Volumetric analysis and clinical outcome in 54 patients with retrobulbar hematoma

Introduction: Recent endovascular trials excluded patients with large ischemic cores on diffusion-weighted imaging (DWI) or perfusion CT using automated volumetric analysis. Hypothesis: We investigated whether the largest diameter of the DWI lesion measured on a single slice could accurately predict large ischemic cores, as defined by automated volumetric analysis; such findings could result in a simple tool for predicting clinical outcome. Methods: Magnetic resonance imaging data from the multicenter AXIS 2-trial were used. Patients were included within 9h of symptom onset and received intravenous thrombolysis if eligible. The maximum diameter of the diffusion lesion was measured on the slice with the largest lesion extension. Maximum diameters on a single slice were compared with the volumes of > 50 ml, >70ml and >100ml determined by standard volumetric analysis. We also assessed whether and for which threshold, largest lesion diameter was a predictor of poor clinical outcome defined as modified ranking scale (mRS) 5 or 6. Results: A total of 304 patients were included of which 50 (16%) presented with a carotid occlusion. 96 (32%) patients had a DWI-volume of more than 50 ml, 63 (21%) more than 70ml and 46 (15%) more than 100ml. A diameter of respectively 5.5, 6.5 and 7 cm on a single slice with the largest lesion extension was the best predictor of a DWI lesion volume of more than 50 (sensitivity (sens) 97%, specificity (spec) 80%), 70 (sens 95%, spec 83%) and 100ml (sens 100%, spec 85%). The maximum diameter was a reasonable predictor of poor clinical outcome with an AUC of 0.76 (95%CI: 0.68-0.83). The optimal cut off point was found to be 5.5 cm (sens 71%, spec 67%). Conclusion: Measuring the maximum lesion diameter on a single slice on DWI identifies patients with large ischemic cores with a high sensitivity and specificity. This finding can be useful in clinical practice and for future clinical trials where rapid and uniform decision making to exclude patients with a malignant profile from endovascular therapy is essential.

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FLAIRectomy in Supramarginal Resection of Glioblastoma Correlates With Clinical Outcome and Survival Analysis: A Prospective, Single Institution, Case Series

Operative Neurosurgery ◽

10.1093/ons/opaa293 ◽

2020 ◽

Cited By ~ 1

Author(s):

Francesco Certo ◽

Roberto Altieri ◽

Massimiliano Maione ◽

Claudio Schonauer ◽

Giuseppe Sortino ◽

...

Keyword(s):

Clinical Outcome ◽

Dna Methyltransferase ◽

Aminolevulinic Acid ◽

Intraoperative Imaging ◽

Tumor Resection ◽

Case Series ◽

Progression Free Survival ◽

Residual Tumor ◽

Volumetric Analysis ◽

Mr Images

Abstract Background Extent of tumor resection (EOTR) in glioblastoma surgery plays an important role in improving survival. Objective To analyze the efficacy, safety and reliability of fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) images used to guide glioblastoma resection (FLAIRectomy) and to volumetrically measure postoperative EOTR, which was correlated with clinical outcome and survival. Methods A total of 68 glioblastoma patients (29 males, mean age 65.8) were prospectively enrolled. Hyperintense areas on FLAIR images, surrounding gadolinium-enhancing tissue on T1-weighted MR images, were screened for signal changes suggesting tumor infiltration and evaluated for supramaximal resection. The surgical protocol included 5-aminolevulinic acid (5-ALA) fluorescence, neuromonitoring, and intraoperative imaging tools. 5-ALA fluorescence intensity was analyzed and matched with the different sites on navigated MR, both on postcontrast T1-weighted and FLAIR images. Volumetric evaluation of EOTR on T1-weighted and FLAIR sequences was compared. Results FLAIR MR volumetric evaluation documented larger tumor volume than that assessed on contrast-enhancing T1 MR (72.6 vs 54.9 cc); residual tumor was seen in 43 patients; postcontrast T1 MR volumetric analysis showed complete resection in 64 cases. O6-methylguanine-DNA methyltransferase promoter was methylated in 8/68 (11.7%) cases; wild type Isocytrate Dehydrogenase-1 (IDH-1) was found in 66/68 patients. Progression free survival and overall survival (PFS and OS) were 17.43 and 25.11 mo, respectively. Multiple regression analysis showed a significant correlation between EOTR based on FLAIR, PFS (R2 = 0.46), and OS (R2 = 0.68). Conclusion EOTR based on FLAIR and 5-ALA fluorescence is feasible. Safety of resection relies on the use of neuromonitoring and intraoperative multimodal imaging tools. FLAIR-based EOTR appears to be a stronger survival predictor compared to gadolinium-enhancing, T1-based resection.

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Longitudinal 8-year Brain Volumetric Analysis in 35 CLN3 Patients: Successful Development of a Sensitive Marker to Measure Clinical Outcome

Neuropediatrics ◽

10.1055/s-0037-1602904 ◽

2017 ◽

Vol 48 (S 01) ◽

pp. S1-S45

Author(s):

J. Hochstein ◽

M. Nickel ◽

U. Löbel ◽

M. Grosser ◽

J. Sedlacik ◽

...

Keyword(s):

Clinical Outcome ◽

Volumetric Analysis ◽

Successful Development ◽

Sensitive Marker

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Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome

Pediatric Neurosurgery ◽

10.1159/000513407 ◽

2021 ◽

Vol 56 (1) ◽

pp. 35-44

Author(s):

Ahmad F. Tamimi ◽

Nosaiba T. Al Ryalat ◽

Amer K. Al Qaisi ◽

Malik E. Juweid ◽

Fatimah N. Obeidat ◽

...

Keyword(s):

Clinical Outcome ◽

Volumetric Analysis ◽

Symptom Improvement ◽

Percentage Decrease ◽

Post Surgery ◽

System Versus ◽

Microsurgical Fenestration ◽

Picture Archiving And Communication ◽

Volumetric Methods

Introduction: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. Methods: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. Results: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). Discussion/Conclusion: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.

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