scholarly journals Qualitative Assessment of Advanced MRI in Post-Treatment High Grade Gliomas Follow Up: Do We Agree?

2021 ◽  
pp. 084653712110135
Author(s):  
Nader Zakhari ◽  
Michael Taccone ◽  
Carlos Torres ◽  
Santanu Chakraborty ◽  
John Sinclair ◽  
...  
Keyword(s):  
High Grade Glioma ◽  
Interrater Agreement ◽  
Qualitative Assessment ◽  
High Grade ◽  
Rater Agreement ◽  
Enhancement Pattern ◽  
Quantitative Measurements ◽  
And Diffusion ◽  
Perfusion Maps

Purpose: MRI is commonly used in follow up of high grade glioma. Our purpose is to assess the interrater agreement on the increasingly used visual qualitative assessment of various conventional and advanced MR techniques in the setting of treated high grade glioma in comparison to the well established quantitative measurements. Methods: We prospectively enrolled HGG patients who underwent reresection of a new enhancing lesion on post-treatment 3T MR examination including DWI, DCE and DSC sequences. Two neuroradiologists objectively assessed the diffusion and perfusion maps by placing ROI on representative post-processed maps. They subjectively assessed the post-contrast, perfusion and diffusion sequences. Interrater agreement and concordance correlation coefficient were calculated. Results: Twenty-eight lesions were included. The interrater agreement on the qualitative assessment was good for k-trans (k = 0.73), moderate for Vp (k = 0.52), fair for AUC and Ve maps (k = 0.37 and 0.21), fair for corrected CBV (k = 0.39) and poor for the enhancement pattern and presence of diffusion restriction (k = 0.02 and 0.07). The concordance between the quantitative measurements was substantial for AUC and Vp (ρc = 0.98 and 0.97), moderate for k-trans and corrected CBV (ρc = 0.94) and poor for Ve and ADC (ρc = 0.86 and 0.24). Conclusion: While the quantitative measurements of DSC and DCE perfusion maps show satisfactory inter-rater agreement, the qualitative assessment has lower interobserver agreement and should not be relied upon solely in the interpretation. Similarly, the suboptimal inter-rater agreement on the interpretation of enhancement pattern and diffusion restriction potentially limits their usefulness in differentiating glioma recurrence from treatment related changes.

scholarly journals Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Robert Terziev ◽  
Dimitri Psimaras ◽  
Yannick Marie ◽  
Loic Feuvret ◽  
Giulia Berzero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
High Grade Glioma ◽  
High Grade ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Radiation Induced ◽  
Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

Enhanced Fiber Tractography Using Edema Correction: Application and Evaluation in High-Grade Gliomas

Neurosurgery ◽  
2021 ◽  
Author(s):  
Fraser Henderson Jr ◽  
Drew Parker ◽  
Anupa A Vijayakumari ◽  
Mark Elliott ◽  
Timothy Lucas ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Diffusion Tensor ◽  
Free Water ◽  
High Grade Glioma ◽  
Fiber Tracking ◽  
High Grade ◽  
Peritumoral Edema ◽  
Fiber Tractography ◽  
Motor Pathways

Abstract BACKGROUND A limitation of diffusion tensor imaging (DTI)-based tractography is peritumoral edema that confounds traditional diffusion-based magnetic resonance metrics. OBJECTIVE To augment fiber-tracking through peritumoral regions by performing novel edema correction on clinically feasible DTI acquisitions and assess the accuracy of the fiber-tracks using intraoperative stimulation mapping (ISM), task-based functional magnetic resonance imaging (fMRI) activation maps, and postoperative follow-up as reference standards. METHODS Edema correction, using our bi-compartment free water modeling algorithm (FERNET), was performed on clinically acquired DTI data from a cohort of 10 patients presenting with suspected high-grade glioma and peritumoral edema in proximity to and/or infiltrating language or motor pathways. Deterministic fiber-tracking was then performed on the corrected and uncorrected DTI to identify tracts pertaining to the eloquent region involved (language or motor). Tracking results were compared visually and quantitatively using mean fiber count, voxel count, and mean fiber length. The tracts through the edematous region were verified based on overlay with the corresponding motor or language task-based fMRI activation maps and intraoperative ISM points, as well as at time points after surgery when peritumoral edema had subsided. RESULTS Volume and number of fibers increased with application of edema correction; concordantly, mean fractional anisotropy decreased. Overlay with functional activation maps and ISM-verified eloquence of the increased fibers. Comparison with postsurgical follow-up scans with lower edema further confirmed the accuracy of the tracts. CONCLUSION This method of edema correction can be applied to standard clinical DTI to improve visualization of motor and language tracts in patients with glioma-associated peritumoral edema.

scholarly journals Impact of mass effect, tumor location, age, and surgery on the cognitive outcome of patients with high-grade gliomas: a longitudinal study

2017 ◽  
Vol 4 (4) ◽  
pp. 229-240 ◽  
Author(s):  
Monica Dallabona ◽  
Silvio Sarubbo ◽  
Stefano Merler ◽  
Francesco Corsini ◽  
Giuseppe Pulcrano ◽  
...  
Keyword(s):  
Tumor Volume ◽  
High Grade Glioma ◽  
Joint Effect ◽  
Cognitive Outcome ◽  
Tumor Localization ◽  
High Grade ◽  
Patient Age ◽  
Patient Âgé ◽  
High Grade Gliomas

Abstract Background High-grade gliomas are the most frequently occurring brain tumors and carry unfavorable prognosis. Literature is controversial regarding the effects of surgery on cognitive functions. Methods We analyzed a homogenous population of 30 patients with high-grade glioma who underwent complete resection. Patients underwent extensive neuropsychological analysis before surgery, 7 days after surgery, and approximately 40 days after surgery, before adjuvant treatments. Thirty-four neuropsychological tests were administered in the language, memory, attention, executive functions, and praxis domains. Results The preoperative percentage of patients with impairment in the considered tests ranged from 0% to 53.3% (mean 20.9%). Despite a general worsening at early follow-up, a significant recovery was observed at late follow-up. Preoperative performances in language and verbal memory tasks depended on the joint effect of tumor volume, volume of surrounding edema, and tumor localization, with major deficits in patients with left lateralized tumor, especially insular and temporal. Preoperative performances in attention and constructive abilities tasks depended on the joint effect of tumor volume, volume of surrounding edema, and patient age, with major deficits in patients ≥ 65 years old. Recovery at late follow-up depended on the volume of resected tumor, edema resorption, and patient age. Conclusions Longitudinal neuropsychological performance of patients affected by high-grade glioma depends, among other factors, on the complex interplay of tumor volume, volume of surrounding edema, tumor localization, and patient age. Reported results support the definition of criteria for surgical indication based on the above factors. They may be used to propose more customized surgical, oncological, and rehabilitative strategies.

scholarly journals High Grade tumor vs stroke. Utility of PET and MRI corregistration

ANALES RANM ◽  
2021 ◽  
Vol 138 (138(02)) ◽  
pp. 176-179
Author(s):  
M.N. Cabrera-Martín ◽  
P. Romero Fernández ◽  
M.K. Meneses Navas ◽  
P. Pérez-Segura ◽  
M. Yus Fuertes ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
High Grade Glioma ◽  
Whole Body ◽  
High Grade ◽  
Mr Images ◽  
Fdg Uptake ◽  
Area Of Interest ◽  
Pet Ct ◽  
Adjacent Brain

Sometimes, the clinical presentation of a brain tumour mimics that of stroke or viceversa. In these cases it is useful to evaluate follow-up with MR. The coregistration of PET and MR images improves the diagnostic performance of both techniques. In the area of interest, FDG uptake of any degree, with reference to the adjacent brain tissue uptake, should be considered suggestive of tumor if it corresponds to brain injury in MR, even when the FDG uptake is equal to or lower than that of the normal cerebral cortex. We present a case in which coregistration of images from both techniques contributed to the differential diagnosis of stroke and high-grade glioma, whole-body PET/CT ruled out metastatic etiology, and the results led to surgery.

scholarly journals Precise ex vivo histological validation of heightened cellularity and diffusion-restricted necrosis in regions of dark apparent diffusion coefficient in 7 cases of high-grade glioma

2014 ◽  
Vol 16 (12) ◽  
pp. 1599-1606 ◽  
Author(s):  
Peter S. LaViolette ◽  
Nikolai J. Mickevicius ◽  
Elizabeth J. Cochran ◽  
Scott D. Rand ◽  
Jennifer Connelly ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
Apparent Diffusion Coefficient ◽  
Ex Vivo ◽  
High Grade Glioma ◽  
High Grade ◽  
Apparent Diffusion ◽  
And Diffusion ◽  
Histological Validation

scholarly journals Radiological assessment schedule for high-grade glioma patients during the surveillance period using parametric modeling

2020 ◽  
Author(s):  
So Young Ji ◽  
Jongjin Lee ◽  
Joo Ho Lee ◽  
Soon-Tae Lee ◽  
Jae Kyung Won ◽  
...  
Keyword(s):  
Standard Treatment ◽  
Risk Group ◽  
High Grade Glioma ◽  
Parametric Model ◽  
Parametric Modeling ◽  
Progression Rate ◽  
High Grade ◽  
Radiological Assessment ◽  
Wild Type

Abstract Background An optimal radiological surveillance plan is crucial for high-grade glioma (HGG) patients, which is determined arbitrarily in daily clinical practice. We propose the radiological assessment schedule using a parametric model of standardized progression-free survival (PFS) curves. Methods A total of 277 HGG patients (178 glioblastoma (GBM) and 99 anaplastic astrocytoma (AA)) from a single institute who completed the standard treatment protocol were enrolled in this cohort study and retrospectively analyzed. The patients were stratified into each layered risk group by genetic signatures and residual mass or through recursive partitioning analysis. PFS curves were estimated using the piecewise exponential survival model. The criterion of a 10% progression rate among the remaining patients at each observation period was used to determine the optimal radiological assessment time point. Results The optimal follow-up intervals for MRI evaluations of the isocitrate dehydrogenase (IDH) wild-type GBM was every 7.4 weeks until 120 weeks after the end of standard treatment, followed by a 22-week inflection period and every 27.6 weeks thereafter. For the IDH mutated GBM, scans every 13.2 weeks until 151 weeks are recommended. The optimal follow-up intervals were every 22.8 weeks for the IDH wild-type AA, and 41.2 weeks for the IDH mutated AA until 241 weeks. Tailored radiological assessment schedules were suggested for each layered risk groups of the GBM and the AA patients. Conclusions The optimal schedule of radiological assessments for each layered risk group of patients with HGG could be determined from the parametric model of PFS.

scholarly journals Microneurosurgical removal of thalamic lesions: surgical results and considerations from a large, single-surgeon consecutive series

2020 ◽  
pp. 1-11
Author(s):  
Carlo Serra ◽  
Hatice Türe ◽  
Cumhur Kaan Yaltırık ◽  
Mehmet Volkan Harput ◽  
Uğur Türe
Keyword(s):  
High Grade Glioma ◽  
Extent Of Resection ◽  
Intraoperative Mri ◽  
Consecutive Series ◽  
Thalamic Lesion ◽  
High Grade ◽  
Surgical Results ◽  
The Mean ◽  
Thalamic Lesions

OBJECTIVEThe object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions.METHODSThis is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI has also been part of the protocol. The main study outcome was extent of resection. Complete neurological examination took place preoperatively, at discharge, and 3 months postoperatively. Descriptive statistics were calculated for the whole cohort.RESULTSIn the study period, 92 patients underwent surgery for a thalamic lesion: 81 gliomas, 6 cavernous malformations, 2 germinomas, 1 metastasis, 1 arteriovenous malformation, and 1 ependymal cyst. In none of the cases was a transcortical approach adopted. Thirty-five patients underwent an AIT approach, 35 a PITS, 19 a PeST, and 3 a PeCSS. The mean follow-up was 38 months (median 20 months, range 1–137 months). No patient was lost to follow-up. The mean extent of resection was 95% (median 100%, range 21%–100%), and there was no surgical mortality. Most patients (59.8%) experienced improvement in their Karnofsky Performance Status. New permanent neurological deficits occurred in 8 patients (8.7%). Early postoperative (< 3 months after surgery) problems in CSF circulation requiring diversion occurred in 7 patients (7.6%; 6/7 cases in patients with high-grade glioma).CONCLUSIONSEndoscope-assisted microsurgery allows for the removal of thalamic lesions with acceptable morbidity. Surgeons must strive to access any given thalamic lesion through one of the four accessible thalamic surfaces, as they can be reached through either a TCTV or TCi approach with no or minimal damage to normal brain parenchyma. Patients harboring a high-grade glioma are likely to develop a postoperative disturbance of CSF circulation. For this reason, the AIT approach should be favored, as it facilitates a microsurgical third ventriculocisternostomy and allows intraoperative MRI to be done.

scholarly journals High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

2014 ◽  
Vol 25 ◽  
pp. iii93-iii101 ◽  
Author(s):  
R. Stupp ◽  
M. Brada ◽  
M.J. van den Bent ◽  
J.-C. Tonn ◽  
G. Pentheroudakis
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
High Grade Glioma ◽  
High Grade

scholarly journals Recurrent high-grade glioma surgery: a multimodal intraoperative protocol to safely increase extent of tumor resection and analysis of its impact on patient outcome

2021 ◽  
Vol 50 (1) ◽  
pp. E20
Author(s):  
Giuseppe Maria Vincenzo Barbagallo ◽  
Francesco Certo ◽  
Stefania Di Gregorio ◽  
Massimiliano Maione ◽  
Marco Garozzo ◽  
...  
Keyword(s):  
Aminolevulinic Acid ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
High Grade ◽  
Functional Grade ◽  
Second Surgery ◽  
Eloquent Area ◽  
The Mean ◽  
Met Pet

OBJECTIVENo consensus exists on the best treatment for recurrent high-grade glioma (HGG), particularly in terms of surgical indications, and scant data are available on the integrated use of multiple technologies to overcome intraoperative limits and pitfalls related to artifacts secondary to previous surgery and radiotherapy. Here, the authors report on their experience with the integration of multiple intraoperative tools in recurrent HGG surgery, analyzing their pros and cons as well as their effectiveness in increasing the extent of tumor resection. In addition, they present a review of the relevant literature on this topic.METHODSThe authors reviewed all cases in which recurrent HGG had been histologically diagnosed after a first surgery and the patient had undergone a second surgery involving neuronavigation with MRI, intraoperative CT (iCT), 11C-methionine–positron emission tomography (11C-MET-PET), 5-aminolevulinic acid (5-ALA) fluorescence, intraoperative neurophysiological monitoring (IONM), and intraoperative navigated ultrasound (iUS). All cases were classified according to tumor functional grade (1, noneloquent area; 2, near an eloquent area; 3, eloquent area).RESULTSTwenty patients with recurrent HGG were operated on using a multimodal protocol. The recurrent tumor functional grade was 1 in 4 patients, 2 in 8 patients, and 3 in the remaining 8 patients. In all patients but 2, 100% EOTR was obtained. Intraoperative 5-ALA fluorescence and navigated iUS showed low specificity and sensitivity. iCT detected tumor remnants in 3 cases. Postoperatively, 6 patients (30%) had worsening neurological conditions: 4 recovered within 90 days, 1 partially recovered, and 1 experienced a permanent deficit. The median Karnofsky Performance Status remained substantially unchanged over the follow-up period. The mean progression-free survival after the second surgery was 7.7 months (range 2–11 months). The mean overall survival was 25.4 months (range 10–52 months), excluding 2 long survivors. Two patients died within 60 days after surgery, and 3 patients were still under follow-up at the end of this study.CONCLUSIONSThis is the first study reporting the integration of neuronavigation, 5-ALA fluorescence, iUS, iCT, 11C-MET-PET, and IOM during microsurgical resection of recurrent glioma. The authors believe that the proposed multimodal protocol is useful to increase the safety, effectiveness, and EOTR in patients with recurrent HGG and brain alterations secondary to radio- and chemotherapy.

scholarly journals PENGARUH HIPERKOAGULASI TERHADAP MORTALITAS ASTROSITOMA PADA PEMANTAUAN 12 BULAN

2020 ◽  
Vol 37 (1) ◽  
Author(s):  
Among Wibowo ◽  
Tiara Aninditha ◽  
Henry Riyanto Sofyan ◽  
Rini Andriani
Keyword(s):  
Brain Tumor ◽  
Prothrombin Time ◽  
Partial Thromboplastin Time ◽  
High Grade Glioma ◽  
Activated Partial Thromboplastin Time ◽  
Hypercoagulable State ◽  
Cancer Center ◽  
High Grade ◽  
D Dimer

EFFECT OF HYPERCOAGULABILITY TO ASTROCYTOMA MORTALITY WITHIN 12-MONTHS OF FOLLOW UPABSTRACTIntroduction: Astrocytoma is the most common primary brain tumor. Hypercoagulable state is one of brain tumor complications which can cause vein thromboembolism (VTE). Vein thromboembolism incidence is increased in astrocytoma patients. Hypercoagulable state in astrocytoma could lower patient’s survival.Aim: To investigate the effect of hypercoagulable state on mortality within 12 months of follow up in astrocytoma patients.Methods: This study design was retrospective cohort. This research data was taken from medical records in Cipto Mangunkusumo General Hospital and Dharmais Cancer Center Hospital on December 2017-February 2018. The subjects were adult astrocytoma patients who had histopathology and hemostasis examination. The variables investigated in this study were gender, age, prothrombin time (PT), activated partial thromboplastin time (aPTT), and D-dimer. Data processed descriptively and analytically using SPSS ver. 20 for Windows.Results: There were 49 subjects in this research. Around 30 (61.2%) subjects were men and 20 (40.8%) subjects aged >50 years old. High grade glioma was found in 39 (79.6%) subjects and hypercoagulable state was found in 34 (69.4%) subjects. There were 20 subjects deceased in 12-month follow-up. Subjects with hypercoagulable state had relative risk (RR) of 3.97 more susceptible to die in 12-month follow-up compared to control (p=0.009).Discussion: Hypercoagulation was a mortality risk factor in 12-month follow-up in patients with astrocytoma.Keywords: Astrocytoma, hypercoagulation, mortality within 12-months of follow upABSTRAKPendahuluan: Astrositoma merupakan tumor otak primer yang paling sering ditemukan. Salah satu komplikasi dari tumor otak adalah keadaan hiperkoagulasi. Keadaan hiperkoagulasi dapat menyebabkan tromboemboli vena. Insiden tromboemboli vena meningkat pada astrositoma. Keadaan hiperkoagulasi pada astrositoma dapat menurunkan kesintasan atau meningkatkan mortalitas pada pasien astrositoma.Tujuan: Mengetahui pengaruh hiperkoagulasi pada mortalitas pasien astrositoma dalam 12 bulan pemantauan.Metode: Penelitian kohort retrospektif terhadap pasien tumor otak jenis astrositoma yang dirawat oleh Divisi Neuroonkologi di RSUPN Dr. Cipto Mangunkusumo (RSCM) dan RS Pusat Kanker Dharmais (RSKD) pada bulan Desember 2017 hingga Februari 2018. Sumber data adalah data sekunder berupa rekam medis pasien dewasa yang telah memiliki hasil pemeriksaan histopatologis dan hemostasis. Variabel yang diambil dalam penelitian ini adalah jenis kelamin, usia, prothrombin time (PT), activated partial thromboplastin time (aPTT), dan D-dimer. Data diolah secara deskriptif dan analitik bivariat menggunakan SPSS ver. 20 for Windows.Hasil: Terdapat 49 subjek dalam penelitian ini yang mayoritas (61,2%) laki-laki, berusia <50 tahun (59,2%), dan memiliki jenis high grade gliomas (75,8%). Sebagian besar subjek mengalami hiperkoagulasi (69,4%) dan dalam kondisi hidup (59,2%) pada 12 bulan pascaperawatan. Subjek dengan hiperkoagulasi memiliki risiko relatif (RR) 3,97 kali lebih rentan mengalami kematian setelah 12 bulan dibandingkan kontrol (p=0,009).Diskusi: Hiperkoagulasi merupakan salah satu faktor risiko kematian dalam 12 bulan pada pasien astrositoma.Kata kunci: Astrositoma, hiperkoagulasi, mortalitas 12 bulan

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