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Kumar VA, Lee J, Liu HL, Allen JW, Filippi CG, Holodny AI, Hsu K, Jain R, McAndrews MP, Peck KK, Shah G, Shimony JS, Singh S, Zeineh M, Tanabe J, Vachha B, Vossough A, Welker K, Whitlow C, Wintermark M, Zaharchuk G, Sair HI. Recommended Resting-State fMRI Acquisition and Preprocessing Steps for Preoperative Mapping of Language and Motor and Visual Areas in Adult and Pediatric Patients with Brain Tumors and Epilepsy. AJNR Am J Neuroradiol 2024; 45:139-148. [PMID: 38164572 DOI: 10.3174/ajnr.a8067] [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: 07/23/2023] [Accepted: 10/12/2023] [Indexed: 01/03/2024]
Abstract
Resting-state (rs) fMRI has been shown to be useful for preoperative mapping of functional areas in patients with brain tumors and epilepsy. However, its lack of standardization limits its widespread use and hinders multicenter collaboration. The American Society of Functional Neuroradiology, American Society of Pediatric Neuroradiology, and the American Society of Neuroradiology Functional and Diffusion MR Imaging Study Group recommend specific rs-fMRI acquisition approaches and preprocessing steps that will further support rs-fMRI for future clinical use. A task force with expertise in fMRI from multiple institutions provided recommendations on the rs-fMRI steps needed for mapping of language, motor, and visual areas in adult and pediatric patients with brain tumor and epilepsy. These were based on an extensive literature review and expert consensus.Following rs-fMRI acquisition parameters are recommended: minimum 6-minute acquisition time; scan with eyes open with fixation; obtain rs-fMRI before both task-based fMRI and contrast administration; temporal resolution of ≤2 seconds; scanner field strength of 3T or higher. The following rs-fMRI preprocessing steps and parameters are recommended: motion correction (seed-based correlation analysis [SBC], independent component analysis [ICA]); despiking (SBC); volume censoring (SBC, ICA); nuisance regression of CSF and white matter signals (SBC); head motion regression (SBC, ICA); bandpass filtering (SBC, ICA); and spatial smoothing with a kernel size that is twice the effective voxel size (SBC, ICA).The consensus recommendations put forth for rs-fMRI acquisition and preprocessing steps will aid in standardization of practice and guide rs-fMRI program development across institutions. Standardized rs-fMRI protocols and processing pipelines are essential for multicenter trials and to implement rs-fMRI as part of standard clinical practice.
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Affiliation(s)
- V A Kumar
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - J Lee
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - H-L Liu
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - J W Allen
- Emory University (J.W.A.), Atlanta, Georgia
| | - C G Filippi
- Tufts University (C.G.F.), Boston, Massachusetts
| | - A I Holodny
- Memorial Sloan Kettering Cancer Center (A.I.H., K.K.P.), New York, New York
| | - K Hsu
- New York University (K.H., R.J.), New York, New York
| | - R Jain
- New York University (K.H., R.J.), New York, New York
| | - M P McAndrews
- University of Toronto (M.P.M.), Toronto, Ontario, Canada
| | - K K Peck
- Memorial Sloan Kettering Cancer Center (A.I.H., K.K.P.), New York, New York
| | - G Shah
- University of Michigan (G.S.), Ann Arbor, Michigan
| | - J S Shimony
- Washington University School of Medicine (J.S.S.), St. Louis, Missouri
| | - S Singh
- University of Texas Southwestern Medical Center (S.S.), Dallas, Texas
| | - M Zeineh
- Stanford University (M.Z., G.Z.), Palo Alto, California
| | - J Tanabe
- University of Colorado (J.T.), Aurora, Colorado
| | - B Vachha
- University of Massachusetts (B.V.), Worcester, Massachusetts
| | - A Vossough
- Children's Hospital of Philadelphia, University of Pennsylvania (A.V.), Philadelphia, Pennsylvania
| | - K Welker
- Mayo Clinic (K.W.), Rochester, Minnesota
| | - C Whitlow
- Wake Forest University (C.W.), Winston-Salem, North Carolina
| | - M Wintermark
- From the The University of Texas MD Anderson Cancer Center (V.A.K., J.L., H.-L.L., M.W.), Houston, Texas
| | - G Zaharchuk
- Stanford University (M.Z., G.Z.), Palo Alto, California
| | - H I Sair
- Johns Hopkins University (H.I.S.), Baltimore, Maryland
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Maniar YM, Peck KK, Jenabi M, Gene M, Holodny AI. Functional MRI Shows Altered Deactivation and a Corresponding Decrease in Functional Connectivity of the Default Mode Network in Patients with Gliomas. AJNR Am J Neuroradiol 2021; 42:1505-1512. [PMID: 33985945 DOI: 10.3174/ajnr.a7138] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/19/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The default mode network normally decreases in activity during externally directed tasks. Although default mode network connectivity is disrupted in numerous brain pathologies, default mode network deactivation has not been studied in patients with brain tumors. We investigated default mode network deactivation with language task-based fMRI by measuring the anticorrelation of a critical default mode network node, the posterior cingulate cortex, in patients with gliomas and controls; furthermore, we examined default mode network functional connectivity in these patients with task-based and resting-state fMRI. MATERIALS AND METHODS In 10 healthy controls and 30 patients with gliomas, the posterior cingulate cortex was identified on task-based fMRI and was used as an ROI to create connectivity maps from task-based and resting-state fMRI data. We compared the average correlation in each default mode network region between patients and controls for each correlation map and stratified patients by tumor location, hemisphere, and grade. RESULTS Patients with gliomas (P = .001) and, in particular, patients with tumors near the posterior default mode network (P < .001) showed less posterior cingulate cortex anticorrelation in task-based fMRI than controls. Patients with both left- and right-hemisphere tumors, as well as those with grade IV tumors, showed significantly lower posterior cingulate cortex anticorrelation than controls (P = .02, .03, and <.001, respectively). Functional connectivity in each default mode network region was not significantly different between task-based and resting-state maps. CONCLUSIONS Task-based fMRI showed impaired deactivation of the default mode network in patients with gliomas. The functional connectivity of the default mode network in both task-based and resting-state fMRI in patients with gliomas using the posterior cingulate cortex identified in task-based fMRI as an ROI for seed-based correlation analysis has strong overlap.
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Affiliation(s)
- Y M Maniar
- From the Department of Radiology (Y.M.M., K.K.P., M.J., M.G., A.I.H.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - K K Peck
- From the Department of Radiology (Y.M.M., K.K.P., M.J., M.G., A.I.H.), Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Medical Physics (K.K.P.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Jenabi
- From the Department of Radiology (Y.M.M., K.K.P., M.J., M.G., A.I.H.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - M Gene
- From the Department of Radiology (Y.M.M., K.K.P., M.J., M.G., A.I.H.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A I Holodny
- From the Department of Radiology (Y.M.M., K.K.P., M.J., M.G., A.I.H.), Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology (A.I.H.), Weill Medical College of Cornell University, New York, New York
- Department of Neuroscience (A.I.H.), Weill-Cornell Graduate School of the Medical Sciences, New York, New York
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Yang J, Gohel S, Zhang Z, Hatzoglou V, Holodny AI, Vachha BA. Glioma-Induced Disruption of Resting-State Functional Connectivity and Amplitude of Low-Frequency Fluctuations in the Salience Network. AJNR Am J Neuroradiol 2021; 42:551-558. [PMID: 33384293 DOI: 10.3174/ajnr.a6929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Received: 06/22/2020] [Accepted: 10/02/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive challenges are prevalent in survivors of glioma, but their neurobiology is incompletely understood. The purpose of this study was to investigate the effect of glioma presence and tumor characteristics on resting-state functional connectivity and amplitude of low-frequency fluctuations of the salience network, a key neural network associated with cognition. MATERIALS AND METHODS Sixty-nine patients with glioma (mean age, 48.74 [SD, 14.32] years) who underwent resting-state fMRI were compared with 31 healthy controls (mean age, 49.68 [SD, 15.54] years). We identified 4 salience network ROIs: left/right dorsal anterior cingulate cortex and left/right anterior insula. Average salience network resting-state functional connectivity and amplitude of low-frequency fluctuations within the 4 salience network ROIs were computed. RESULTS Patients with gliomas showed decreased overall salience network resting-state functional connectivity (P = .001) and increased amplitude of low-frequency fluctuations in all salience network ROIs (P < .01) except in the left dorsal anterior cingulate cortex. Compared with controls, patients with left-sided gliomas showed increased amplitude of low-frequency fluctuations in the right dorsal anterior cingulate cortex (P = .002) and right anterior insula (P < .001), and patients with right-sided gliomas showed increased amplitude of low-frequency fluctuations in the left anterior insula (P = .002). Anterior tumors were associated with decreased salience network resting-state functional connectivity (P < .001) and increased amplitude of low-frequency fluctuations in the right anterior insula, left anterior insula, and right dorsal anterior cingulate cortex. Patients with high-grade gliomas had decreased salience network resting-state functional connectivity compared with healthy controls (P < .05). The right anterior insula showed increased amplitude of low-frequency fluctuations in patients with grade II and IV gliomas compared with controls (P < .01). CONCLUSIONS By demonstrating decreased resting-state functional connectivity and an increased amplitude of low-frequency fluctuations related to the salience network in patients with glioma, this study adds to our understanding of the neurobiology underpinning observable cognitive deficits in these patients. In addition to more conventional functional connectivity, amplitude of low-frequency fluctuations is a promising functional-imaging biomarker of tumor-induced vascular and neural pathology.
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Affiliation(s)
- J Yang
- From the Departments of Radiology (J.Y., V.H., A.I.H., B.A.V.)
- New York University Grossman School of Medicine (J.Y.), New York University, New York, New York
| | - S Gohel
- Department of Health Informatics (S.G.), Rutgers University School of Health Professions, Newark, New Jersey
| | - Z Zhang
- Epidemiology and Biostatistics (Z.Z.)
| | - V Hatzoglou
- From the Departments of Radiology (J.Y., V.H., A.I.H., B.A.V.)
- Brain Tumor Center (V.H., A.I.H., B.A.V.), Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology (V.H., A.I.H., B.A.V.), Weill Medical College of Cornell University, New York, New York
| | - A I Holodny
- From the Departments of Radiology (J.Y., V.H., A.I.H., B.A.V.)
- Brain Tumor Center (V.H., A.I.H., B.A.V.), Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology (V.H., A.I.H., B.A.V.), Weill Medical College of Cornell University, New York, New York
- Department of Neuroscience (A.I.H.), Weill-Cornell Graduate School of the Medical Sciences, New York, New York
| | - B A Vachha
- From the Departments of Radiology (J.Y., V.H., A.I.H., B.A.V.)
- Brain Tumor Center (V.H., A.I.H., B.A.V.), Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiology (V.H., A.I.H., B.A.V.), Weill Medical College of Cornell University, New York, New York
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4
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Gohel S, Laino ME, Rajeev-Kumar G, Jenabi M, Peck K, Hatzoglou V, Tabar V, Holodny AI, Vachha B. Resting-State Functional Connectivity of the Middle Frontal Gyrus Can Predict Language Lateralization in Patients with Brain Tumors. AJNR Am J Neuroradiol 2019; 40:319-325. [PMID: 30630835 DOI: 10.3174/ajnr.a5932] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/12/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE A recent study using task-based fMRI demonstrated that the middle frontal gyrus is comparable with Broca's area in its ability to determine language laterality using a measure of verbal fluency. This study investigated whether the middle frontal gyrus can be used as an indicator for language-hemispheric dominance in patients with brain tumors using task-free resting-state fMRI. We hypothesized that no significant difference in language lateralization would occur between the middle frontal gyrus and Broca area and that the middle frontal gyrus can serve as a simple and reliable means of measuring language laterality. MATERIALS AND METHODS Using resting-state fMRI, we compared the middle frontal gyrus with the Broca area in 51 patients with glial neoplasms for voxel activation, the language laterality index, and the effect of tumor grade on the laterality index. The laterality index derived by resting-state fMRI and task-based fMRI was compared in a subset of 40 patients. RESULTS Voxel activations in the left middle frontal gyrus and left Broca area were positively correlated (r = 0.47, P < .001). Positive correlations were seen between the laterality index of the Broca area and middle frontal gyrus regions (r = 0.56, P < .0005). Twenty-seven of 40 patients (67.5%) showed concordance of the laterality index based on the Broca area using resting-state fMRI and the laterality index based on a language task. Thirty of 40 patients (75%) showed concordance of the laterality index based on the middle frontal gyrus using resting-state fMRI and the laterality index based on a language task. CONCLUSIONS The middle frontal gyrus is comparable with the Broca area in its ability to determine hemispheric dominance for language using resting-state fMRI. Our results suggest the addition of resting-state fMRI of the middle frontal gyrus to the list of noninvasive modalities that could be used in patients with gliomas to evaluate hemispheric dominance of language before tumor resection. In patients who cannot participate in traditional task-based fMRI, resting-state fMRI offers a task-free alternate to presurgically map the eloquent cortex.
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Affiliation(s)
- S Gohel
- From the Department of Health Informatics (S.G.), Rutgers University School of Health Professions, Newark, New Jersey
| | - M E Laino
- Departments of Radiology (M.E.L., M.J., K.P., V.H., A.I.H., B.V.).,Department of Radiology (M.E.L.), Catholic University of the Sacred Heart, Rome, Italy
| | - G Rajeev-Kumar
- Icahn School of Medicine at Mount Sinai (G.R.-K.), New York, New York
| | - M Jenabi
- Departments of Radiology (M.E.L., M.J., K.P., V.H., A.I.H., B.V.)
| | - K Peck
- Departments of Radiology (M.E.L., M.J., K.P., V.H., A.I.H., B.V.).,Medical Physics (K.P.)
| | - V Hatzoglou
- Departments of Radiology (M.E.L., M.J., K.P., V.H., A.I.H., B.V.)
| | - V Tabar
- Neurosurgery (V.T.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A I Holodny
- Departments of Radiology (M.E.L., M.J., K.P., V.H., A.I.H., B.V.)
| | - B Vachha
- Departments of Radiology (M.E.L., M.J., K.P., V.H., A.I.H., B.V.)
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Morales KA, Arevalo-Perez J, Peck KK, Holodny AI, Lis E, Karimi S. Differentiating Atypical Hemangiomas and Metastatic Vertebral Lesions: The Role of T1-Weighted Dynamic Contrast-Enhanced MRI. AJNR Am J Neuroradiol 2018; 39:968-973. [PMID: 29650780 DOI: 10.3174/ajnr.a5630] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 01/18/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Vertebral hemangiomas are benign vascular lesions that are almost always incidentally found in the spine. Their classic typical hyperintense appearance on T1- and T2-weighted MR images is diagnostic. Unfortunately, not all hemangiomas have the typical appearance, and they can mimic metastases on routine MR imaging. These are generally referred to as atypical hemangiomas and can result in misdiagnosis and ultimately additional imaging, biopsy, and unnecessary costs. Our objective was to assess the utility of dynamic contrast-enhanced MR imaging perfusion in distinguishing vertebral atypical hemangiomas and malignant vertebral metastases. We hypothesized that permeability and vascular density will be increased in metastases compared with atypical hemangiomas. MATERIALS AND METHODS Consecutive patients from 2011 to 2015 with confirmed diagnoses of atypical hemangiomas and spinal metastases from breast and lung carcinomas with available dynamic contrast-enhanced MR imaging were analyzed. Time-intensity curves were qualitatively compared among the groups. Perfusion parameters, plasma volume, and permeability constant were quantified using an extended Tofts 2-compartment pharmacokinetic model. Statistical significance was tested using the Mann-Whitney U test. RESULTS Qualitative inspection of dynamic contrast-enhanced MR imaging time-intensity curves demonstrated differences in signal intensity and morphology between metastases and atypical hemangiomas. Quantitative analysis of plasma volume and permeability constant perfusion parameters showed significantly higher values in metastatic lesions compared with atypical hemangiomas (P < .001). CONCLUSIONS Our data demonstrate that plasma volume and permeability constant perfusion parameters and qualitative inspection of contrast-enhancement curves can be used to differentiate atypical hemangiomas from vertebral metastatic lesions. This work highlights the benefits of adding perfusion maps to conventional sequences to improve diagnostic accuracy.
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Affiliation(s)
- K A Morales
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.).,University of Puerto Rico Medical Sciences Campus (K.A.M.), San Juan, Puerto Rico
| | - J Arevalo-Perez
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
| | - K K Peck
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.).,Medical Physics (K.K.P.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A I Holodny
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
| | - E Lis
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
| | - S Karimi
- From the Departments of Radiology (K.A.M., J.A.-P., K.K.P., A.I.H., E.L., S.K.)
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Pronin IN, Batalov AI, Zakharova NE, Fadeeva LM, Pogosbekyan EL, Goryaynov SA, Buklina SB, Ogurtsova AA, Kulikov AS, Rodionov PV, Voss HU, Peck KK, Holodny AI, Potapov AA. [Evaluation of vascular reactivity to overcome limitations of neurovascular uncoupling in BOLD fMRI of malignant brain tumors]. Zh Vopr Neirokhir Im N N Burdenko 2018; 82:21-29. [PMID: 30412153 DOI: 10.17116/neiro20188205121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The sensitivity of fMRI in identification of eloquent cortical centers in the case of large infiltrative growing tumors and pronounced peritumoral edema may be reduced or significantly limited in some cases. The main cause is an attenuated Blood-Oxygen-Level-Dependent response (BOLD) caused by pathological vascular reactivity and subsequent neurovascular uncoupling of fMRI. In our study, we attempted to overcome these limitations and increase the sensitivity of this technique in identification of eloquent cortical areas adjacent to brain tumors by using vasoreactivity features of a breath-holding test and including these data in the BOLD analysis. Local vasoreactivity using a breath-holding paradigm with the same block design of both motor and speech tests was determined in 5 healthy volunteers and 3 patients in the preoperative period (two patients with high grade gliomas and one patient with single metastasis). A coherence-based model was developed for analysis of BOLD fMRI, which took into account altered hemodynamics in peritumoral zones. Obtained coherence maps demonstrated clinically more significant activation zones that were not seen with standard methods of fMRI processing. Thus, neurovascular uncoupling that is known to affect the accuracy of the BOLD fMRI response adjacent to brain tumors may be partially overcome by including an independent measurement of vasoreactivity using a breath-holding test in the BOLD analysis.
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Affiliation(s)
- I N Pronin
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - A I Batalov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - L M Fadeeva
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - S B Buklina
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A S Kulikov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - P V Rodionov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - H U Voss
- Weill Medical College of Cornell University, New York, USA
| | - K K Peck
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - A I Holodny
- Weill Medical College of Cornell University, New York, USA; Memorial Sloan Kettering Cancer Center, New York, USA
| | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
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7
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Santos P, Peck KK, Arevalo-Perez J, Karimi S, Lis E, Yamada Y, Holodny AI, Lyo J. T1-Weighted Dynamic Contrast-Enhanced MR Perfusion Imaging Characterizes Tumor Response to Radiation Therapy in Chordoma. AJNR Am J Neuroradiol 2017; 38:2210-2216. [PMID: 28912284 DOI: 10.3174/ajnr.a5383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Chordomas notoriously demonstrate a paucity of changes following radiation therapy on conventional MR imaging. We hypothesized that dynamic contrast-enhanced MR perfusion imaging parameters of chordomas would change significantly following radiation therapy. MATERIALS AND METHODS Eleven patients with pathology-proved chordoma who completed dynamic contrast-enhanced MR perfusion imaging pre- and postradiation therapy were enrolled. Quantitative tumor measurements were obtained by 2 attending neuroradiologists. ROIs were used to calculate vascular permeability and plasma volume and generate dynamic contrast-enhancement curves. Quantitative analysis was performed to determine mean and maximum plasma volume and vascular permeability values, while semiquantitative analysis on averaged concentration curves was used to determine the area under the curve. A Mann-Whitney U test at a significance level of P < .05 was used to assess differences of the above parameters between pre- and postradiation therapy. RESULTS Plasma volume mean (pretreatment mean = 0.82; posttreatment mean = 0.42), plasma volume maximum (pretreatment mean = 3.56; posttreatment mean = 2.27), and vascular permeability mean (pretreatment mean = 0.046; posttreatment mean = 0.028) in the ROIs significantly decreased after radiation therapy (P < .05); this change thereby demonstrated the potential for assessing tumor response. Area under the curve values also demonstrated significant differences (P < .05). CONCLUSIONS Plasma volume and vascular permeability decreased after radiation therapy, suggesting that these dynamic contrast-enhanced MR perfusion parameters may be useful for monitoring chordoma growth and response to radiation therapy. Additionally, the characteristic dynamic MR signal intensity-time curve of chordoma may provide a radiographic means of distinguishing chordoma from other spinal lesions.
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Affiliation(s)
- P Santos
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.)
| | - K K Peck
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.) .,Medical Physics (K.K.P.)
| | - J Arevalo-Perez
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.)
| | - S Karimi
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.)
| | - E Lis
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.)
| | - Y Yamada
- Radiation Oncology (Y.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A I Holodny
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.)
| | - J Lyo
- From the Departments of Radiology (P.S., K.K.P., J.A.-P., S.K., E.L., A.I.H., J.L.)
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8
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Lin X, Lee M, Buck O, Woo KM, Zhang Z, Hatzoglou V, Omuro A, Arevalo-Perez J, Thomas AA, Huse J, Peck K, Holodny AI, Young RJ. Diagnostic Accuracy of T1-Weighted Dynamic Contrast-Enhanced-MRI and DWI-ADC for Differentiation of Glioblastoma and Primary CNS Lymphoma. AJNR Am J Neuroradiol 2016; 38:485-491. [PMID: 27932505 DOI: 10.3174/ajnr.a5023] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/07/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Glioblastoma and primary CNS lymphoma dictate different neurosurgical strategies; it is critical to distinguish them preoperatively. However, current imaging modalities do not effectively differentiate them. We aimed to examine the use of DWI and T1-weighted dynamic contrast-enhanced-MR imaging as potential discriminative tools. MATERIALS AND METHODS We retrospectively reviewed 18 patients with primary CNS lymphoma and 36 matched patients with glioblastoma with pretreatment DWI and dynamic contrast-enhanced-MR imaging. VOIs were drawn around the tumor on contrast-enhanced T1WI and FLAIR images; these images were transferred onto coregistered ADC maps to obtain the ADC and onto dynamic contrast-enhanced perfusion maps to obtain the plasma volume and permeability transfer constant. Histogram analysis was performed to determine the mean and relative ADCmean and relative 90th percentile values for plasma volume and the permeability transfer constant. Nonparametric tests were used to assess differences, and receiver operating characteristic analysis was performed for optimal threshold calculations. RESULTS The enhancing component of primary CNS lymphoma was found to have significantly lower ADCmean (1.1 × 10-3 versus 1.4 × 10-3; P < .001) and relative ADCmean (1.5 versus 1.9; P < .001) and relative 90th percentile values for plasma volume (3.7 versus 5.0; P < .05) than the enhancing component of glioblastoma, but not significantly different relative 90th percentile values for the permeability transfer constant (5.4 versus 4.4; P = .83). The nonenhancing portions of glioblastoma and primary CNS lymphoma did not differ in these parameters. On the basis of receiver operating characteristic analysis, mean ADC provided the best threshold (area under the curve = 0.83) to distinguish primary CNS lymphoma from glioblastoma, which was not improved with normalized ADC or the addition of perfusion parameters. CONCLUSIONS ADC was superior to dynamic contrast-enhanced-MR imaging perfusion, alone or in combination, in differentiating primary CNS lymphoma from glioblastoma.
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Affiliation(s)
- X Lin
- From the Departments of Neurology (X.L., A.O., A.A.T.).,Department of Neurology (X.L.), National Neuroscience Institute, Singapore
| | - M Lee
- Radiology (M.L., O.B., V.H., J.A.-P., A.I.H., R.J.Y.)
| | - O Buck
- Radiology (M.L., O.B., V.H., J.A.-P., A.I.H., R.J.Y.)
| | - K M Woo
- Epidemiology and Biostatistics (K.M.W., Z.Z.)
| | - Z Zhang
- Epidemiology and Biostatistics (K.M.W., Z.Z.)
| | - V Hatzoglou
- Radiology (M.L., O.B., V.H., J.A.-P., A.I.H., R.J.Y.).,The Brain Tumor Center (V.H., A.O., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - A Omuro
- From the Departments of Neurology (X.L., A.O., A.A.T.).,The Brain Tumor Center (V.H., A.O., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - A A Thomas
- From the Departments of Neurology (X.L., A.O., A.A.T.)
| | | | | | - A I Holodny
- Radiology (M.L., O.B., V.H., J.A.-P., A.I.H., R.J.Y.).,The Brain Tumor Center (V.H., A.O., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - R J Young
- Radiology (M.L., O.B., V.H., J.A.-P., A.I.H., R.J.Y.) .,The Brain Tumor Center (V.H., A.O., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
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9
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Holodny AI. "Am I about to Lose my Job?!": A Comment on "Computer-Extracted Texture Features to Distinguish Cerebral Radiation Necrosis from Recurrent Brain Tumors on Multiparametric MRI: A Feasibility Study". AJNR Am J Neuroradiol 2016; 37:2237-2238. [PMID: 27737854 DOI: 10.3174/ajnr.a5002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A I Holodny
- Department of Radiology Memorial Sloan-Kettering Cancer Center New York, New York
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10
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Arevalo-Perez J, Thomas AA, Kaley T, Lyo J, Peck KK, Holodny AI, Mellinghoff IK, Shi W, Zhang Z, Young RJ. T1-Weighted Dynamic Contrast-Enhanced MRI as a Noninvasive Biomarker of Epidermal Growth Factor Receptor vIII Status. AJNR Am J Neuroradiol 2015; 36:2256-61. [PMID: 26338913 DOI: 10.3174/ajnr.a4484] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 04/30/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Epidermal growth factor receptor variant III is a common mutation in glioblastoma, found in approximately 25% of tumors. Epidermal growth factor receptor variant III may accelerate angiogenesis in malignant gliomas. We correlated T1-weighted dynamic contrast-enhanced MR imaging perfusion parameters with epidermal growth factor receptor variant III status. MATERIALS AND METHODS Eighty-two consecutive patients with glioblastoma and known epidermal growth factor receptor variant III status who had dynamic contrast-enhanced MR imaging before surgery were evaluated. Volumes of interest were drawn around the entire enhancing tumor on contrast T1-weighted images and then were transferred onto coregistered dynamic contrast-enhanced MR imaging perfusion maps. Histogram analysis with normalization was performed to determine the relative mean, 75th percentile, and 90th percentile values for plasma volume and contrast transfer coefficient. A Wilcoxon rank sum test was applied to assess the relationship between baseline perfusion parameters and positive epidermal growth factor receptor variant III status. The receiver operating characteristic method was used to select the cutoffs of the dynamic contrast-enhanced MR imaging perfusion parameters. RESULTS Increased relative plasma volume and increased relative contrast transfer coefficient parameters were both significantly associated with positive epidermal growth factor receptor variant III status. For epidermal growth factor receptor variant III-positive tumors, relative plasma volume mean was 9.3 and relative contrast transfer coefficient mean was 6.5; for epidermal growth factor receptor variant III-negative tumors, relative plasma volume mean was 3.6 and relative contrast transfer coefficient mean was 3.7 (relative plasma volume mean, P < .001, and relative contrast transfer coefficient mean, P = .008). The predictive powers of relative plasma volume histogram metrics outperformed those of the relative contrast transfer coefficient histogram metrics (P < = .004). CONCLUSIONS Dynamic contrast-enhanced MR imaging shows greater perfusion and leakiness in epidermal growth factor receptor variant III-positive glioblastomas than in epidermal growth factor receptor variant III-negative glioblastomas, consistent with the known effect of epidermal growth factor receptor variant III on angiogenesis. Quantitative evaluation of dynamic contrast-enhanced MR imaging may be useful as a noninvasive tool for correlating epidermal growth factor receptor variant III expression and related tumor neoangiogenesis. This potential may have implications for monitoring response to epidermal growth factor receptor variant III-targeted therapies.
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Affiliation(s)
- J Arevalo-Perez
- From the Departments of Radiology (J.A.-P., J.L., A.I.H., R.J.Y.)
| | | | - T Kaley
- Neurology (A.A.T., T.K., I.K.M.) the Brain Tumor Center (T.K., J.L., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - J Lyo
- From the Departments of Radiology (J.A.-P., J.L., A.I.H., R.J.Y.) the Brain Tumor Center (T.K., J.L., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - A I Holodny
- From the Departments of Radiology (J.A.-P., J.L., A.I.H., R.J.Y.) the Brain Tumor Center (T.K., J.L., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - W Shi
- Epidemiology and Biostatistics (W.S., Z.Z.)
| | - Z Zhang
- Epidemiology and Biostatistics (W.S., Z.Z.)
| | - R J Young
- From the Departments of Radiology (J.A.-P., J.L., A.I.H., R.J.Y.) the Brain Tumor Center (T.K., J.L., A.I.H., R.J.Y.), Memorial Sloan Kettering Cancer Center, New York, New York.
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11
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Jenabi M, Peck KK, Young RJ, Brennan N, Holodny AI. Identification of the Corticobulbar Tracts of the Tongue and Face Using Deterministic and Probabilistic DTI Fiber Tracking in Patients with Brain Tumor. AJNR Am J Neuroradiol 2015; 36:2036-41. [PMID: 26251424 DOI: 10.3174/ajnr.a4430] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE The corticobulbar tract of the face and tongue, a critical white matter tract connecting the primary motor cortex and the pons, is rarely detected by deterministic DTI fiber tractography. Detection becomes even more difficult in the presence of a tumor. The purpose of this study was to compare identification of the corticobulbar tract by using deterministic and probabilistic tractography in patients with brain tumor. MATERIALS AND METHODS Fifty patients with brain tumor who underwent DTI were studied. Deterministic tractography was performed by using the fiber assignment by continuous tractography algorithm. Probabilistic tractography was performed by using a Monte Carlo simulation method. ROIs were drawn of the face and tongue motor homunculi and the pons in both hemispheres. RESULTS In all subjects, fiber assignment by continuous tractography was ineffectual in visualizing the entire course of the corticobulbar tract between the face and tongue motor cortices and the pons on either side. However, probabilistic tractography successfully visualized the corticobulbar tract from the face and tongue motor cortices in all patients on both sides. No significant difference (P < .08) was found between both sides in terms of the number of voxels or degree of connectivity. The fractional anisotropy of both the face and tongue was significantly lower on the tumor side (P < .03). When stratified by tumor type, primary-versus-metastatic tumors, no differences were observed between tracts in terms of the fractional anisotropy and connectivity values (P > .5). CONCLUSIONS Probabilistic tractography successfully reconstructs the face- and tongue-associated corticobulbar tracts from the lateral primary motor cortex to the pons in both hemispheres.
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Affiliation(s)
- M Jenabi
- From the Departments of Radiology (M.J., K.K.P., R.J.Y., N.B., A.I.H.)
| | - K K Peck
- From the Departments of Radiology (M.J., K.K.P., R.J.Y., N.B., A.I.H.) Medical Physics (K.K.P.)
| | - R J Young
- From the Departments of Radiology (M.J., K.K.P., R.J.Y., N.B., A.I.H.) Brain Tumor Center (R.J.Y., A.I.H.), Memorial Sloan-Kettering Cancer Center, New York, New York Department of Radiology (R.J.Y., A.I.H.), Weill Medical College of Cornell University, New York, New York
| | - N Brennan
- From the Departments of Radiology (M.J., K.K.P., R.J.Y., N.B., A.I.H.)
| | - A I Holodny
- From the Departments of Radiology (M.J., K.K.P., R.J.Y., N.B., A.I.H.) Brain Tumor Center (R.J.Y., A.I.H.), Memorial Sloan-Kettering Cancer Center, New York, New York Department of Radiology (R.J.Y., A.I.H.), Weill Medical College of Cornell University, New York, New York.
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12
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Fisicaro RA, Jiao RX, Stathopoulos C, Petrovich Brennan NM, Peck KK, Holodny AI. Challenges in Identifying the Foot Motor Region in Patients with Brain Tumor on Routine MRI: Advantages of fMRI. AJNR Am J Neuroradiol 2015; 36:1488-93. [PMID: 25882288 DOI: 10.3174/ajnr.a4292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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] [Received: 11/20/2014] [Accepted: 01/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Accurate localization of the foot/leg motor homunculus is essential because iatrogenic damage can render a patient wheelchair- or bed-bound. We hypothesized the following: 1) Readers would identify the foot motor homunculus <100% of the time on routine MR imaging, 2) neuroradiologists would perform better than nonradiologists, and 3) those with fMRI experience would perform better than those without it. MATERIALS AND METHODS Thirty-five attending-level raters (24 neuroradiologists, 11 nonradiologists) evaluated 14 brain tumors involving the frontoparietal convexity. Raters were asked to identify the location of the foot motor homunculus and determine whether the tumor involved the foot motor area and/or motor cortex by using anatomic MR imaging. Results were compared on the basis of prior fMRI experience and medical specialty by using Mann-Whitney U test statistics. RESULTS No rater was 100% correct. Raters correctly identified whether the tumor was in the foot motor cortex 77% of the time. Raters with fMRI experience were significantly better than raters without experience at foot motor fMRI centroid predictions (13 ± 6 mm versus 20 ± 13 mm from the foot motor cortex center, P = 2 × 10(-6)) and arrow placement in the motor gyrus (67% versus 47%, P = 7 × 10(-5)). Neuroradiologists were significantly better than nonradiologists at foot motor fMRI centroid predictions (15 ± 8 mm versus 20 ± 14 mm, P = .005) and arrow placement in the motor gyrus (61% versus 46%, P = .008). CONCLUSIONS The inability of experienced readers to consistently identify the location of the foot motor homunculus on routine MR imaging argues for using fMRI in the preoperative setting. Experience with fMRI leads to improved accuracy in identifying anatomic structures, even on routine MR imaging.
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Affiliation(s)
- R A Fisicaro
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - R X Jiao
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - C Stathopoulos
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - N M Petrovich Brennan
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.)
| | - K K Peck
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.) Department of Medical Physics (K.K.P.)
| | - A I Holodny
- From the Functional MRI Laboratory, Department of Radiology (R.A.F., R.X.J., C.S., N.M.P.B., K.K.P, A.I.H.) the Brain Tumor Center (A.I.H.), Memorial Sloan-Kettering Cancer Center, New York, New York.
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Nanney AD, Adel JG, Smith TR, Chandler JP, Kimmell KT, Walter K, Zacharia BE, Deibert C, Malone HR, Sonabend AM, Neugut AI, Spencer B, Bruce JN, Wang Y, Li S, Zhang Z, Chen X, You G, Yang P, Yan W, Bao Z, Yao K, Liu Y, Wang L, Jiang T, Farhoud MK, Ruge MI, Brandes AA, Ermani M, Fioravanti A, Andreoli A, Pozzati E, Bacci A, Bartolini S, Poggi R, Crisi G, Franceschi E, Recinos PF, Grabowski MM, Nowacki AS, Thompson N, Vogelbaum MA, Sun P, Krueger D, Liu Z, Kohrman M, Dagens AB, Rachinger W, Kunz M, Eigenbrod S, Lutz J, Tonn JC, Kreth FW, Duong HT, Chaloner C, Bordo G, Eisenberg A, Rosenthal K, Sim MS, Boasberg P, Faries MB, Hamid O, Kelly DF, Kreth FW, Thon N, Simon M, Westphal M, Schackert G, Nikkhah G, Hentschel B, Pietsch T, Reifenberger G, Weller M, Tonn JC, Ironside S, Perry J, Tsao M, Mainprize T, Keith J, Laperrierre N, Paszat L, Sahgal A, Hoover JM, Nwojo M, Puffer R, Parney IF, Tanaka S, Nakada M, Hayashi Y, Hamada JI, Lee IY, Ekram T, Jain R, Scarpace L, Omodon M, Rock J, Rosenblum M, Kalkanis S, Amankulor NM, Kim JH, Tabar V, Peck KK, Holodny AI, Gutin PH, Kim CY, Kim YH, Kim T, Kim IK, Kim JW, Kim YH, Han JH, Park CK, Kim DG, Jung HW, Nonaka M, Bamba Y, Kanemura Y, Nakajima S. NEUROSURGICAL TREATMENTS. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos230] [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: 11/13/2022] Open
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14
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Khadem NR, Karimi S, Peck KK, Yamada Y, Lis E, Lyo J, Bilsky M, Vargas HA, Holodny AI. Characterizing hypervascular and hypovascular metastases and normal bone marrow of the spine using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol 2012; 33:2178-85. [PMID: 22555585 DOI: 10.3174/ajnr.a3104] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The role of DCE-MR imaging in the study of bone marrow perfusion is only partially developed, though potential applications for routine use in the clinical setting are beginning to be described. We hypothesize that DCE-MR imaging can be used to discriminate between hypervascular and hypovascular metastases based on measured perfusion variables. MATERIALS AND METHODS We conducted a retrospective study of 26 patients using conventional MR imaging and DCE-MR imaging. Patients were assigned to a hypervascular or hypovascular group based on tumor pathology. ROIs were drawn around normal-appearing bone marrow (internal controls) and enhancing tumor areas. Average wash-in enhancement slope, average peak enhancement signal percentage change, and average peak enhancement signal percentage change in areas of highest wash-in enhancement slope were calculated. Indices were compared among control, hypervascular, and hypovascular groups. Conventional imaging was assessed by calculating pre- to postgadolinium signal percentage changes in hypervascular and hypovascular lesions. RESULTS Hypervascular and hypovascular tumors differed significantly with regard to wash-in enhancement slope (P < .01; hypervascular 95% CI, 22.5-26.5 AU/s; hypovascular 95% CI, 14.1-20.9 AU/s) and peak enhancement signal percentage change in areas of highest wash-in enhancement slope (P < .01; hypervascular 95% CI, 174.1-323.3%; hypovascular 95% CI, 39.5-150.5%). Peak enhancement signal percentage change over all voxels was not significant (P = .62). Areas of normal-appearing marrow showed no appreciable contrast enhancement. Conventional contrast-enhanced MR imaging was unable to differentiate between hypervascular and hypovascular tumors (P = .58). CONCLUSIONS Our data demonstrate that, unlike conventional MR imaging sequences, DCE-MR imaging may be a more accurate technique in discriminating hypervascular from hypovascular spinal metastases.
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Affiliation(s)
- N R Khadem
- Departments of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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15
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Pan C, Peck KK, Young RJ, Holodny AI. Somatotopic organization of motor pathways in the internal capsule: a probabilistic diffusion tractography study. AJNR Am J Neuroradiol 2012; 33:1274-80. [PMID: 22460344 DOI: 10.3174/ajnr.a2952] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The location of the motor pathways in the PLIC remains controversial. In the current study, we trace the fibers from the tongue, face, hand, and foot motor cortices by using probabilistic diffusion tractography and define their somatotopic organization in the PLIC. MATERIALS AND METHODS Twenty subjects were retrospectively studied. Fiber tracts were separately calculated between ROIs in the cerebral peduncle and in the 4 different motor regions in the precentral gyrus. Probabilistic connectivity maps were generated, and the voxel with the highest probability was designated as the position of the motor pathway. The PI and LI were defined as the relative anteroposterior and mediolateral locations of the motor pathways. RESULTS Tongue pathways were located anteromedial to face in 16 hemispheres (40%), with P < .05 for the PI and LI. Face pathways were located anteromedial to hand in 25 hemispheres (62.5%) with P < .05 for PI and LI. Hand pathways were anteromedial to foot in 14 hemispheres (35%) and anterior in 11 hemispheres (27.5%), with P < .05 for PI but P > .13 for LI. Group analysis showed that the somatotopic arrangement of the bilateral hemispheres was symmetric. CONCLUSIONS Probabilistic tractography demonstrated the anteroposterior alignment of the motor pathways along the long axis in the PLIC. Probabilistic tractography successfully tracked the motor pathways of the tongue, face, hand, and foot from the precentral gyrus through their intersection with the larger superior longitudinal fasciculus to the PLIC in all cases, overcoming limitations of standard (nonprobabilistic) tractography methods.
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Affiliation(s)
- C Pan
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065, USA
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16
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Young RJ, Gupta A, Shah AD, Graber JJ, Zhang Z, Shi W, Holodny AI, Omuro AMP. Potential utility of conventional MRI signs in diagnosing pseudoprogression in glioblastoma. Neurology 2011; 76:1918-24. [PMID: 21624991 DOI: 10.1212/wnl.0b013e31821d74e7] [Citation(s) in RCA: 137] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine the potential utility of conventional MRI signs in differentiating pseudoprogression (PsP) from early progression (EP). METHODS This retrospective study reviewed initial postradiotherapy MRI scans of 321 patients with glioblastoma undergoing chemotherapy and radiotherapy. A total of 93 patients were found to have new or increased enhancing mass lesions, raising the possibility of PsP. Final diagnosis of PsP or EP was established upon review of surgical specimens from a second resection or by clinical and radiologic follow-up. A total of 11 MRI signs potentially helpful in the differentiation between PsP and EP were examined on the initial post-RT MRI and were correlated with the final diagnosis through χ(2) or Fisher exact test. RESULTS Sixty-three (67.7%) of the 93 patients had EP, of which 22 (34.9%) were diagnosed by pathology. Thirty patients (32.3%) had PsP; 6 (16.7% of the 30) were diagnosed by pathology. Subependymal enhancement was predictive for EP (p = 0.001) with 38.1% sensitivity, 93.3% specificity, and 41.8% negative predictive value. The other 10 signs had no predictive value (p = 0.06-1.0). CONCLUSIONS Conventional MRI signs have limited utility in diagnosing PsP in patients with recently treated glioblastomas and worsening enhancing lesions. We did not find a sign with a high negative predictive value for PsP that would have been the most useful for the clinical physician. When present, subependymal spread of the enhancing lesion is a useful MRI marker in identifying EP rather than PsP.
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Affiliation(s)
- R J Young
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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Gupta A, Young RJ, Karimi S, Sood S, Zhang Z, Mo Q, Gutin PH, Holodny AI, Lassman AB. Isolated diffusion restriction precedes the development of enhancing tumor in a subset of patients with glioblastoma. AJNR Am J Neuroradiol 2011; 32:1301-1306. [PMID: 21596805 DOI: 10.3174/ajnr.a2479] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Most response criteria for patients with glioblastoma rely on increases in the contrast enhancing abnormality to determine tumor progression. Our aim was to determine retrospectively in patients with glioblastoma whether diffusion restriction can predict the development of new enhancing mass lesions. MATERIALS AND METHODS We reviewed the brain MR imaging scans (including DWI and ADC maps) of 208 patients with glioblastoma. Patients with restricted diffusion in or adjacent to the tumor were identified, with further analysis only performed on those patients with low-ADC lesions without enhancement. These patients were followed to determine if new concordant enhancement developed at the site of the low-ADC lesion. A Wilcoxon signed rank test, competing risk analysis, and Kaplan-Meier curves were used to compare the mean drop in ADC values, assess enhancement-free survival, and determine overall survival, respectively. RESULTS In 67 of the 208 patients (32.2%), visibly detectable restricted diffusion was seen during treatment. The study cohort was formed by the 27 patients with low-ADC lesions and no corresponding enhancement. Twenty-three (85.2%) patients developed gadolinium-enhancing tumor at the site of restricted diffusion a median of 3.0 months later (95% CI, 2.6-4.1 months). The mean decrease in ADC was 22.9% from baseline (P < .001). The 3-month enhancement-free survival probability was 0.481 (95% CI, 0.288-0.675). The 12-month overall survival probability was 0.521 (95% CI, 0.345-0.788). Restricted diffusion predicted enhancement regardless of antiangiogenic therapy with bevacizumab. CONCLUSIONS In a subset of patients with glioblastoma, development of a new focus of restricted diffusion during treatment may precede the development of new enhancing tumor.
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Affiliation(s)
- A Gupta
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - R J Young
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - S Karimi
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - S Sood
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Z Zhang
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Q Mo
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - P H Gutin
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A I Holodny
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - A B Lassman
- Department of Radiology (A.G., R.J.Y., S.K., S.S., A.I.H.), Brain Tumor Center (R.J.Y., S.K., P.H.G., A.I.H., A.B.L.), Departments of Neurosurgery (P.H.G.), Epidemiology and Biostatistics (Z.Z., Q.M.), and Neurology (A.B.L.), Memorial Sloan-Kettering Cancer Center, New York, New York
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Holodny AI, Makeyev S, Beattie BJ, Riad S, Blasberg RG. Apparent diffusion coefficient of glial neoplasms: correlation with fluorodeoxyglucose-positron-emission tomography and gadolinium-enhanced MR imaging. AJNR Am J Neuroradiol 2010; 31:1042-8. [PMID: 20150307 DOI: 10.3174/ajnr.a1989] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gd-enhancement provides essential information in the assessment of brain tumors. However, enhancement does not always correlate with histology or disease activity, especially in the setting of current therapies. Our aim was to compare FDG-PET scans to ADC maps and Gd-enhanced MR images in patients with glial neoplasms to assess whether DWI might offer information not available on routine MR imaging sequences and whether such findings have prognostic significance. MATERIALS AND METHODS Institutional review board approval was obtained for this retrospective review, which was conducted in full compliance with HIPAA regulations. Twenty-one patients (11 men and 10 women) with glial tumors underwent FDG-PET and MR imaging, including ADC and Gd- enhancement. Subjectively, regions of interest were drawn around the following areas: 1) increased FDG uptake, 2) decreased signal intensity on ADC maps, and 3) Gd-enhancement. Objectively, FDG-PET and MR images were co-registered, and pixel-by-pixel comparison of ADC to PET values was made for all regions of interest. Correlation coefficients (r values) were calculated for each region of interest. Percentage overlap between regions of interest was calculated for each case. RESULTS Subjective evaluation showed 60% of patients with excellent or good correlation between ADC maps and FDG-PET. Pixel-by-pixel comparison demonstrated r values that ranged from -0.72 to -0.21. There was significantly greater overlap between decreased ADC and increased FDG-PET uptake (67.1 +/- 15.5%) versus overlap between Gd-enhancement and increased FDG-PET uptake (54.4 +/- 27.5%) (P < .05). ADC overlap was greater with increased FDG-PET than with Gd-enhancement in 8/9 cases. Survival data revealed that the presence of restricted diffusion on ADC correlated with patient survival (P < .0001). CONCLUSIONS ADC maps in patients with brain tumors provide unique information that is analogous to FDG-PET. There is a greater overlap between ADC and FDG-PET compared with Gd-enhancement. ADC maps can serve to approximate tumor grade and predict survival.
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Affiliation(s)
- A I Holodny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
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Ruff IM, Petrovich Brennan NM, Peck KK, Hou BL, Tabar V, Brennan CW, Holodny AI. Assessment of the language laterality index in patients with brain tumor using functional MR imaging: effects of thresholding, task selection, and prior surgery. AJNR Am J Neuroradiol 2008; 29:528-35. [PMID: 18184849 DOI: 10.3174/ajnr.a0841] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Functional MR imaging (fMRI) is used to determine preoperatively the laterality of cortical language representation along with the relationship of language areas to adjacent brain tumors. The purpose of this study was to determine whether changing the statistical threshold for different language tasks influences the language laterality index (LI) for a group of controls, patients with tumor without prior surgery, and patients with tumor and prior surgery. MATERIALS AND METHODS Seven controls, 9 patients with tumor without prior surgery, and 4 patients with tumor and prior surgery performed verb-generation, phonemic fluency, and semantic fluency language tasks during fMRI. Interhemispheric activation differences between the left and right Broca regions of interest were determined by calculating language LIs. LIs were compared within each group, between groups, and between language tasks. Intraoperative electrocortical mapping or the presence of aphasia during postoperative neurology examinations or both were used as ground truth. RESULTS The language LI varied as a result of statistical thresholding, presence of tumor, prior surgery, and language task. Although patients and controls followed a similar shape in the LI curve, there was no optimal P value for determining the LI. Three patients demonstrated a shift in the LI between hemispheres as a function of statistical threshold. Verb generation was the least variable task both between tasks and across groups. CONCLUSION For preoperative patients with tumor, the LI should be examined across a spectrum of P values and a range of tasks to ensure reliability. Our data suggest that the LI may be threshold- and task-dependent, particularly in the presence of adjacent tumor.
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Affiliation(s)
- I M Ruff
- Northwestern University Feinberg School of Medicine, Chicago, Ill., USA
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Abstract
We present the first description of CT of a meningioma of the mandible in the literature. Extracranial meningiomas are exceedingly rare. There have been 3 cases of meningioma of the mandible described in the literature, but none characterized with cross-sectional imaging. We describe the clinical and CT features used to establish the diagnosis as well as how to differentiate this lesion from other pathology of the mandible.
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Affiliation(s)
- E N Mussak
- Weill Medical College of Cornell University, New York, NY, USA
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Holodny AI, Schwartz TH, Ollenschleger M, Liu WC, Schulder M. Tumor involvement of the corticospinal tract: diffusion magnetic resonance tractography with intraoperative correlation. J Neurosurg 2001; 95:1082. [PMID: 11765829 DOI: 10.3171/jns.2001.95.6.1082] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A I Holodny
- Department of Radiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey 10021, USA
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Lange G, Holodny AI, DeLuca J, Lee HJ, Yan XH, Steffener J, Natelson BH. Quantitative assessment of cerebral ventricular volumes in chronic fatigue syndrome. Appl Neuropsychol 2001; 8:23-30. [PMID: 11388120 DOI: 10.1207/s15324826an0801_4] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Previous qualitative volumetric assessment of lateral ventricular enlargement in chronic fatigue syndrome (CFS) has provided evidence for subtle structural changes in the brains of some individuals with CFS. The aim of this pilot study was to determine whether a more sensitive quantitative assessment of the lateral ventricular system would support the previous qualitative findings. In this study, we compared the total lateral ventricular volume, as well as the right and left hemisphere subcomponents in 28 participants with CFS and 15 controls. Ventricular volumes in the CFS group were larger than in control groups, a difference that approached statistical significance. Group differences in ventricular asymmetry were not observed. The results of this study provide further evidence of subtle pathophysiological changes in the brains of participants with CFS.
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Affiliation(s)
- G Lange
- Departments of Psychiatry and Radiology, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 30 Bergen Street, Newark, NJ 07107, USA.
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Holodny AI, Kirsch CF, Hameed M, Sclar G. Tumefactive fibroinflammatory lesion of the neck with progressive invasion of the meninges, skull base, orbit, and brain. AJNR Am J Neuroradiol 2001; 22:876-9. [PMID: 11337332 PMCID: PMC8174950] [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: 02/20/2023]
Abstract
SUMMARY Tumefactive fibroinflammatory lesions of the head and neck are rare. CNS involvement has not been reported. We present a histologically proven case of a tumefactive fibroinflammatory lesion that originated in the left side of the neck and progressed over 2 years to involve the meninges, the cavernous sinuses, the right temporal lobe, and the right orbit. The lesion caused destruction of the skull base and a subdural hematoma. The relationship of the present lesion to idiopathic hypertrophic pachymeningitis and Tolosa-Hunt syndrome is discussed.
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Affiliation(s)
- A I Holodny
- Department of Radiology, New Jersey Medical School, University Hospital, 150 Bergen Street, Newark, NJ 07103, USA
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Affiliation(s)
- A I Holodny
- Department of Radiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103-2714, USA
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Holodny AI, Schulder M, Liu WC, Wolko J, Maldjian JA, Kalnin AJ. The effect of brain tumors on BOLD functional MR imaging activation in the adjacent motor cortex: implications for image-guided neurosurgery. Radiology 2001; 248:971-8. [PMID: 11003273 DOI: 10.1148/radiol.2483071280] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Functional MR (fMR) imaging data coregistered to a neurosurgical navigation system have been proposed as guides for the resection of brain tumor in or adjacent to eloquent cortices. The purpose of this study was to compare data obtained from the side of the brain affected by tumor with the contralateral side and to determine if there are physiological limitations of fMR imaging in accurately determining the location of the primary motor cortex. METHODS Ten patients with tumors in or directly adjacent to the motor cortex were studied with fMR imaging (finger-tapping paradigm). fMR imaging data were analyzed using multiple R values. These data were coregistered to a real-time intraoperative neurosurgical navigation system. RESULTS Significant variability of motor cortex activation patterns was noted among individual patients. The activation volumes on the side of the tumor were significantly smaller compared with the contralateral side for all tumors not previously resected (0.66+/-0.47). This was most pronounced in glioblastomas (0.27+/-0.21). We propose that these differences were caused by a loss of autoregulation in the tumor vasculature of glioblastomas and venous effects. CONCLUSION Notwithstanding the differences noted, the motor cortex was identified successfully in all patients. This was confirmed by intraoperative physiological identification of the motor cortex and a lack of postoperative neurologic deficit.
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Affiliation(s)
- A I Holodny
- Department of Radiology, UMDNJ-New Jersey Medical School, Newark, University Hospital, 07103-2714, USA
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Holodny AI, Ollenschleger MD, Liu WC, Schulder M, Kalnin AJ. Identification of the corticospinal tracts achieved using blood-oxygen-level-dependent and diffusion functional MR imaging in patients with brain tumors. AJNR Am J Neuroradiol 2001; 22:83-8. [PMID: 11158892 PMCID: PMC7975563] [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: 02/18/2023]
Abstract
Diffusion-weighted MR imaging was used to delineate the corticospinal tract (CST) successfully and to depict its relationship to adjacent brain tumors. The CST was defined by a method by which it seems possible to delimit the distance from the CST to the main tumor mass and to show displacement and infiltration of the tract by the neoplasia. This information cannot be gathered from routine anatomic MR imaging.
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Affiliation(s)
- A I Holodny
- Department of Radiology, UMDNJ-New Jersey Medical School, Newark 07103-2714, USA
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Holodny AI, Schulder M, Liu WC, Wolko J, Maldjian JA, Kalnin AJ. The effect of brain tumors on BOLD functional MR imaging activation in the adjacent motor cortex: implications for image-guided neurosurgery. AJNR Am J Neuroradiol 2000; 21:1415-22. [PMID: 11003273 PMCID: PMC7974044] [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] [Received: 02/08/1999] [Accepted: 03/02/2000] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND PURPOSE Functional MR (fMR) imaging data coregistered to a neurosurgical navigation system have been proposed as guides for the resection of brain tumor in or adjacent to eloquent cortices. The purpose of this study was to compare data obtained from the side of the brain affected by tumor with the contralateral side and to determine if there are physiological limitations of fMR imaging in accurately determining the location of the primary motor cortex. METHODS Ten patients with tumors in or directly adjacent to the motor cortex were studied with fMR imaging (finger-tapping paradigm). fMR imaging data were analyzed using multiple R values. These data were coregistered to a real-time intraoperative neurosurgical navigation system. RESULTS Significant variability of motor cortex activation patterns was noted among individual patients. The activation volumes on the side of the tumor were significantly smaller compared with the contralateral side for all tumors not previously resected (0.66+/-0.47). This was most pronounced in glioblastomas (0.27+/-0.21). We propose that these differences were caused by a loss of autoregulation in the tumor vasculature of glioblastomas and venous effects. CONCLUSION Notwithstanding the differences noted, the motor cortex was identified successfully in all patients. This was confirmed by intraoperative physiological identification of the motor cortex and a lack of postoperative neurologic deficit.
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Affiliation(s)
- A I Holodny
- Department of Radiology, UMDNJ-New Jersey Medical School, Newark, University Hospital, 07103-2714, USA
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Vaicys C, Schulder M, Maniker A, Holodny AI. Acute posttraumatic pituitary gland hemorrhage. J Comput Assist Tomogr 2000; 24:546-7. [PMID: 10966184 DOI: 10.1097/00004728-200007000-00006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C Vaicys
- Department of Neurosurgery, Neurological Institute of New Jersey, Newark 07103-2499, USA
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Liu WC, Schulder M, Narra V, Kalnin AJ, Cathcart C, Jacobs A, Lange G, Holodny AI. Functional magnetic resonance imaging aided radiation treatment planning. Med Phys 2000; 27:1563-72. [PMID: 10947259 DOI: 10.1118/1.599022] [Citation(s) in RCA: 31] [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] [Indexed: 11/07/2022] Open
Abstract
Functional MRI (magnetic resonance imaging) allows one to noninvasively identify various eloquent cortices in the brain. The integration of cortical activation information into radiosurgical treatment planning may provide an alternative to prevent or minimize radiation damage to eloquent cortex. A novel approach of directly integrating the fMRI (functional magnetic resonance imaging) brain map into treatment planning is proposed. Three brain tumor patients have been studied using this method with motor and/or visual paradigms. Brain activation was demonstrated in eloquent cortex at the precentral gyrus (motor area) and medial occipital lobe (visual area). The activation maps were transferred to a treatment planning workstation, (XKnife), and 3D (three-dimensional) activation maps were generated and co-registered to a 3D CT (computed tomography) anatomical data set, which provided the calibration localizer, for treatment planning. Radiosurgery was designed based on both functional and structural information by the medical team consisting of a radiation oncologist, a neurosurgeon and a physicist. The average maximum dose for the tumor was 2113 cGy. The average maximum dose for tissue surrounding the tumor was 1600 cGy. The average dose with fMRI information to the eloquent cortex was 163.4 cGy over three patients, while without fMRI information it was 240.5 cGy. The average percentage dose reduction over three patients is 32%. The results suggest that using this method can reduce the dose to the eloquent cortex. This approach provides the physician with additional information for treatment planning and may spare the patient unnecessary radiation exposure to adjacent eloquent cortices.
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Affiliation(s)
- W C Liu
- Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103, USA.
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30
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Wolansky LJ, Holodny AI, Sheth MP, Axen R, Prasad V. Double-shot magnetic resonance imaging of cerebral lesions: fast spin-echo versus echo planar sequences. J Neuroimaging 2000; 10:131-7. [PMID: 10918738 DOI: 10.1111/jon2000103131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 11/28/2022] Open
Abstract
The authors compared two new rapid MRI techniques: double-shot echo-planar imaging (DS-EPI) versus double-shot fast spin-echo (DS-FSE) in the evaluation of cerebral lesions. The authors examined 35 patients with 37 lesions, which were hyperintense on long TR images. Patients were scanned with both DS-EPI and DS-FSE with a time of repetition (TR) of 10,000 milliseconds and an echo time (TE) of 80 milliseconds. Conspicuity was determined from region of interest measurements to calculate contrast to noise ratio (C/N). Visual comparisons between DS-EPI and DS-FSE, and between DS-EPI and T2-weighted conventional spin-echo (CSE) were also performed to evaluate the sequences' ability to depict hemorrhage. The mean C/N for both sequences was comparable: 36.7 for DS-FSE and 35.6 for DS-EPI, with no statistically significant difference (p = 0.77). With regards to depicting blood products, DS-EPI proved far more effective than DS-FSE and comparable to CSE. Also, DS-EPI proved to be more time-efficient, requiring 1.67 seconds per section, while DS-FSE required 3.33 seconds per section. Whereas DS-FSE and DS-EPI are comparable in their ability to depict hyperintense cerebral pathology, DS-EPI is more time-efficient, and therefore appears preferable. Because of the high magnetic susceptibility of DS-EPI, geometric distortion degrades visualization of lesions in the posterior fossa or near the sinuses. On the other hand, the high magnetic susceptibility results in high conspicuity of blood products.
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Affiliation(s)
- L J Wolansky
- Department of Radiology, New Jersey Medical School/University of Medicine and Dentistry of New Jersey, Newark 07103, USA
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31
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Holodny AI, Kisza PS, Contractor S, Liu WC. Does a herniated nucleus pulposus contribute significantly to a decrease in height of the intervertebral disc? Quantitative volumetric MRI. Neuroradiology 2000; 42:451-4. [PMID: 10929308 DOI: 10.1007/s002340000319] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [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: 11/24/2022]
Abstract
A lumbar intervertebral disc with a herniated nucleus pulposus (HNP) often exhibits a decrease in the height of the intervertebral space. Our purpose was to ascertain whether the loss of volume of an HNP is sufficient to cause a perceptible decrease in the height of the intervertebral space. MRI of 44 patients with 51 HNPs were reviewed. The volumes of the herniated material and of the intervertebral discs were calculated for every level from L1-2 to L5-S1. The average volume of the HNP was 503 +/- 301 mm3. The average volumes of all 220 intervertebral discs and of the 127 normal-appearing discs were 14,442 +/- 4200 mm3 and 17,476 +/- 2885 mm3 respectively. The average volume of the HNP represented 3.5% of the parent disc. An average HNP caused a decrease in intervertebral space height of 0.35 mm (0.56 pixels). Therefore, the loss of the volume of the HNP does not cause a significant decrease in the intervertebral space height. The average calculated decrease in the disc height is less than that reported in normal diurnal variation.
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Affiliation(s)
- A I Holodny
- Department of Radiology, UMDNJ-New Jersey Medical School, University Hospital C-320, Newark 07103-2714, USA.
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Holodny AI, Nusbaum AO, Festa S, Pronin IN, Lee HJ, Kalnin AJ. Correlation between the degree of contrast enhancement and the volume of peritumoral edema in meningiomas and malignant gliomas. Neuroradiology 1999; 41:820-5. [PMID: 10602854 DOI: 10.1007/s002340050848] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [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: 11/29/2022]
Abstract
Peritumoral edema and contrast enhancement of brain tumors are both thought to be due to breakdown of the blood-brain barrier (BBB); however, the exact mechanism by which these two phenomena occur and whether there is a quantitative or etiological relationship is not known. Our purpose was to determine whether the relationship between the breakdown of the BBB, defined radiologically as the degree of contrast enhancement, and the volume of surrounding edema is different for high-grade gliomas and meningiomas. We analyzed 13 meningiomas and 23 gliomas. A direct linear relationship between the degree of contrast enhancement (dC) and volume of peritumoral edema (V) with a high correlation coefficient (R = 0.66, P = 0.0006) was established for gliomas. A mathematical relationship between dC and V could not be established for meningioma. The findings for gliomas offer indirect radiological evidence that the defect in the BBB which causes edema is quantitatively and etiologically related to the defect in the BBB responsible for contrast enhancement. For meningiomas, the lack of a relationship between dC and V implies either that the mechanisms responsible for formation of edema and contrast enhancement are fundamentally different or that a physical barrier in certain meningiomas limits propagation of edema into the adjacent white matter.
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Affiliation(s)
- A I Holodny
- Department of Radiology, New Jersey Medical School, University Hospital C-320, 150 Bergen St., Newark, NJ 07103-2714, USA.
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Wolansky LJ, Finden SG, Chen J, Hanna R, Holodny AI, Ahmad I, Liu WC, Contractor S. Optimization of gray/white matter contrast with fast inversion recovery for myelin suppression: a comparison of fast spin-echo and echo-planar MR imaging sequences. AJNR Am J Neuroradiol 1999; 20:1653-7. [PMID: 10543636 PMCID: PMC7056192] [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: 02/14/2023]
Abstract
We compared two MR imaging sequences, fast inversion recovery for myelin suppression (FIRMS) and echo-planar FIRMS (EP-FIRMS), for depicting gray/white matter contrast. In 18 patients, the frequency bandwidth (BW) was optimized for each sequence; in nine patients, the BW was held constant. In the BW-optimized group, the mean contrast-to-noise ratio (C/N) was three times higher with the FIRMS sequence. In the BW-constant group, the mean C/N was 27% higher with the EP-FIRMS sequence; however, geometric distortion degraded the EP-FIRMS images excessively. For optimal gray/white contrast, FIRMS appears to be the superior pulse sequence.
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Affiliation(s)
- L J Wolansky
- Department of Radiology, University of Medicine and Dentistry of New Jersey, Newark 07103, USA
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Holodny AI, Kornienko VN, Pronin IN, Klimchuk OV, George AE. [The computed and magnetic resonance tomographic anatomy of the normal hippocampal area and in neurosurgical pathology]. Zh Vopr Neirokhir Im N N Burdenko 1999:10-6. [PMID: 10599158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
To make a correct diagnosis, a volumetric presentation of the anatomy of perihippocampal fluid spaces (PHFS) may be useful if there are abnormalities in the medial portion of the temporal region. Pathological processes in the region result in changes in the normal anatomy of PHFS. Hippocampal atrophy accompanied by enlarged PHFS is a sign of Alzheimer's disease (1081 patients). These changes are best detected on frontal MR images, but they can be seen at routine CT study. Hydrocephalus (88 patients) is characterized by dilatation of the lower horn of the lateral ventricles without increased dimensions of the transverse fissure. Normotensive hydrocephalus and Alzheimer's disease may be differentiated in evaluating the PHFS. The understanding of the anatomy of PHFS is useful in making a better assessment of the degree of both intra- and extracerebral tumors (in 296 patients) and arterioventricular malformations (in 12 patients) in the medial portions of the temporal regions.
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Holodny AI, Schulder M, Liu WC, Maldjian JA, Kalnin AJ. Decreased BOLD functional MR activation of the motor and sensory cortices adjacent to a glioblastoma multiforme: implications for image-guided neurosurgery. AJNR Am J Neuroradiol 1999; 20:609-12. [PMID: 10319970 PMCID: PMC7056038] [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] [Received: 10/08/1998] [Indexed: 02/12/2023]
Abstract
A patient with a glioblastoma multiforme and mild sensorimotor deficits had significantly less activation of the motor and sensory cortices on the side with the tumor than on the contralateral side on blood oxygen level-dependent (BOLD) functional MR images. This difference, which may be due to pressure effects or loss of vascular autoregulation, should be considered in preoperative planning in which BOLD functional MR imaging is used to identify eloquent cortices to be avoided during brain tumor surgery.
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Affiliation(s)
- A I Holodny
- Department of Radiology, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA
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Holodny AI, George AE, de Leon MJ, Golomb J, Kalnin AJ, Cooper PR. Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus. J Neurosurg 1998; 89:742-7. [PMID: 9817411 DOI: 10.3171/jns.1998.89.5.0742] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [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: 11/06/2022]
Abstract
OBJECT The authors describe a subgroup of patients with shunt-proven normal-pressure hydrocephalus (NPH) who presented with focal fissural and sulcal dilation on imaging studies. The specific radiological features and methods of differentiating this condition from cortical atrophy are delineated. METHODS Normal-pressure hydrocephalus has been described as dilation of the ventricles that is out of proportion to the sulci. Sulcal dilation has been taken as evidence of cortical atrophy and has even been used as a criterion to exclude patients from undergoing a shunting procedure. The authors describe five cases of patients with shunt-proven NPH who presented with focal dilation of cortical fissures and sulci. In three of the cases, there was a paradoxical decrease in the size of the dilated fissures and sulci that paralleled the decrease in the size of the lateral ventricles following successful shunting. CONCLUSIONS This study demonstrates that focal fissural and sulcal dilation may represent reservoirs of cerebrospinal fluid analogous to the ventricular system. Patients should not be denied a shunting procedure solely on the basis of focally dilated fissures of sulci.
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Affiliation(s)
- A I Holodny
- Department of Radiology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark 07103-2714, USA.
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Abstract
We describe a hemorrhagic chondroid chordoma involving the sella turcica with suprasellar extension. The CT and MRI appearances mimiked a hemorrhagic pituitary adenoma. Chondroid chordoma is a variant composed of elements of both chordoma and cartilaginous tissue. An uncommon bone neoplasm, located almost exclusively in the spheno-occipital region, it is usually not considered in the differential diagnosis of a tumor with acute hemorrhage in the sellar region. We discuss the clinical and radiological characteristics which may allow one to differentiate chondroid chordoma from other tumors of this area.
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Affiliation(s)
- H J Lee
- Department of Radiology, University Hospital, UMDNJ-NJ Medical School, Newark 07103, USA
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Schulder M, Maldjian JA, Liu WC, Holodny AI, Kalnin AT, Mun IK, Carmel PW. Functional image-guided surgery of intracranial tumors located in or near the sensorimotor cortex. J Neurosurg 1998; 89:412-8. [PMID: 9724115 DOI: 10.3171/jns.1998.89.3.0412] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.4] [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: 11/06/2022]
Abstract
OBJECT The purpose of this study was to evaluate the efficacy of noninvasive preoperative functional imaging data used in an interactive fashion in the operating room. The authors describe a method of registering preoperative functional magnetic resonance (fMR) imaging localization of sensorimotor cortex with a frameless stereotactic surgical navigation device. METHODS The day before surgery, patients underwent blood oxygen level-dependent fMR imaging while performing a finger-tapping motor paradigm. Immediately afterward an anatomical stereotactic MR image was acquired. Raw fMR imaging data were analyzed offline at a separate workstation, and the resulting functional maps were registered to a high-resolution anatomical scan. The fused functional-anatomical images were then downloaded onto a surgical navigation computer via an ethernet connection. At surgery, the brain was exposed in the standard fashion, and the sensorimotor cortex was identified by direct cortical stimulation, the use of somatosensory evoked potentials, or both. This localization was then compared with that predicted by the registered fMR study. Thirteen procedures were performed in 12 patients. The mean registration error was 2.2 mm. The predicted location of motor and/or sensory cortex matched that found on intraoperative mapping in all 12 patients tested. Maximal tumor resection was accomplished in each case and no new permanent neurological deficits resulted. CONCLUSIONS Compared with conventional brain mapping techniques, fMR image-guided surgery may allow for smaller brain exposures, localization of the language cortex with the patient under general anesthesia, and the mapping of multiple functional sites. The scanning equipment used in this method may be more readily available than for other functional imaging techniques such as positron emission tomography or magnetoencephalography.
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Affiliation(s)
- M Schulder
- Section of Neurosurgery, New Jersey Medical School, Newark, USA.
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Holodny AI, Waxman R, George AE, Rusinek H, Kalnin AJ, de Leon M. MR differential diagnosis of normal-pressure hydrocephalus and Alzheimer disease: significance of perihippocampal fissures. AJNR Am J Neuroradiol 1998; 19:813-9. [PMID: 9613493 PMCID: PMC8337558] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE In the older patient with dilated ventricles, it is often difficult to differentiate normal pressure hydrocephalus (NPH) from cerebral atrophy caused by Alzheimer disease (AD). This study was undertaken to see if dilatation of the perihippocampal fissures (PHFs) could be used as a distinguishing characteristic of these two disorders. METHODS MR images of 17 patients with AD were compared with those from an equal number of patients with NPH who improved after ventriculoperitoneal shunting. The PHFs, lateral ventricles, third ventricle, and temporal horns were graded subjectively. Objective, computer-aided volumetric measurements of the PHFs and lateral ventricles were obtained. The preshunt images of the NPH patients were evaluated. RESULTS Significant differences between the two groups were found for the PHFs and lateral ventricles by both the subjective and objective methods, with a high degree of correlation between the two methods. CONCLUSION The degree of dilatation of PHFs appears to be a sensitive and specific marker for differentiating AD from NPH by both subjective and objective means, with a very small overlap between the two groups. This observation may have relevance in day-to-day practice.
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Affiliation(s)
- A I Holodny
- Department of Radiology, New York University Medical Center, New York, USA
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Abstract
Understanding the three-dimensional anatomy of the perihippocampal fissures (PHFs) can be helpful in making the correct diagnosis of diseases of the mesial temporal lobe. Disorders of the parenchyma and cerebrospinal fluid spaces are reflected by specific changes in the PHFs. A marker for Alzheimer disease and mesial temporal sclerosis is atrophy of the hippocampus and associated dilatation of the PHFs. This finding is best visualized on coronal magnetic resonance images but can and should be appreciated on routine computed tomographic scans. Hydrocephalus is characterized by dilatation of the temporal horn of the lateral ventricle without dilatation of the transverse fissure and its extensions. Normal-pressure hydrocephalus can usually be distinguished from Alzheimer disease on the basis of the pattern of dilatation of the PHFs. Understanding the anatomy of the PHFs often makes it possible to better characterize the extents of intra- and extraaxial tumors of the mesial temporal lobe.
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Affiliation(s)
- A I Holodny
- Department of Radiology, New York University Medical Center, New York, USA
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Pronin IN, Holodny AI, Kornienko VN, Petraikin AV, Golovanov AV, Lee HJ. The use of hyperventilation in contrast-enhanced MR of brain tumors. AJNR Am J Neuroradiol 1997; 18:1705-8. [PMID: 9367318 PMCID: PMC8338456] [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: 02/05/2023]
Abstract
Angiographic studies have demonstrated improved visibility of glial tumors after hyperventilation. The present study was undertaken to determine whether hyperventilation would change the MR enhancement characteristics of various glial tumors. Eighteen patients were studied twice: once with standard contrast-enhanced MR imaging and again with standard imaging plus hyperventilation. After hyperventilation, six low-grade astrocytomas showed no change and three showed a small decrease in relative enhancement (<10%). The ependymomas showed a 10% to 13% increase in the degree of enhancement, but no change in the area of enhancement. All the anaplastic astrocytomas showed an increase in the degree of enhancement (mean, 38%). Three of the anaplastic astrocytomas showed new foci of enhancement that were not seen on the nonhyperventilation study. Hyperventilation appears to be an inexpensive and safe method for increasing the conspicuity of abnormal areas of the blood-brain barrier.
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Affiliation(s)
- I N Pronin
- Department of Radiology, Burdenko Institute of Neurosurgery, Moscow, Russia
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Holodny AI, Arutiunov NV, Kornienko VN, Gonzales R, Vaicys C, Petraikin AV, Maldjian JA. Aqueductal stenosis leading to herniation of the frontal horn of the lateral ventricle into the frontal sinus. J Comput Assist Tomogr 1997; 21:837-9. [PMID: 9294586 DOI: 10.1097/00004728-199709000-00035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- A I Holodny
- Department of Radiology, UMDNJ-New Jersey Medical School, Newark 07103-2714, USA
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Pronin IN, Holodny AI, Petraikin AV. MRI of high-grade glial tumors: correlation between the degree of contrast enhancement and the volume of surrounding edema. Neuroradiology 1997; 39:348-50. [PMID: 9189880 DOI: 10.1007/s002340050421] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [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: 02/04/2023]
Abstract
Contrast enhancement of malignant gliomas and the development of peritumoral edema are thought to be due to a breakdown of the blood-brain barrier (BBB). The degree to which these two factors are related to each other or to the degree of damage to the BBB is unknown. Our purpose was to quantitatively correlate the degree of enhancement with Gd-DTPA of anaplastic gliomas and glioblastoma multiforme with the volume of surrounding edema. In 14 patients, quantitative measurements of the volume of peritumoral edema and the degree of contrast enhancement were made. A high degree of correlation was found (r = 0.86, P < 0.01). These results can be viewed as indirect, radiological evidence that edema production is quantitatively related to the degree of breakdown of the BBB as determined by gadolinium enhancement. These results imply that the origin of the edema is in the area of breakdown of the BBB.
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Affiliation(s)
- I N Pronin
- Department of Radiology, Burdenko Institute of Neurosurgery, Moscow, Russia
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Holodny AI. San Lucas, Spanish school, early 15th century. Neurosurgery 1996; 39:211-3. [PMID: 8805166 DOI: 10.1097/00006123-199607000-00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Holodny AI, Deck M, Petito CK. Induction and subsequent rupture of aneurysms of the circle of Willis after radiation therapy in Ehlers-Danlos syndrome: a plausible hypothesis. AJNR Am J Neuroradiol 1996; 17:226-32. [PMID: 8938290 PMCID: PMC8338389] [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: 02/03/2023]
Abstract
Multiple aneurysms of the circle of Willis developed in a 62-year-old woman with Ehlers-Danlos syndrome (EDS) within 7 months of initiation of radiation therapy to the brain. A major response of the arterial wall to radiation damage is the formation of collagen. In patients with EDS, in whom there is a defect in collagen, this repair is incomplete. We propose that the incomplete repair of the arterial wall consequent to EDS resulted in weakness of these walls, formation of an aneurysm, and, ultimately, fatal subarachnoid hemorrhage.
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Affiliation(s)
- A I Holodny
- Department of Pathology, The New York Hospital-Cornell University Medical College, USA
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Godwin TA, Mercer G, Holodny AI. Fatal embolization of intestinal contents through a duodenocaval fistula. Arch Pathol Lab Med 1991; 115:93-5. [PMID: 1987923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Embolization of intestinal contents to the lung is an exceedingly rare event, which to our knowledge, has never been reported as a cause of death. Equally rare is duodenocaval fistula resulting from a penetrating duodenal peptic ulcer. We present the case of a 51-year-old man whose duodenal ulcer led to a fistulous tract with the inferior vena cava and subsequently to progressive pulmonary embolization of intestinal contents, ultimately resulting in death from respiratory failure.
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Affiliation(s)
- T A Godwin
- Department of Pathology, New York Hospital-Cornell Medical Center, NY 10021
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