An Approach to Extract Low-Grade Tumor from Brain MRI Slice Using Soft-Computing Scheme

Abstract BACKGROUND MAPK pathway is the hallmark of pediatric low grade gliomas (pLGGs); hyperactivation of mTOR (mammalian target of rapamycin) might be a suitable biomarker for therapeutic response. We investigated the feasibility of Everolimus, mTOR inhibitor, in patients affected by pLGGs. METHODS Patients 1 to 18 years old, diagnosed with pLGG, with a positive tumor biopsy for mTOR/phospho-mTOR and radiological and / or clinical disease progression, treated at Bambino Gesù Children’s Hospital in Rome were evaluated. Tumor DNA methylation analysis was performed in 10 cases. Exclusion criteria included: Tuberous Sclerosis patients, Sub Ependymal Giant Astrocytoma. Everolimus was administered orally at a dose of 2.5 mg or 5 mg daily based on body weight. Patients were evaluated with brain MRI every 4, 8 and 12 months after treatment start and every six months thereafter. RESULTS 16 patients were enrolled from September 2014 and 2019. The median age was 7.5 years old. All patients had at least one adverse event. Events rated as severe (grade 3/4) were reported in 6 patients. Stomatitis was the most frequent adverse event. One patient discontinued treatment due to grade 4 toxicity (ulcerative stomatitis and fatigue). The median duration of treatment was 21 months (4–57 months). Brain MRI evaluations have showed disease stability in 11 patients, partial response in 2 patients and disease progression in 3 patients. CONCLUSIONS Everolimus has proven to be well tolerated and effective treatment in terms of disease stability in patients with pLGGs. It’s also an excellent example of chemo-free personalized approach.

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LINC-06. OBSERVATION ONLY IN A PATIENT WITH SUSPECTED LOW GRADE GLIOMA. SHOULD NEUROSURGERY ALWAYS BE THE FIRST STEP IN LOW AND MIDDLE INCOME COUNTRIES?

Neuro-Oncology ◽

10.1093/neuonc/noaa222.441 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii379-iii379

Author(s):

Carlos Leal - Cavazos ◽

Jose Arenas-Ruiz ◽

Oscar Vidal-Gutierrez

Keyword(s):

Brain Mri ◽

Internal Capsule ◽

Pediatric Brain Tumor ◽

Clinical History ◽

Low Grade ◽

Large Tumor ◽

Middle Income ◽

Dismal Prognosis ◽

Close Observation ◽

The Right

Abstract BACKGROUND Low grade gliomas (LGGs) are the most frequent pediatric brain tumor and they comprise a variety of histologies. Complete surgery is curative but sometimes its location makes it difficult. Recent publications highlight the excellent long-term outcomes of patients with LGGs with complete and incomplete resected tumors. Current strategies are focused on reducing risks of treatment related sequelae. METHOD We describe a patient with a suspected LGG managed by close observation. We describe the case of a 6 year old female with 5 months history of focal onset seizures. During this time a brain MRI was requested and tumor was evidenced. After “tumor diagnosis” was made family visited a handful of private neurosurgeons with a uniformly dismal prognosis and high risk morbidity from procedures offered. When first seen at our Hospital, the clinical history seemed compatible with a LGG and seizures well controlled with antiepileptic drugs. Neurological examination was completely normal. MRI showed a large tumor (7x5x5 cm) hypointense on T1, hyperintense on T2, without contrast enhancement, involving the right temporal lobe white matter, insula, internal capsule, hipoccampus, thalamus and mesencephalus with middle cerebral artery encasement. Interval imaging was proposed and after 4.5 years since diagnosis the tumor has been stable and patient clinically excellent. CONCLUSION Overall survival in pediatric LGGs is excellent and risk of sequelae should always be part of multidisciplinary team considerations. In centers with significant neurosurgical morbidity, biopsy of large tumors that are compatible with LGG may not be required in selected cases.

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Low and high grade glioma segmentation in multispectral brain MRI data

Acta Universitatis Sapientiae Informatica ◽

10.2478/ausi-2018-0007 ◽

2018 ◽

Vol 10 (1) ◽

pp. 110-132 ◽

Cited By ~ 8

Author(s):

László Szilágyi ◽

David Iclănzan ◽

Zoltán Kapás ◽

Zsófia Szabó ◽

Ágnes Győrfi ◽

...

Keyword(s):

Early Stage ◽

Brain Mri ◽

High Grade Glioma ◽

Detection Algorithm ◽

Gabor Wavelet ◽

Low Grade ◽

Data Sets ◽

Morphological Operations ◽

High Grade ◽

Mass Screening System

Abstract Several hundreds of thousand humans are diagnosed with brain cancer every year, and the majority dies within the next two years. The chances of survival could be easiest improved by early diagnosis. This is why there is a strong need for reliable algorithms that can detect the presence of gliomas in their early stage. While an automatic tumor detection algorithm can support a mass screening system, the precise segmentation of the tumor can assist medical staff at therapy planning and patient monitoring. This paper presents a random forest based procedure trained to segment gliomas in multispectral volumetric MRI records. Beside the four observed features, the proposed solution uses 100 further features extracted via morphological operations and Gabor wavelet filtering. A neighborhood-based post-processing was designed to regularize and improve the output of the classifier. The proposed algorithm was trained and tested separately with the 54 low-grade and 220 high-grade tumor volumes of the MICCAI BRATS 2016 training database. For both data sets, the achieved accuracy is characterized by an overall mean Dice score > 83%, sensitivity > 85%, and specificity > 98%. The proposed method is likely to detect all gliomas larger than 10 mL.

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Developing an innovative soft computing scheme for prediction of air overpressure resulting from mine blasting using GMDH optimized by GA

Engineering With Computers ◽

10.1007/s00366-019-00720-5 ◽

2019 ◽

Vol 36 (2) ◽

pp. 647-654 ◽

Cited By ~ 5

Author(s):

Wei Gao ◽

Abdulrahman Saad Alqahtani ◽

Azath Mubarakali ◽

Dinesh Mavaluru ◽

Seyedamirhesam khalafi

Keyword(s):

Soft Computing ◽

Air Overpressure ◽

Computing Scheme

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Semiautomatic segmentation and follow-up of multicomponent low-grade tumors in longitudinal brain MRI studies

Medical Physics ◽

10.1118/1.4871040 ◽

2014 ◽

Vol 41 (5) ◽

pp. 052303 ◽

Cited By ~ 16

Author(s):

Lior Weizman ◽

Liat Ben Sira ◽

Leo Joskowicz ◽

Daniel L. Rubin ◽

Kristen W. Yeom ◽

...

Keyword(s):

Brain Mri ◽

Low Grade ◽

Semiautomatic Segmentation ◽

Mri Studies

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Parahippocampal Corpora Amylacea

Neurosurgery ◽

10.1227/01.neu.0000369196.94664.4e ◽

2010 ◽

Vol 66 (6) ◽

pp. E1206-E1207 ◽

Cited By ~ 8

Author(s):

Taylor J. Abel ◽

Adam O. Hebb ◽

C. Dirk Keene ◽

Donald E. Born ◽

Daniel L. Silbergeld

Keyword(s):

Hippocampal Sclerosis ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

High Density ◽

Low Grade ◽

Corpora Amylacea ◽

Hypoxic Injury ◽

Migraine Headaches ◽

History Of ◽

Magnetic Resonance Imaging Mri

Abstract OBJECTIVE Corpora amylacea (CA) normally accumulate within perivascular, subpial, and subependymal astrocytic processes. CA are associated with a number of conditions including normal aging, hippocampal sclerosis associated with temporal lobe epilepsy, multiple sclerosis, Lafora-type progressive myoclonic epilepsy, and adult polyglucosan body disease. Reports of massive localized accumulation of CA in the brain outside of these conditions are rare. CLINICAL PRESENTATION A 49-year-old woman, with a long-standing history of migraine headaches, presented to her primary care provider for increased headache duration. Brain magnetic resonance imaging (MRI) revealed a left parahippocampal lesion, suggestive of low-grade glioma. INTERVENTION Given the MRI suggestive of left parahippocampal glioma, left-sided frontotemporal craniotomy was performed for resection of the lesion. Specimens obtained during the operation revealed focal high-density accumulation of CA with no evidence of neoplasm, ischemia, or hypoxic injury. CONCLUSION This case illustrates the possibility that localized high-density CA accumulation can present as an intrinsic lesion on brain MRI. CA should be included in the differential diagnosis for patients presenting with brain MRI suggestive of nonenhancing space-occupying lesions.

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Strategies to maximize resection of complex, or high surgical risk, low-grade gliomas

Neurosurgical FOCUS ◽

10.3171/2012.12.focus12338 ◽

2013 ◽

Vol 34 (2) ◽

pp. E5 ◽

Cited By ~ 16

Author(s):

Jessica A. Wilden ◽

Jason Voorhies ◽

Kristine M. Mosier ◽

Darren P. O'Neill ◽

Aaron A. Cohen-Gadol

Keyword(s):

Seizure Control ◽

Diffusion Tensor ◽

Brain Mri ◽

Awake Craniotomy ◽

Low Grade ◽

Normal Brain ◽

Surgical Risk ◽

Motor Mapping ◽

Low Grade Gliomas ◽

High Surgical Risk

Object Early and aggressive resection of low-grade gliomas (LGGs) leads to increased overall patient survival, decreased malignant progression, and better seizure control. This case series describes the authors' approach to achieving optimal neurological and surgical outcomes in patients referred by outside neurosurgeons for stereotactic biopsy of tumors believed to be complex or a high surgical risk, due to their diffuse nature on neuroimaging and their obvious infiltration of functional cortex. Methods Seven patients underwent individualized neuroimaging evaluation preoperatively, which included routine brain MRI with and without contrast administration for intraoperative neuronavigation, functional MRI with speech and motor mapping, diffusion tensor imaging to delineate white matter tracts, and MR perfusion to identify potential foci of higher grade malignancy within the tumor. Awake craniotomy with intraoperative motor and speech mapping was performed in all patients. Tumor removal was initiated through a transsylvian approach for insular lesions, and through multiple corticotomies in stimulation-confirmed noneloquent areas for all other lesions. Resection was continued until neuronavigation indicated normal brain, cortical or subcortical stimulation revealed functional cortex, or the patient began to experience a minor neurological deficit on intraoperative testing. Results Gross-total resection was achieved in 1 patient and subtotal resection (> 80%) in 6 patients, as assessed by postoperative MRI. Over the average follow-up duration of 31 months, no patient experienced a progression or recurrence. Long-term seizure control was excellent in 6 patients who achieved Engel Class I outcomes. Neurologically, all 7 patients experienced mild temporary deficits or seizures that completely resolved, and 1 patient continues to have mild expressive aphasia. Conclusions Significant resection of diffuse, infiltrating LGGs is possible, even in presumed eloquent cortex. Aggressive resection maximizes seizure control and does not necessarily cause permanent neurological deficits. Individualized preoperative neuroimaging evaluation, including tractography and awake craniotomy with intraoperative speech and motor mapping, is an essential tool in achieving these outcomes.

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Brain Tumor Detection from MR Images Employing Fuzzy Graph Cut Technique

Recent Advances in Computer Science and Communications ◽

10.2174/2213275912666181207152633 ◽

2020 ◽

Vol 13 (3) ◽

pp. 362-369 ◽

Cited By ~ 2

Author(s):

Jyotsna Dogra ◽

Shruti Jain ◽

Ashutosh Sharma ◽

Rajiv Kumar ◽

Meenakshi Sood

Keyword(s):

Performance Metrics ◽

Brain Mri ◽

Tumor Detection ◽

Graph Cut ◽

Tumor Segmentation ◽

Low Grade ◽

Seed Selection ◽

Selection Technique ◽

Kernel Selection ◽

Mri Image

Background: This research aims at the accurate selection of the seed points from the brain MRI image for the detection of the tumor region. Since, the conventional way of manual seed selection leads to inappropriate tumor extraction therefore, fuzzy clustering technique is employed for the accurate seed selection for performing the segmentation through graph cut method. Methods: In the proposed method Fuzzy Kernel Seed Selection technique is used to define the complete brain MRI image into different groups of similar intensity. Among these groups the most accurate kernels are selected empirically that show highest resemblance with the tumor. The concept of fuzziness helps making the selection even at the boundary regions. Results: The proposed Fuzzy kernel selection technique is applied on the BraTS dataset. Among the four modalities, the proposed technique is applied on Flair images. This dataset consists of Low Grade Glioma (LGG) and High Grade Glioma (HGG) tumor images. The experiment is conducted on more than 40 images and validated by evaluating the following performance metrics: 1. Disc Similarity Coefficient (DSC), 2. Jaccard Index (JI) and 3. Positive Predictive Value (PPV). The mean DSC and PPV values obtained for LGG images are 0.89 and 0.87 respectively; and for HGG images it is 0.92 and 0.90 respectively. Conclusion: On comparing the proposed Fuzzy kernel selection graph cut technique approach with the existing techniques it is observed that the former provides an automatic accurate tumor detection. It is highly efficient and can provide a better performance for HGG and LGG tumor segmentation in clinical application.

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Bilateral peripheral facial paralysis during pregnancy: a presentation of acute HIV seroconversion

BMJ Case Reports ◽

10.1136/bcr-2021-242150 ◽

2021 ◽

Vol 14 (5) ◽

pp. e242150

Author(s):

Adam T Ladzinski ◽

Nicholas B George ◽

Brett W Jagger

Keyword(s):

Hiv Infection ◽

Facial Paralysis ◽

Brain Mri ◽

Cervical Lymphadenopathy ◽

Fourth Generation ◽

Low Grade ◽

Peripheral Facial Paralysis ◽

Early Postpartum ◽

Hiv Seroconversion ◽

Cerebrospinal Fluid Pleocytosis

A G7P5A1 woman in her 40s presented to the emergency department at 37 weeks 3 days’ estimated gestational age (EGA) with headache, lip tingling and several days of difficulty speaking. Physical examination demonstrated bilateral facial weakness in a peripheral distribution, as well as decreased corneal reflexes and cervical lymphadenopathy. Routine fourth generation HIV screening had previously been negative at 14 and 28 weeks’ EGA. Brain MRI was unremarkable, and lumbar puncture disclosed a low-grade, mononuclear cerebrospinal fluid pleocytosis; the patient was treated supportively. She returned for induction of labour at 39 weeks, at which time HIV infection was unexpectedly diagnosed. While unilateral idiopathic peripheral facial paralysis is associated with the third trimester of pregnancy and the early postpartum period, bilateral facial paralysis is rare and should prompt work-up for an underlying systemic cause, such as HIV infection.

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Brain involvement by leprosy presenting as a frontal cystic lesion

Journal of Neurosurgery ◽

10.3171/2014.1.jns131429 ◽

2014 ◽

Vol 121 (1) ◽

pp. 184-188 ◽

Cited By ~ 4

Author(s):

Kyung-Hwa Lee ◽

Kyung-Sub Moon ◽

Sook Jung Yun ◽

Young Ho Won ◽

Jae-Hyuk Lee ◽

...

Keyword(s):

Cystic Lesion ◽

Polymerase Chain Reaction Amplification ◽

Brain Mri ◽

Lepromatous Leprosy ◽

Molecular Evidence ◽

Low Grade ◽

Perivascular Spaces ◽

Cns Involvement ◽

Nested Polymerase Chain Reaction ◽

Presumptive Diagnosis

Leprosy has a predilection for peripheral nerves and is not considered to involve the CNS. The idea that the CNS is exempt from Mycobacterium leprae bacilli has been suspected from a clinical perspective or CSF study in leprosy patients. However, there has been no direct evidence for CNS involvement by leprosy in a living patient. To the best of the authors' knowledge, the present case is the first report providing histopathological and molecular evidence for CNS involvement by leprosy in a living patient. Brain MRI revealed a 2-cm cystic lesion in the right frontal lobe of the patient. The medical history revealed that the patient had been receiving multidrug therapy for borderline lepromatous leprosy. Neuronavigation-guided craniotomy and lesion removal were performed due to a presumptive diagnosis of low-grade glioma. The brain specimen demonstrated variably thickened blood vessels and densely scattered foamy macrophages in the perivascular spaces and parenchymal stroma. Fite acid-fast stain displayed red granular inclusions that were suggestive for fragmented M. leprae. M. leprae-specific nested polymerase chain reaction amplification showed positive bands, and DNA sequencing also demonstrated homology with the M. leprae genome. This case supports the notion that M. leprae can involve the cerebral cortex regardless of cranial nerve engagement.

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