunter JL, Cutsforth-Gregory JK, Jones DT, Elder BD, Huston Iii J, Jack CR. CSF dynamics disorders: Association of brain MRI and nuclear medicine cisternogram findings. Neuroimage Clin 2020; 28:102481. [PMID: 33395973 PMCID: PMC7658703 DOI: 10.1016/j.nicl.2020.102481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022]
Abstract
MR features of DESH are associated with abnormalities on NM cisternogram. These finding support DESH as an indicator of a CSF dynamics disorder. Abnormal radiotracer distribution is more frequent in DESH vs ventriculomegaly or high convexity tight sulci alone. Abnormal radiotracer distribution is more frequent with ventriculomegaly or HCTS vs neither. These findings indicate that CSF dynamics disorders occur on a spectrum.
Disproportionately enlarged subarachnoid space hydrocephalus (DESH), characterized by ventriculomegaly, high convexity/midline tight sulci, and enlarged sylvian fissures on brain MRI has been increasingly recognized as a distinct diagnostic imaging entity that falls within the larger category of idiopathic normal pressure hydrocephalus. Normal pressure hydrocephalus has been previously characterized as a CSF dynamics disorder based on abnormalities on nuclear medicine cisternography: radiotracer in the lateral ventricles and absent or delayed ascent of radiotracer over the cerebral convexity. The purpose of this work was to evaluate for differences in nuclear medicine cisternography between patients with vs without DESH and thereby provide support for the concept that DESH is a structural imaging marker of a CSF dynamics disorder. The study included 102 patients (mean age 71 years, range 46–86, 38 females), 58 patients with cisternogram performed to evaluate suspected normal pressure hydrocephalus (mean age 73 years, range 46–86 years, 24 female) and 44 patients evaluated for headache (mean age 68 years, range 60–82 years, 14 female). All patients had an MRI of the brain performed within 13 months of the cisternogram. Cisternogram imaging, typically acquired at 0.5, 1, 2, 4, and 24 h post injection, was evaluated for the time at which radiotracer reached the basal cisterns, presence of persistent radiotracer in the lateral ventricles, time radiotracer first entered the lateral ventricles, presence of radiotracer over the cerebral convexity, and time at which radiotracer was first visualized over the cerebral convexity. MRI features of ventriculomegaly (defined as Evans’ index ≥ 0.3) and high convexity tight sulci (HCTS) were recorded. Based on the MRI features, patients were grouped according to presence or absence of DESH (ventriculomegaly and HCTS). Those without DESH were separated into groups of ventriculomegaly alone, HCTS alone, and neither ventriculomegaly nor HCTS. Cisternogram metrics were compared between MR-defined groups. Patients with DESH showed a higher frequency of radiotracer in the lateral ventricles and delayed or absent ascent over the cerebral convexity compared to those without DESH, higher frequency of ventricular radioactivity vs those with HCTS alone, and shorter time to ventricular radioactivity compared to those with ventriculomegaly alone. Patients with ventriculomegaly or HCTS alone had a higher frequency of radiotracer in the lateral ventricles and delayed ascent of radiotracer over the cerebral convexity compared to those with neither ventriculomegaly nor HCTS. These findings support DESH and the individual components of ventriculomegaly and HCTS as markers of disordered CSF dynamics.
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Affiliation(s)
- Petrice M Cogswell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA.
| | | | - Lincoln I Wurtz
- Mayo Clinic Alix School of Medicine, 200 First Street SW, Rochester, MN 55902, USA
| | - Neill R Graff-Radford
- Department of Neurology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Christopher H Hunt
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Information Technology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | | | - David T Jones
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA; Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Benjamin D Elder
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - John Huston Iii
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA
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Muthusamy K, Hanna C, Johnson DR, Cramer CH, Tebben PJ, Libi SE, Poling GL, Lanpher BC, Morava E, Schimmenti LA. Growth hormone deficiency in a child with branchio-oto-renal spectrum disorder: Clinical evidence of EYA1 in pituitary development and a recommendation for pituitary function surveillance. Am J Med Genet A 2020; 185:261-266. [PMID: 33098377 DOI: 10.1002/ajmg.a.61942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/12/2020] [Indexed: 11/07/2022]
Abstract
Branchio-oto-renal spectrum disorder (BORSD) is a rare autosomal dominant condition characterized by ear abnormalities with hard of hearing/deafness, second branchial arch malformations and renal anomalies. Pathogenic variations in EYA1 gene are found in the majority of clinically diagnosed individuals with BORSD. We describe an infant with BORSD related to a paternally inherited heterozygous pathogenic variation in EYA1 gene presenting with poor growth and hypoglycemia due to growth hormone deficiency. Magnetic resonance imaging revealed a diminutive pituitary gland and morphologically abnormal sella. Upon initiation of growth hormone therapy, the hypoglycemia resolved and catch up growth ensued. Pituitary abnormalities have not been reported previously in patients with BORSD. The zebrafish ortholog of eya1 is important for the development of adenohypophysis, suggesting that this patient's growth hormone deficiency and pituitary abnormality are part of BORSD. Inclusion of screening for pituitary hormone deficiency and pituitary imaging should be considered as a part of surveillance in patients with BORSD.
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Affiliation(s)
- Karthik Muthusamy
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - Christian Hanna
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Derek R Johnson
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Carl H Cramer
- Division of Pediatric Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter J Tebben
- Divisions of Pediatric Endocrinology and Endocrinology, Diabetes and Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sharon E Libi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gayla L Poling
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Brendan C Lanpher
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA
| | - Eva Morava
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa A Schimmenti
- Department of Clinical Genomics, Mayo Clinic, Rochester, Minnesota, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA.,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota, USA.,Center for Individualized Medicine, Mayo Clinic, Rochester, Minnesota, USA
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48
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Affiliation(s)
- Derek R Johnson
- Departments of Radiology and Neurology, Mayo Clinic, Rochester, Minnesota, USA
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49
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Neth BJ, Ruff MW, Uhm JH, Johnson DR, Divekar RD, Maddox DE. Temozolomide desensitization followed by metronomic dosing in patients with hypersensitivity. Cancer Chemother Pharmacol 2020; 86:375-382. [PMID: 32778906 DOI: 10.1007/s00280-020-04123-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Temozolomide is the most effective chemotherapy for malignant glioma. Hypersensitivity requiring interruption of therapy may significantly impact patient survival. We have successfully employed temozolomide desensitization followed by metronomic dosing of temozolomide. Our purpose was to report patient characteristics and outcomes in patients with glioma (Grade 2-4) and temozolomide hypersensitivity managed by desensitization and metronomic dosing. METHODS We performed an observational study of 15 patients at Mayo Clinic (Rochester) with a diagnosis of glioma who underwent temozolomide desensitization with subsequent metronomic dosing from May 2012 to January 2017. We calculated overall and progression-free survival using the Kaplan-Meier method, and log-rank analyses to assess for differences in survival by WHO Grade or treatment initiation. RESULTS Median age at time of desensitization was 49.3 years (26.8-64.7 years). Median follow-up after desensitization was 35.5 months. One patient (6.7%) was unable to resume temozolomide due to recurrent allergy. The median time from first desensitization to discontinuation of metronomic temozolomide was 4.2 months (0-15.2 months). Median OS and PFS for the whole sample were 181.7 months and 44.9 months. For Grade 4, OS was 100% at 1 year, 40% at 3 years, 20% at 5 years; and PFS was 60% at 1 year, 40% at 3 years, and 20% at 5 years. CONCLUSION Our results suggest that rapid-desensitization followed by metronomic temozolomide should be considered in patients with glioma who experience hypersensitivity. This strategy provides comparable outcomes to therapy with standard protocols, with the majority of patients able to tolerate temozolomide after desensitization with favorable disease control.
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Affiliation(s)
- Bryan J Neth
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
| | - Michael W Ruff
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Joon H Uhm
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Derek R Johnson
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.,Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Rohit D Divekar
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Daniel E Maddox
- Division of Allergic Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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50
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Abstract
Perfusion, as measured by imaging, is considered a standard of care biomarker for the evaluation of many tumors. Measurements of tumor perfusion may be used in a number of ways, including improving the visual detection of lesions, differentiating malignant from benign findings, assessing aggressiveness of tumors, identifying ischemia and by extension hypoxia within tumors, and assessing treatment response. While most clinical perfusion imaging is currently performed with CT or MR, a number of methods for PET imaging of tumor perfusion have been described. The inert PET radiotracer 15O-water PET represents the recognized gold standard for absolute quantification of tissue perfusion in both normal tissue and a variety of pathological conditions including cancer. Other cancer PET perfusion imaging strategies include the use of radiotracers with high first-pass uptake, analogous to those used in cardiac perfusion PET. This strategy produces more visually pleasing high-contrast images that provide relative rather than absolute perfusion quantification. Lastly, multiple timepoint imaging of PET tracers such as 18F-FDG, are not specifically optimized for perfusion, but have advantages related to availability, convenience, and reimbursement. Multiple obstacles have thus far blocked the routine use of PET imaging for tumor perfusion, including tracer production and distribution, image processing, patient body coverage, clinical validation, regulatory approval and reimbursement, and finally feasible clinical workflows. Fortunately, these obstacles are being overcome, especially within larger imaging centers, opening the door for PET imaging of tumor perfusion to become standard clinical practice. In the foreseeable future, it is possible that whole-body PET perfusion imaging with 15O-water will be able to be performed in a single imaging session concurrent with standard PET imaging techniques such as 18F-FDG-PET. This approach could establish an efficient clinical workflow. The resultant ability to measure absolute tumor blood flow in combination with glycolysis will provide important complementary information to inform prognosis and clinical decisions.
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Affiliation(s)
- Geoffrey B Johnson
- Department of Radiology, Mayo Clinic, Rochester, MNDepartment of Neurology, Mayo Clinic, Rochester, MN; Department of Immunology, Mayo Clinic, Rochester, MN.
| | - Hendrik J Harms
- Department of Surgical Sciences, Nuclear Medicine, PET and Radiology, Uppsala University, Uppsala Sweden
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, MNDepartment of Neurology, Mayo Clinic, Rochester, MN
| | - Mark S Jacobson
- Department of Radiology, Mayo Clinic, Rochester, MNDepartment of Neurology, Mayo Clinic, Rochester, MN
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