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Oberndorfer S, Woehrer A, Borkovec M, Marosi C, Payer F, Urbanic-Purkart T, Nowosielski M, Iglseder S, Stockhammer G, Kleindienst W, Florea C, Hager A, Tinchon A, Stultschnig M, Surboeck B, Pichler J, Leibetseder A, Weiss S, Hutterer M, Seebrecht L, Roetzer T, Hainfellner A, Hainfellner J. OS06.6.A Real-World Pattern of Care Study on Glioblastoma in the Austrian Population. Final results from 2014-2020. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.044] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The Austrian ABTR-SANO Glioblastoma Registry is the first population-based assessment of patterns of care for patients with Glioblastoma across Austrian healthcare institutions. The primary aim is to assess the real world effectiveness of administered therapies.
Material and Methods
Clinical data are collected via a common web-based IT platform “ABTR-SANO Net” since 2014. The database and the ongoing evaluation of clinical parameters, as well as interims analysis are provided in cooperation with a review board. First Outcome analysis, including patients from 2014-2020, was performed at the end of 2021.
Results
Eleven centers across Austria are involved, and the data of 1416 patients (m/f ratio: 1,35, median age: 66 years) were recently analyzed in detail. Age, extent of resection, as well as ECOG was associated with improved survival. Methylated MGMT Status also showed a moderate survival benefit. Patients with re-resection and re-radiation also exhibited improved survival, which however may be attributed to a selection bias.Second line treatment manly comprised of antiangiogenic treatment, followed by alkylated agents, re-radiation and re-surgery. Median overall survival of all patients was 344 days and clearly age dependent (best for <50 years, worse for>80 years).
Conclusion
This is the first population based outcome analysis of Glioblastoma in Austria. Results regarding prognostic markers and outcome are mostly comparable with international data. Robust population based data are important in order to monitor quality of health care, and to match the data with results from clinical studies.
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Affiliation(s)
- S Oberndorfer
- Department Neurology, University Clinic , St Poelten , Austria
- KL-Institute for Neurology and Neuropsychology , St. Poelten, St. Poelten , Austria
| | - A Woehrer
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - M Borkovec
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - C Marosi
- Department of Medicine I, Medical University of Vienna , Vienna , Austria
| | - F Payer
- Department Neurology, University Clinic Graz , Graz , Austria
| | | | - M Nowosielski
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - S Iglseder
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - G Stockhammer
- Department Neurology, University Clinic Innsbruck , Innsbruck , Austria
| | - W Kleindienst
- Department Neurology, CDK-University Clinic Salzburg , Salzburg , Austria
| | - C Florea
- Department Neurology, CDK-University Clinic Salzburg , Salzburg , Austria
| | - A Hager
- Department Neurology, LKH Wiener Neustadt , Wiener Neustadt , Austria
| | - A Tinchon
- Department Neurology, KLPU, University Clinic , St Pölten , Austria
| | - M Stultschnig
- Department Neurology, Clinic Klagenfurt , Klagenfurt , Austria
| | - B Surboeck
- Department Neurology, KFJ Vienna , Vienna , Austria
| | - J Pichler
- Department Internal Medicine, J Kepler University Clinic, Linz , Linz , Austria
| | - A Leibetseder
- Department Neurology, J Kepler University Clinic, Linz , Linz , Austria
| | - S Weiss
- Department Neurolopathology, J Kepler University Clinic Linz , Linz , Austria
| | - M Hutterer
- Department Neurology, J Kepler University Clinic, Linz , Linz , Austria
| | - L Seebrecht
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - T Roetzer
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - A Hainfellner
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
| | - J Hainfellner
- Department Neurology, Division of Neuropathology and Neurochemistry, Medical University of Vienna , Vienna , Austria
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Urbanic Purkart T, Holl E, Seifert-Held T, Asslaber M, Payer F. P21.12 Germinoma mimicking a vanishing midbrain lesion on the MRI. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.300] [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: 11/14/2022] Open
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3
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Schmidt R, Fazekas F, Kleinert R, Offenbacher H, Payer F, Porsch G. Magnetic Resonance Imaging, Computed Tomography, and Autopsy Findings after Cardiorespiratory Arrest. J Neuroimaging 2016. [DOI: 10.1111/jon199114197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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4
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Woehrer A, Hackl M, Waldhör T, Weis S, Pichler J, Olschowski A, Buchroithner J, Maier H, Stockhammer G, Thomé C, Haybaeck J, Payer F, von Campe G, Kiefer A, Würtz F, Vince GH, Sedivy R, Oberndorfer S, Marhold F, Bordihn K, Stiglbauer W, Gruber-Mösenbacher U, Bauer R, Feichtinger J, Reiner-Concin A, Grisold W, Marosi C, Preusser M, Dieckmann K, Slavc I, Gatterbauer B, Widhalm G, Haberler C, Hainfellner JA. Relative survival of patients with non-malignant central nervous system tumours: a descriptive study by the Austrian Brain Tumour Registry. Br J Cancer 2014; 110:286-96. [PMID: 24253501 PMCID: PMC3899758 DOI: 10.1038/bjc.2013.714] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 10/04/2013] [Accepted: 10/21/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival. METHODS We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival. RESULTS Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%). CONCLUSION The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.
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Affiliation(s)
- A Woehrer
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - M Hackl
- Austrian National Cancer Registry, Statistics Austria, Guglgasse 13, A-1110 Vienna, Austria
| | - T Waldhör
- Center for Public Health, Department of Epidemiology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - S Weis
- Department of Pathology and Neuropathology, State Neuropsychiatric Hospital Wagner-Jauregg, Linz, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - J Pichler
- Internal Medicine and Neurooncology, State Neuropsychiatric Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - A Olschowski
- Department of Neurosurgery, State Neuropsychiatric Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - J Buchroithner
- Department of Neurosurgery, State Neuropsychiatric Hospital Wagner-Jauregg, Wagner-Jauregg-Weg 15, A-4020 Linz, Austria
| | - H Maier
- Department of Neuropathology, Institute of Pathology, Medical University of Innsbruck, Christoph-Probst-Platz Innrain 52, A-6020 Innsbruck, Austria
| | - G Stockhammer
- Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz Innrain 52, A-6020 Innsbruck, Austria
| | - C Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Christoph-Probst-Platz Innrain 52, A-6020 Innsbruck, Austria
| | - J Haybaeck
- Department of Neuropathology, Institute of Pathology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - F Payer
- Division of General Neurology and Division of Neuroradiology, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - G von Campe
- Department of Neurosurgery, Medical University of Graz, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - A Kiefer
- Institute of Pathology, State Hospital Klagenfurt, St Veiter Strasse 47, A-9020 Klagenfurt, Austria
| | - F Würtz
- Institute of Pathology, State Hospital Klagenfurt, St Veiter Strasse 47, A-9020 Klagenfurt, Austria
| | - G H Vince
- Department of Neurosurgery, State Hospital Klagenfurt, St Veiter Strasse 47, A-9020 Klagenfurt, Austria
| | - R Sedivy
- Department of Clinical Pathology, General Hospital St Pölten, Probst-Führer-Strasse 4, A-3100 St Pölten, Austria
| | - S Oberndorfer
- Department of Neurology, General Hospital St Pölten, Probst-Führer-Strasse 4, A-3100 St Pölten, Austria
| | - F Marhold
- Department of Neurosurgery, General Hospital St Pölten, Probst-Führer-Strasse 4, A-3100 St Pölten, Austria
| | - K Bordihn
- Department of Neurosurgery, Christian Doppler Clinic, Paracelsus Private Medical University, Strubergasse 21, A-5020 Salzburg, Austria
| | - W Stiglbauer
- Institute of Pathology, General Hospital Wiener Neustadt, Corvinusring 3–5, A-2700 Wiener Neustadt, Austria
| | - U Gruber-Mösenbacher
- Department of Pathology, Feldkirch State Hospital, Carinagasse 47, A-6807 Feldkirch, Austria
| | - R Bauer
- Department of Neurosurgery, Feldkirch State Hospital, Carinagasse 47, A-6807 Feldkirch, Austria
| | - J Feichtinger
- Department of Pathology, Krankenanstalt Rudolfstiftung, Juchgasse 25, A-1030 Vienna, Austria
| | - A Reiner-Concin
- Institute of Pathology, Danube Hospital, Langobardenstrasse 122, A-1220 Vienna, Austria
| | - W Grisold
- Department of Neurology, KFJ-Hospital Vienna, Kundratstrasse 3, A-1100 Vienna, Austria
| | - C Marosi
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - M Preusser
- Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - K Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - I Slavc
- Department of Paediatrics, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - B Gatterbauer
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - G Widhalm
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - C Haberler
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
| | - J A Hainfellner
- Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, A-1097 Vienna, Austria
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Aghi M, Vogelbaum MA, Jolly DJ, Robbins JM, Ostertag D, Ibanez CE, Gruber HE, Kasahara N, Bankiewicz K, Cloughesy TF, Chang SM, Butowski N, Kesari S, Chen C, Mikkelsen T, Landolfi J, Chiocca EA, Elder JB, Foltz G, Pertschuk D, Anaizi A, Taylor C, Kosty J, Zimmer L, Theodosopoulos P, Anaizi A, Gantwerker E, Pensak M, Theodosopoulos P, Anaizi A, Grewal S, Theodosopoulos P, Zimmer L, Anaizi A, Pensak M, Theodosopoulos P, Arakawa Y, Kang Y, Murata D, Fujimoto KI, Miyamoto S, Blagia M, Paulis M, Orunesu G, Serra S, Akers J, Ramakrishnan V, Kim R, Skog J, Nakano I, Pingle S, Kalinina J, Kesari S, Breakfield X, Hochberg F, Van Meir E, Carter B, Chen C, Czech T, Nicholson J, Frappaz D, Kortmann RD, Alapetite C, Garre ML, Ricardi U, Saran F, Calaminus G, Hamer PDW, Hendriks E, Mandonnet E, Barkhof F, Zwinderman K, Duffau H, Esquenazi Y, Johnson J, Tandon N, Esquenazi Y, Friedman E, Lin Y, Zhu JJ, Tandon N, Fujimaki T, Kobayashi M, Wakiya K, Ohta M, Adachi J, Fukuoka K, Suzuki T, Yanagisawa T, Matsutani M, Mishima K, Sasaki J, Nishikawa R, Hoffermann M, Bruckmann L, Ali KM, Asslaber M, Payer F, von Campe G, Jungk C, Beigel B, Abb V, Herold-Mende C, Unterberg A, Kim JH, Cho YH, Kim CJ, Mardor Y, Nissim O, Grober Y, Guez D, Last D, Daniels D, Hoffmann C, Nass D, Talianski A, Spiegelmann R, Cohen Z, Zach L, Marupudi N, Mittal S, Michaud K, Cantin L, Cottin S, Dandurand C, Mohammadi A, Hawasli A, Rodriguez A, Schroeder J, Laxton A, Elson P, Tatter S, Barnett G, Leuthardt E, Moriuchi S, Dehara M, Fukunaga T, Hagiwara Y, Soda H, Imakita M, Nitta M, Maruyama T, Iseki H, Ikuta S, Tamura M, Chernov M, Okamoto S, Okada Y, Muragaki Y, Ohue S, Kohno S, Inoue A, Yamashita D, Kumon Y, Ohnishi T, Oppido P, Villani V, Vidiri A, Pace A, Pompili A, Carapella C, Orringer D, Lau D, Niknafs Y, Piquer J, Llacer JL, Rovira V, Riesgo P, Cremades A, Rotta R, Levine N, Prabhu S, Sawaya R, Weinberg J, Rao G, Tummala S, Tilley C, Rovin R, Kassam A, Schwartz C, Romagna A, Thon N, Tonn JC, Schwarz SB, Kreth FW, Sonoda Y, Shibahara I, Saito R, Kanamori M, Kumabe T, Tominaga T, Steele C, Lawrence J, Rovin R, Winn R, Rachinger W, Simon M, Dutzmann S, Feigl G, Kremenevskaya N, Thon N, Tonn JC, Whelan H, Kelly M, Jogel S, Kaufmann B, Foy A, Lew S, Quirk B, Yong RL, Wu T, Mihatov N, Shen MJ, Brown MA, Zaghloul KA, Park GE, Park JK. SURGICAL THERAPIES. Neuro Oncol 2013; 15:iii217-iii225. [PMCID: PMC3823906 DOI: 10.1093/neuonc/not191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
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Langsenlehner T, Groll MJ, Quehenberger F, Payer F, Mokry M, Kapp KS. Interdisciplinary treatment of glioblastoma: analysis of prognostic factors and treatment results in unselected patients. Neoplasma 2012; 59:662-8. [PMID: 22862166 DOI: 10.4149/neo_2012_084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Aim of the present study was to investigate survival rates of unselected patients with glioblastoma after multimodal treatment and estimation of prognostic factors. Data of 189 patients (118 men; 71 women; median age: 59 years) with histologically confirmed glioblastoma treated from 1999 to 2009 were analyzed retrospectively. Complete tumor resection was performed in 99 patients (52%), subtotal excision in 65 patients (34%), and stereotactic biopsy in 25 patients (13%). In 135 patients (71%), residual tumors were detectable in post-surgical imaging. All patients underwent three-dimensional conformal radiotherapy of the tumor region in shrinking-field technique to a total dose of 60 Gy. Beginning in 2002, 124 patients (66%) received concomitant temozolomide (TMZ) treatment, 76 patients among them were additionally treated with adjuvant TMZ. After disease progression, 74 patients underwent salvage therapy (salvage chemotherapy, n=61; local therapy, n=30). Actuarial 1- and 2- year progression-free survival (PFS) rates were 32% and 7%, overall survival (OS) rates were 54% and 22%, respectively. Without TMZ, 1- and 2- year OS rates were 47% and 11%, with concomitant TMZ 57% and 28%, and with concomitant and adjuvant TMZ 72% and 44%. In multivariate Cox proportional hazards regression models, age (p<0.001), extent of resection (p = 0.001), and TMZ (p < 0.001) were significantly associated with OS. Furthermore, a significant association between salvage therapy and improved survival was observed (p=0.020). RT with concomitant TMZ was well tolerated in the majority of patients and completed as scheduled in 78% of patients. Multimodal treatment including extensive surgical resection, radiotherapy and chemotherapy significantly improves prognosis of patients with glioblastoma and is feasible with acceptable toxicity in routine practice. To achieve optimal results, close coordination among all disciplines is required.
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Affiliation(s)
- T Langsenlehner
- Department of Therapeutic Radiology and Oncology, Medical University of Graz, Austria.
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Clarke JL, Ennis MM, Lamborn KR, Prados MD, Puduvalli VK, Penas-Prado M, Gilbert MR, Groves MD, Hess KR, Levin VA, de Groot J, Colman H, Conrad CA, Loghin ME, Hunter K, Yung WK, Chen C, Damek D, Liu A, Gaspar LE, Waziri A, Lillehei K, Kavanagh B, Finlay JL, Haley K, Dhall G, Gardner S, Allen J, Cornelius A, Olshefski R, Garvin J, Pradhan K, Etzl M, Goldman S, Atlas M, Thompson S, Hirt A, Hukin J, Comito M, Bertolone S, Torkildson J, Joyce M, Moertel C, Letterio J, Kennedy G, Walter A, Ji L, Sposto R, Dorris K, Wagner L, Hummel T, Drissi R, Miles L, Leach J, Chow L, Turner R, Gragert MN, Pruitt D, Sutton M, Breneman J, Crone K, Fouladi M, Friday BB, Buckner J, Anderson SK, Giannini C, Kugler J, Mazurczac M, Flynn P, Gross H, Pajon E, Jaeckle K, Galanis E, Badruddoja MA, Pazzi MA, Stea B, Lefferts P, Contreras N, Bishop M, Seeger J, Carmody R, Rance N, Marsella M, Schroeder K, Sanan A, Swinnen LJ, Rankin C, Rushing EJ, Hutchins LF, Damek DM, Barger GR, Norden AD, Lesser G, Hammond SN, Drappatz J, Fadul CE, Batchelor TT, Quant EC, Beroukhim R, Ciampa A, Doherty L, LaFrankie D, Ruland S, Bochacki C, Phan P, Faroh E, McNamara B, David K, Rosenfeld MR, Wen PY, Hammond SN, Norden AD, Drappatz J, Phuphanich S, Reardon D, Wong ET, Plotkin SR, Lesser G, Mintz A, Raizer JJ, Batchelor TT, Quant EC, Beroukhim R, Kaley TJ, Ciampa A, Doherty L, LaFrankie D, Ruland S, Smith KH, Wen PY, Chamberlain MC, Graham C, Mrugala M, Johnston S, Kreisl TN, Smith P, Iwamoto F, Sul J, Butman JA, Fine HA, Westphal M, Heese O, Warmuth-Metz M, Pietsch T, Schlegel U, Tonn JC, Schramm J, Schackert G, Melms A, Mehdorn HM, Seifert V, Geletneky K, Reuter D, Bach F, Khasraw M, Abrey LE, Lassman AB, Hormigo A, Nolan C, Gavrilovic IT, Mellinghoff IK, Reiner AS, DeAngelis L, Omuro AM, Burzynski SR, Weaver RA, Janicki TJ, Burzynski GS, Szymkowski B, Acelar SS, Mechtler LL, O'Connor PC, Kroon HA, Vora T, Kurkure P, Arora B, Gupta T, Dhamankar V, Banavali S, Moiyadi A, Epari S, Merchant N, Jalali R, Moller S, Grunnet K, Hansen S, Schultz H, Holmberg M, Sorensen MM, Poulsen HS, Lassen U, Reardon DA, Vredenburgh JJ, Desjardins A, Janney DE, Peters K, Sampson J, Gururangan S, Friedman HS, Jeyapalan S, Constantinou M, Evans D, Elinzano H, O'Connor B, Puthawala MY, Goldman M, Oyelese A, Cielo D, Dipetrillo T, Safran H, Anan M, Seyed Sadr M, Alshami J, Sabau C, Seyed Sadr E, Siu V, Guiot MC, Samani A, Del Maestro R, Bogdahn U, Stockhammer G, Mahapatra AK, Venkataramana NK, Oliushine VE, Parfenov VE, Poverennova IE, Hau P, Jachimczak P, Heinrichs H, Schlingensiepen KH, Shibui S, Kayama T, Wakabayashi T, Nishikawa R, de Groot M, Aronica E, Vecht CJ, Toering ST, Heimans JJ, Reijneveld JC, Batchelor T, Mulholland P, Neyns B, Nabors LB, Campone M, Wick A, Mason W, Mikkelsen T, Phuphanich S, Ashby LS, DeGroot JF, Gattamaneni HR, Cher LM, Rosenthal MA, Payer F, Xu J, Liu Q, van den Bent M, Nabors B, Fink K, Mikkelsen T, Chan M, Trusheim J, Raval S, Hicking C, Henslee-Downey J, Picard M, Reardon D, Kaley TJ, Wen PY, Schiff D, Karimi S, DeAngelis LM, Nolan CP, Omuro A, Gavrilovic I, Norden A, Drappatz J, Purow BW, Lieberman FS, Hariharan S, Abrey LE, Lassman AB, Perez-Larraya JG, Honnorat J, Chinot O, Catry-Thomas I, Taillandier L, Guillamo JS, Campello C, Monjour A, Tanguy ML, Delattre JY, Franz DN, Krueger DA, Care MM, Holland-Bouley K, Agricola K, Tudor C, Mangeshkar P, Byars AW, Sahmoud T, Alonso-Basanta M, Lustig RA, Dorsey JF, Lai RK, Recht LD, Reardon DA, Paleologos N, Groves M, Rosenfeld MR, Meech S, Davis T, Pavlov D, Marshall MA, Sampson J, Slot M, Peerdeman SM, Beauchesne PD, Faure G, Noel G, Schmitt T, Kerr C, Jadaud E, Martin L, Taillandier L, Carnin C, Desjardins A, Reardon DA, Peters KB, Herndon JE, Kirkpatrick JP, Friedman HS, Vredenburgh JJ, Nayak L, Panageas KS, Deangelis LM, Abrey LE, Lassman AB. Ongoing Clinical Trials. Neuro Oncol 2010. [DOI: 10.1093/neuonc/noq116.s9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Reishofer G, Fazekas F, Keeling S, Enzinger C, Payer F, Simbrunner J, Stollberger R. Minimizing macrovessel signal in cerebral perfusion imaging using independent component analysis. Magn Reson Med 2007; 57:278-88. [PMID: 17260383 DOI: 10.1002/mrm.21154] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 11/12/2022]
Abstract
The pronounced susceptibility effect of macrovessels in MR bolus-tracking studies induces spots of artificially high blood flow and volume in perfusion parameter images. These high-intensity regions impede the detection of perfusion changes and lead to elevated perfusion parameters in adjacent tissues. The purpose of this work was to explore postprocessing methods to reduce the influence of macrovessel signal in dynamic MRI. After data reduction was performed with the use of a principal component analysis (PCA), an independent component analysis (ICA) was applied to separate signal components of different compartments. Based on this decomposition, the dynamic time series were reconstructed with minimized contributions of macrovessel signal and noise. The influence of the temporal resolution and signal-to-noise ratio (SNR) of the source data were investigated by means of a simulation study. A region-of-interest (ROI)-based analysis of corrected and uncorrected in vivo data demonstrated that the influence of arteries and veins was reduced at least by 50%, while gray matter (GM) and white matter (WM) tissues were nearly unaffected by the correction process. Hemodynamic parameter images of the cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transit time (MTT) were calculated from corrected and uncorrected scans. The corrected parameter images showed a clearly reduced macrovessel signal and an improved perceptibility of microvascular perfusion changes compared to the uncorrected ones.
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Affiliation(s)
- G Reishofer
- Department of Radiology, Medical University Graz, Graz, Austria
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9
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Feichtinger M, Holl A, Körner E, Schröttner O, Eder H, Unger F, Pendl G, Wurst L, Golaszewski S, Payer F, Fazekas F, Ott E. Future aspects of the presurgical evaluation in epilepsy. Acta Neurochir Suppl 2003; 84:17-26. [PMID: 12379001 DOI: 10.1007/978-3-7091-6117-3_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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Epilepsy surgery is a successful therapeutic approach in patients with medically intractable epilepsy. The presurgical evaluation aims to detect the epileptogenic brain area by use of different diagnostic techniques. In this review article the current diagnostic procedures applied for this purpose are described. The diagnostic armamentarium can be divided conceptually into three different groups: assessment of function/dysfunction, structural/morphologic imaging methods and functional neuroimaging techniques. Properties, diagnostic power and limits of all diagnostic tools used in the diagnostic evaluation are discussed. In addition, future perspectives and the diagnostic value of new technologies are mentioned. Some are increasingly gaining acceptance in the routine preoperative diagnostic procedure like MR volumetry or MR spectroscopy of the hippocampus in patients with temporal lobe epilepsy. Some, on the other hand, like MEG and 11C-flumazenil PET, still remain experimental diagnostic tools as they are technically demanding and cost intensive. Besides the refinement of established techniques, co-registration of different modalities like spike-triggered functional MRI will play an important role in the non-invasive detection of the epileptic seizure focus and may change the regimen of the preoperative diagnostic work up of epilepsy patients in the future.
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Affiliation(s)
- M Feichtinger
- Department of Neurology, Karl-Franzens University, Graz, Austria
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10
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Abstract
Positron emission tomography using F-18-fluorodeoxyglucose (F-18-FDG-PET) is an ideal tool for imaging regional cerebral metabolism as glucose is the most important source of energy for neurons. Under physiologic conditions the pattern of metabolism reflects the state of cerebral activation which can be modulated by various stimuli to investigate cerebral organization. Pathologic conditions usually cause a drop in metabolism because of neuronal inactivity or loss. They can, however, also be associated with an increased rate of glucose metabolism such as in case of active epileptic foci or malignant tumors. As a consequence F-18-FDG-PET has become a valuable functional imaging modality especially for the diagnostic clarification of non-contributory or negative morphologic imaging results. Dementia, pre-surgical evaluation of epilepsy and neurooncology are currently frequent indications for referral to F-18-FDG-PET in neurology.
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Affiliation(s)
- F Fazekas
- Universitätsklinik für Neurologie, Karl-Franzens-Universität, Auenbruggerplatz 22, A-8036 Graz.
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11
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Auer-Grumbach M, Wagner K, Payer F, Hartung HP. Proximal Charcot-Marie-Tooth syndrome with duplication on chromosome 17p11.2. Ann N Y Acad Sci 1999; 883:469-71. [PMID: 10586276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- M Auer-Grumbach
- Department of Neurology, Karl-Franzens-University, Graz, Austria.
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12
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Fazekas F, Roob G, Payer F, Kapeller P, Strasser-Fuchs S, Aigner RM. Technetium-99m-ECD SPECT fails to show focal hyperemia of acute herpes encephalitis. J Nucl Med 1998; 39:790-2. [PMID: 9591576] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This is a case of herpes simplex encephalitis (HSE) examined with 99mTc-ethyl cysteinate dimer (ECD) and 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT. Static images obtained with 99mTc-ECD showed a reduced tracer uptake of the temporal lobe but focal hyperactivity using 99mTc-HMPAO. Dynamic images indicated regional increase of cerebral blood perfusion with both tracers. Technetium-99m-ECD had rapid washout from the inflamed tissue, while 99mTc-HMPAO had avid uptake. Hypofixation of 99mTc-ECD leads to failure to detect the characteristic finding of temporal lobe hyperemia in acute HSE.
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Affiliation(s)
- F Fazekas
- Department of Neurology, MR Institute, Graz, Austria
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13
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Grossman M, Payer F, Onishi K, D'Esposito M, Morrison D, Sadek A, Alavi A. Language comprehension and regional cerebral defects in frontotemporal degeneration and Alzheimer's disease. Neurology 1998; 50:157-63. [PMID: 9443473 DOI: 10.1212/wnl.50.1.157] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We related profiles of language comprehension difficulty to patterns of reduced cerebral functioning obtained with high-resolution single photon emission computed tomography (SPECT) in patients with neurodegenerative conditions. We found different patterns of reduced relative cerebral perfusion in patients with frontotemporal degeneration (FD) and patients with Alzheimer's disease (AD). Cognitive assessments also showed different patterns of impaired comprehension in patients with FD and patients with AD. Grammatical comprehension difficulty in FD correlated with relative cerebral perfusion in left frontal and anterior temporal brain regions; impaired semantic processing in AD correlated with relative cerebral perfusion in inferior parietal and superior temporal regions of the left hemisphere. These findings are consistent with the hypothesis that a neural network distributed throughout the left hemisphere subserving different aspects of language comprehension, rather than a single brain region, is responsible for understanding language.
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Affiliation(s)
- M Grossman
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA
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14
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Grossman M, Payer F, Onishi K, White-Devine T, Morrison D, D'Esposito M, Robinson K, Alavi A. Constraints on the cerebral basis for semantic processing from neuroimaging studies of Alzheimer's disease. J Neurol Neurosurg Psychiatry 1997; 63:152-8. [PMID: 9285450 PMCID: PMC2169652 DOI: 10.1136/jnnp.63.2.152] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Functional activation studies of semantic processing in healthy adults have yielded conflicting results. The purpose was to evaluate the relative role of the brain regions implicated in semantic processing with converging evidence from imaging studies of patients with impaired semantic processing. METHODS Semantic memory was assessed in patients with Alzheimer's disease using two measures, and these performance patterns were related to profiles of reduced cerebral functioning obtained with high resolution single photon emission computed tomography (SPECT). Patients with frontotemporal degeneration were similarly evaluated as a control group. RESULTS Reduced relative cerebral perfusion was seen in parietal and posterior temporal brain regions of patients with Alzheimer's disease but not patients with frontotemporal degeneration. Impairments on semantically guided category membership decision tasks were also seen in patients with Alzheimer's disease but not those with frontotemporal degeneration. Performance on the semantic measures correlated with relative cerebral perfusion in inferior parietal and superior temporal regions of the left hemisphere only in Alzheimer's disease. Relative perfusion was significantly lower in these regions in patients with Alzheimer's disease with semantic difficulty compared with patients with Alzheimer's disease with relatively preserved semantic processing. CONCLUSION These findings provide converging evidence to support the contribution of superior temporal and inferior parietal regions of the left hemisphere to semantic processing.
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Affiliation(s)
- M Grossman
- Department of Neurology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA
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15
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Fazekas F, Kapeller P, Schmidt R, Offenbacher H, Payer F, Fazekas G. The relation of cerebral magnetic resonance signal hyperintensities to Alzheimer's disease. J Neurol Sci 1996; 142:121-5. [PMID: 8902731 DOI: 10.1016/0022-510x(96)00169-4] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.2] [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: 02/02/2023]
Abstract
To further elucidate the relation of cerebral magnetic resonance signal hyperintensities to Alzheimer's disease (AD) we performed a case-control comparison between 30 consecutive patients with probable AD (age range 49-76, mean 65 years) and 60 asymptomatic volunteers matched for age, sex, and major cerebrovascular risk factors. We used a 1.5T magnet and determined the extent of morphologic abnormalities both by visual grading and measurement. AD patients showed comparable grades of deep/subcortical white matter hyperintensities (WMH) and a similar extent of the total WMH area as controls (3.3 cm2 +/- 8.8 vs. 2.0 cm2 +/- 4.6). They had significantly more often a "halo' of periventricular hyperintensity (PVH) (p < 0.0005) and an increased mean PVH thickness (3.0 mm +/- 1.9 vs. 1.3 mm +/- 1.2; p < 0.001). This PVH thickness correlated significantly with measures of ventricular enlargement. While univariate logistic regression also suggested a significant association of PVH thickness with a diagnosis of AD this association was lost against atrophy measures in a multivariate analysis. Our results confirm a significantly greater extent of PVH in AD patients than controls even when matched for cerebrovascular risk factors. However, this abnormality was not independently related to the disease but rather appears to be an epiphenomenon of brain atrophy.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Karl-Franzens University, Graz, Austria
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16
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Mozley PD, Hornig-Rohan M, Woda AM, Kim HJ, Alavi A, Payer F, Amsterdam JD. Cerebral HMPAO SPECT in patients with major depression and healthy volunteers. Prog Neuropsychopharmacol Biol Psychiatry 1996; 20:443-58. [PMID: 8771600 DOI: 10.1016/0278-5846(96)00008-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
1. The authors examined the regional cerebral distribution of [Tc-99m] HMPAO using single photon emission computed tomography (SPECT) in patients with major depression and in healthy controls. 2. 19 patients and 16 healthy controls had SPECT images of the brain acquired with 740 MBq (20 mCl) of [Tc-99m] HMPAO on a triple-headed camera equipped with fan beam collimators. 3. Mean counts per pixel were measured in 13 regions of each hemisphere and compared to the mean activity in the whole brain, the ipsilateral hemisphere, and cerebellum. A "laterality score" was calculated for each structure by subtracting the mean counts per pixel in a region of the right hemisphere from the mean counts in the homotopic region of the left hemisphere and normalizing the difference by the average in both regions. The degree of hemispheric asymmetry was calculated from the absolute values of the laterality scores. 4. The distribution of HMPAO was more variable in patients than in controls; while the mean activity ratios were not significantly different in any region. Asymmetries between homotopic regions of the limbic system were more pronounced in patients than in controls. However, there were no consistent left-to-right asymmetries in either group. 5. The present data indicate that regional cerebral distribution of HMPAO may not be discretely abnormal in depression, but demonstrates heightened variability in depressives (vs. control subjects).
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Affiliation(s)
- P D Mozley
- Division of Nuclear Medicine, University of Pennsylvania Medical Center, Philadelphia, USA
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17
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Abstract
Complementary morphological information is a prerequisite for the detailed analysis of cerebral SPET studies. We therefore developed a technique which allows the alignment of SPET and magnetic resonance scans by imaging identical slices using external landmarks on an individually fitted mask and subsequent two-dimensional image processing for in-plane matching. Regional analysis of tracer activities can be performed directly on the superimposed SPET and MR outline images or by tracing a region of interest on the original MR scan with a parallel display on the matched SPET image, and vice versa. Tests assessing correct in-plane alignment using MRI, inter- and intra-variability of the matching procedure, and its comparability with an objectively determined best-matching position, confirmed the feasibility, accuracy and usefulness of this procedure.
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Affiliation(s)
- R Stollberger
- Magnetic Resonance Institute, Karl-Franzens University, Graz, Austria
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18
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Newberg AB, Alavi A, Payer F. Single photon emission computed tomography in Alzheimer's disease and related disorders. Neuroimaging Clin N Am 1995; 5:103-23. [PMID: 7743079] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Alzheimer's disease and other dementia syndromes can be characterized by single photon emission computed tomography (SPECT). SPECT can be used to measure cerebral blood flow or neurotransmitter activity in these disorders. SPECT can help distinguish various neurologic disorders and also help elucidate their pathophysiologic processes. This article focuses on the use of SPECT in the study of Alzheimer's disease and related neurologic disorders.
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Affiliation(s)
- A B Newberg
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
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19
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Fazekas F, Kleinert R, Offenbacher H, Schmidt R, Kleinert G, Payer F, Radner H, Lechner H. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993; 43:1683-9. [PMID: 8414012 DOI: 10.1212/wnl.43.9.1683] [Citation(s) in RCA: 1069] [Impact Index Per Article: 34.5] [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: 02/07/2023] Open
Abstract
We related the histopathologic changes associated with incidental white matter signal hyperintensities on MRIs from 11 elderly patients (age range, 52 to 82 years) to a descriptive classification for such abnormalities. Punctate, early confluent, and confluent white matter hyperintensities corresponded to increasing severity of ischemic tissue damage, ranging from mild perivascular alterations to large areas with variable loss of fibers, multiple small cavitations, and marked arteriolosclerosis. Microcystic infarcts and patchy rarefaction of myelin were also characteristic for irregular periventricular high signal intensity. Hyperintense periventricular caps and a smooth halo, however, were of nonischemic origin and constituted areas of demyelination associated with subependymal gliosis and discontinuity of the ependymal lining. Based on these findings, our classification appears to reflect both the different etiologies and severities of incidental MRI signal abnormalities, if it is modified to treat irregular periventricular and confluent deep white matter hyperintensities together.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Karl-Franzens University, Graz, Austria
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20
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Abstract
BACKGROUND AND PURPOSE We studied six patients suffering from pure, unilateral brain stem infarction to explore the association of remote cerebral and cerebellar blood flow changes with damage at different sites of this region of the brain. METHODS We used single-photon emission computed tomography and [123I]iodoamphetamine to measure regional differences in tracer uptake. Qualitative image analysis and calculated asymmetry indexes were correlated to the location of the infarcted area on magnetic resonance imaging and to the patients' clinical findings. RESULTS Significant perfusion asymmetries were noted in the two patients with infarction in the upper pons but not in those with lesions below this level. They comprised a contralateral cerebellar and ipsilateral supratentorial hypoactivity that was most marked in the frontoparietal cortex. There was no clear relation between the patterns of cerebral or cerebellar tracer uptake and specific neurological findings. CONCLUSIONS Remote perfusion changes after pure brain stem infarction may be seen both infratentorially and supratentorially and depend on the lesion site rather than on the neurological deficit. In this context, our study confirmed damage to the corticopontocerebellar pathways as the key event in the genesis of a crossed cerebellar diaschisis. The exact mechanisms causing ipsilateral cerebral hemispheric diaschisis await further clarification.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Karl-Franzens University, Graz, Austria
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21
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Abstract
To test the reliability of four previously proposed MRI criteria for the diagnosis of MS, we reviewed 1,500 consecutive brain scans for the presence, number, size, and location of areas of increased signal (AIS) on proton-density and T2-weighted images, unaware of the patients' clinical presentations and ages. This series included 134 subjects with a clinical diagnosis of MS. Relying exclusively on the presence of at least three or four AIS for a positive diagnosis of MS resulted in high sensitivity (90% for three AIS and 87% for four) but inadequate specificity (71% for three AIS and 74% for four) and positive predictive value (23% for three AIS and 25% for four). If one of these lesions was required to border the lateral ventricles, specificity was 92% and positive predictive value was 50% at a sensitivity of 87%. Using the Fazekas criteria (at least three AIS and two of the following features: abutting body of lateral ventricles, infratentorial lesion location, and size > 5 mm) led to a further highly significant improvement of specificity (96%; p = 0.0000) and increase of the positive predictive value (65%) at the expense of a less significant decrease in sensitivity (81%; p < 0.01).
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Affiliation(s)
- H Offenbacher
- Department of Neurology, Karl-Franzens University, Graz, Austria
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22
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Schmidt R, Fazekas F, Offenbacher H, Mächler H, Freidl W, Payer F, Rigler B, Harrison MI, Lechner H. Brain magnetic resonance imaging in coronary artery bypass grafts: a pre- and postoperative assessment. Neurology 1993; 43:775-8. [PMID: 8469339 DOI: 10.1212/wnl.43.4.775] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [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: 01/30/2023] Open
Abstract
We undertook a study to determine (1) the frequency and prognostic significance of preexisting MRI brain abnormalities in patients undergoing coronary artery bypass grafts (CABG) and (2) whether MRI can detect surgery-related brain damage in 31 neurologically asymptomatic CABG patients (mean age, 61.0 +/- 6.6 years). MRIs were performed within 7 days before and 8 to 17 days after surgery. When we compared the preoperative images with those of 31 age- and risk factor-matched neurologically asymptomatic controls free of cardiac disease (mean age, 60.3 +/- 6.1 years), higher rates of thromboembolic infarcts (16% versus 0%), lacunes (58.1% versus 32.3%), and brainstem lesions (22.6% versus 3.8%) were noted. Subjective rating demonstrated significantly larger ventricles in patients than in controls (p = 0.002). CABG candidates also had significantly increased ventricular-to-intracranial cavity ratios (VICR) as determined by semiquantitative volumetric measurements (6.9 +/- 2.5% versus 4.9 +/- 1.6%; p = 0.0004). Eleven patients had postsurgical complications, with eight having symptoms consistent with diffuse encephalopathy. The only MRI finding that separated encephalopathic from complication-free patients was ventricular size (VICR 9.0 +/- 2.5% versus 4.9 +/- 1.6%; p = 0.006). This difference remained statistically significant after adjustment for the effects of age (p = 0.04). Postoperative MRI consistently failed to demonstrate surgery-related brain damage responsible for the encephalopathy.
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Affiliation(s)
- R Schmidt
- Department of Neurology, Karl-Franzens University Graz, Austria
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23
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Kleinert G, Fazekas F, Kleinert R, Schmidt R, Payer F, Offenbacher H, Lechner H. Bilateral medial medullary infarction: magnetic resonance imaging and correlative histopathologic findings. Eur Neurol 1993; 33:74-6. [PMID: 8440293 DOI: 10.1159/000116906] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [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: 01/30/2023]
Abstract
Bilateral medial medullary infarction is a rare event which clinically presents with flaccid tetraplegia sparing the face, bilateral disturbance of deep sensation, hypoglossal nerve palsy and respiratory failure. We here report a patient with such symptoms in whom magnetic resonance imaging enabled the detection of signal abnormalities in the lower brainstem as soon as 9 h after onset. Results of a control study 3 weeks later correlated well with the extent of infarction that was seen at autopsy. Early lesion detection in the lower medulla by magnetic resonance imaging and the unfavorable prognosis of patients with ischemic damage at that location may provide the rationale for aggressive therapeutic strategies in such a condition.
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Affiliation(s)
- G Kleinert
- Department of Neurology, Karl-Franzens University, Graz, Austria
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24
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Schmidt R, Fazekas F, Kleinert G, Offenbacher H, Gindl K, Payer F, Freidl W, Niederkorn K, Lechner H. Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matter. A comparative study between stroke patients and normal volunteers. Arch Neurol 1992; 49:825-7. [PMID: 1524515 DOI: 10.1001/archneur.1992.00530320049011] [Citation(s) in RCA: 167] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Mixed population studies suggest a relationship between deep and subcortical white matter hyperintensities on magnetic resonance imaging and cerebrovascular disease. To further clarify this issue we compared the prevalence and extent of such signal abnormalities between a group of 133 consecutive stroke patients (mean age, 54.7 +/- 16.7 years) and 101 normal volunteers (mean age, 54.7 +/- 13.1 years). Diabetes and cardiac disease were significantly more common in patients than in normal subjects. Prevalence rates of clinically silent lesions were 44% and 47.5%, respectively. Beginning confluent and confluent foci were seen in 19.5% of patients, but in only 7.5% of normal subjects. Significant univariate correlations were found for the presence and extent of lesions with age, diabetes, cardiac disease, severity of extracranial carotid arteriosclerosis, and arterial hypertension, but not with the diagnosis of stroke or the type of brain infarction. Multivariate regression analysis established age and diabetes mellitus as the only independent predictors of white matter damage. We conclude that more extensive white matter abnormalities in stroke patients stem from their higher rate of cerebrovascular risk factors but are unrelated to the occurrence of ischemic attacks per se.
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Affiliation(s)
- R Schmidt
- Department of Neurology, Karl Franzens University, Graz, Austria
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25
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Abstract
Studies on the prevalence of MRI signal abnormalities in the brains of migraineurs have yielded controversial results. In order to provide further data on this issue we reviewed the MRI scans of 38 migraine patients without current neurologic symptoms (mean age 35.8 +/- 11.9 years). In addition, we compared the findings in those 24 migraineurs under 50 years without major cerebrovascular risk factors (mean age 30.1 +/- 9.0 years) to that in 14 headache and risk factor free volunteers (mean age 37.8 +/- 5.3 years). Overall, focal areas of hyperintense signal were seen in 15 (39%) patients. They were present on both proton density and T2-weighted spin-echo sequences. Lesion prevalence varied according to the type of headache (18% in migraine without aura, 53% in migraine with typical aura, 38% in basilar migraine). The subset of migraine patients under 50 years exhibited MRI signal abnormalities more than twice as often as controls (33% vs. 14%). Punctate white matter hyperintensities were the predominant finding and were seen in 10 of 15 individuals with MRI lesions. More striking signal abnormalities consisted of symmetrical areas of hyperintensity lateral to the posterior horns in two 24 year old patients and of extensive white matter damage with lacunar infarcts in a 59 year old woman. Our findings confirm a higher prevalence of MRI lesions in a mixed group of migraineurs than in headache free individuals. Signal abnormalities are most often non-specific, however their occurrence relates to the type of migraine.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Karl-Franzens University, Graz, Austria
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26
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Offenbacher H, Fazekas F, Reisecker F, Schmidt R, Payer F, Lechner H. Superficial siderosis of the spinal cord: a rare cause of myelopathy diagnosed by MRI. Neurology 1991; 41:1987-9. [PMID: 1745361 DOI: 10.1212/wnl.41.12.1987] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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: 12/28/2022] Open
Abstract
Repeated bleeding into CSF spaces may cause superficial siderosis with progressive neurologic impairment. The unique physical properties of MRI provide a basis for the in vivo diagnosis of this entity.
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Affiliation(s)
- H Offenbacher
- Department of Neurology, Karl-Franzens University, Graz, Austria
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27
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Offenbacher H, Fazekas F, Schmidt R, Kleinert R, Payer F, Kleinert G, Lechner H. MRI in tuberculous meningoencephalitis: report of four cases and review of the neuroimaging literature. J Neurol 1991; 238:340-4. [PMID: 1940987 DOI: 10.1007/bf00315335] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [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: 12/29/2022]
Abstract
The contribution of MRI is reported in four adult patients with tuberculous meningoencephalitis (TbM) and with autopsy correlation in one. Contrast-enhanced T1-weighted MRI revealed the characteristic basal meningeal inflammation of TbM and its focal spreading into adjacent brain. Mixed and T2-weighted pulse sequences delineated a plethora of parenchymal abnormalities. Their relation to TbM was established by a close matching of the patient's neurological findings, contrast enhancement or a change in lesion size. The latter accurately reflected the clinical course in all patients. It remained difficult, however, to distinguish between ischaemic and inflammatory changes, which in some locations were intermixed even histologically. From our experience and that of other groups, MRI provides more diagnostic information in TbM than CT. Moreover, MRI promises to be a useful tool for monitoring treatment response.
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Affiliation(s)
- H Offenbacher
- Universitätsklinik für Neurologie, Karl-Franzens Universität, Graz, Austria
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28
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Schmidt R, Fazekas F, Offenbacher H, Lytwyn H, Blematl B, Niederkorn K, Horner S, Payer F, Freidl W. Magnetic resonance imaging white matter lesions and cognitive impairment in hypertensive individuals. Arch Neurol 1991; 48:417-20. [PMID: 2012517 DOI: 10.1001/archneur.1991.00530160087019] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
To search for a morphologic basis of cognitive impairment possibly associated with essential hypertension, we studied 35 otherwise asymptomatic hypertensive individuals (mean age, 38.7 years; range, 22 to 49 years) and 20 normotensive control subjects (mean age, 37.9 years; range, 26 to 49 years) using neuropsychologic tests and magnetic resonance imaging. Irrespective of drug treatment, hypertensive individuals performed significantly worse than did control subjects when assessed for verbal memory and total learning and memory capacity, while there were no differences in test results of visual memory, attention, vigilance, and reaction time. The hypertensive individuals also described themselves as less active but ranked similar on five other mood subscales. Punctate high-signal intensities of the white matter were found almost twice as often in the hypertensive group (38%) as in the control group (20%). There was no difference in test performance between hypertensive individuals with and those without white matter lesions, however. Our results confirm the presence of subtle neuropsychologic deficits and indicate a higher frequency of white matter signal abnormalities in essential hypertension, as shown on magnetic resonance imaging, but do not indicate a correlation of these findings with each other.
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Affiliation(s)
- R Schmidt
- Department of Neurology, Karl Franzens University Graz, Austria
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29
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Horina JH, Fazekas F, Niederkorn K, Payer F, Valetitsch H, Winkler HM, Horner S, Freidl W, Pogglitsch H, Krejs GJ. Cerebral hemodynamic changes following treatment with erythropoietin. Nephron Clin Pract 1991; 58:407-12. [PMID: 1922604 DOI: 10.1159/000186471] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 12/29/2022] Open
Abstract
Adverse hemorheologic effects induced by erythropoietin (EPO) treatment of renal anemia may pose a cerebrovascular risk. We therefore investigated the changes in cerebral perfusion, cerebral blood flow velocity (BFV) and neuropsychologic performance in 11 patients (mean age 37 years) receiving EPO. In response to EPO there was a significant (p less than 0.01) increase in hematocrit (35%), hemoglobin (43%) and whole-blood viscosity (50% at high and 90% at low shear rate). The initially increased blood flow velocity dropped significantly (p less than 0.05) and returned toward normal values in the middle cerebral arteries and the basilar artery (22 and 19% decrease, respectively). Global cerebral blood flow (CBF) decreased by 10% (not significant). The score of the Wechsler Adult Intelligence Scale digit symbol test improved significantly (p less than 0.01) after EPO treatment. None of the patients developed cerebrovascular symptoms or side effects. We conclude that the hematologic and rheologic changes following EPO treatment cause CBF and BFV to return toward normal and improve neuropsychologic performance in patients with end-stage renal disease.
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Affiliation(s)
- J H Horina
- Department of Internal Medicine, Karl Franzens University, Graz, Austria
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30
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Fazekas F, Kleinert R, Offenbacher H, Payer F, Schmidt R, Kleinert G, Radner H, Lechner H. The morphologic correlate of incidental punctate white matter hyperintensities on MR images. AJNR Am J Neuroradiol 1991; 12:915-21. [PMID: 1950921 PMCID: PMC8333504] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Postmortem examinations were made of the brains of six patients, 52-63 years old, who exhibited incidental punctate white matter hyperintensities on MR images before death. Our aim was to unravel the morphologic correlate of such lesions. By repeating the MR study after fixation on four specimens, cutting the brain parallel to the MR imaging plane, and examining whole-hemisphere microscopic sections, we optimized lesion identification. The white matter signal abnormalities were better delineated on pre- than postmortem scans, and visual inspection of the brain slices was normal in all but one location. Histologically, we found areas of reduced myelination with atrophy of the neuropil around fibrohyalinotic arteries as well as different stages of perivenous damage. The latter ranged from spongiform transformation of the neuropil and scattered foci of demyelination to large perivenous areas with marked rarefaction of myelinated fibers. Edematous glial swelling in foci of ganglion cell heterotopia caused subcortical white matter hyperintensities in one case. Our results suggest minor perivascular damage but not infarction as the most likely substrate of punctate MR white matter hyperintensities in elderly brains. Histologic correlations with MR images obtained during life or with studies of unfixed material are necessary to analyze such small lesions.
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Affiliation(s)
- F Fazekas
- Department of Neurology, Karl-Franzens University, Graz, Austria
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