scholarly journals How much tumor volume is responsible for development of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas?

2021 ◽  
Author(s):  
Shuhei Yamada ◽  
Noriyuki Kijima ◽  
Tomoyoshi Nakagawa ◽  
Ryuichi Hirayama ◽  
Manabu Kinoshita ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Volumetric Analysis ◽  
Tumor Diameter ◽  
Peritumoral Edema ◽  
Asymptomatic Group ◽  
Maximum Tumor Diameter

Abstract Purpose Meningiomas are the most common primary intracranial neoplasms. Their volume and location are important factors related to the appearance of clinical symptoms. This study aimed to identify factors that influence clinical symptoms and to determine a specific threshold tumor volume for the prediction of symptomatic progression in patients with convexity, parasagittal, and falx meningiomas. Methods We retrospectively studied patients with radiologically suspected convexity, parasagittal, or falx meningiomas at our institution. Results The data of three hundred thirty-three patients were analyzed. We further divided patients into two groups based on clinical symptoms: as asymptomatic group (250 cases) and a symptomatic group (83 cases). Univariate analysis revealed significant differences between the groups in terms of sex (p = 0.002), age at the time of volumetric analysis (p < 0.001), hyperintense lesions on T2-weighted images (p = 0.029), peritumoral edema (p < 0.001), maximum tumor diameter (p < 0.001), and tumor volume (p < 0.001). Further multivariate analysis revealed significant differences between the groups in terms of age at the time of volumetric analysis (p = 0.002), peritumoral edema (p < 0.001), and tumor volume (p < 0.001). Receiver operating characteristic curve revealed a threshold tumor volume of 21.1 ml for predicting whether a patient would develop symptoms (sensitivity 0.843, specificity 0.880, an area under the curve 0.919 [95% confidence interval: 0.887–0.951]). Conclusion We identified factors predictive of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas and determined the first-ever threshold tumor volume for predicting symptomatic progression in such patients.

scholarly journals How Much Tumor Volume Is Responsible for Development of Clinical Symptoms in Patients With Convexity, Parasagittal, and Falx Meningiomas?

2021 ◽  
Vol 12 ◽  
Author(s):  
Shuhei Yamada ◽  
Noriyuki Kijima ◽  
Tomoyoshi Nakagawa ◽  
Ryuichi Hirayama ◽  
Manabu Kinoshita ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Clinical Symptoms ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Volumetric Analysis ◽  
Tumor Diameter ◽  
Peritumoral Edema ◽  
Asymptomatic Group ◽  
Maximum Tumor Diameter

Purpose: Meningiomas are the most common primary intracranial neoplasms and clinical symptom appearance depends on their volume and location. This study aimed to identify factors that influence clinical symptoms and to determine a specific threshold tumor volume for the prediction of symptomatic progression in patients with convexity, parasagittal, and falx meningiomas.Materials and Methods: We retrospectively studied patients with radiologically suspected convexity, parasagittal, or falx meningiomas at our institution.Results: The data of three hundred thirty-three patients were analyzed. We further divided patients into two groups based on clinical symptoms: an asymptomatic group (250 cases) and a symptomatic group (83 cases). Univariate analysis revealed significant differences between the groups in terms of sex (p = 0.002), age at the time of volumetric analysis (p &lt; 0.001), hyperintense lesions on T2-weighted images (p = 0.029), peritumoral edema (p &lt; 0.001), maximum tumor diameter (p &lt; 0.001), and tumor volume (p &lt; 0.001). Further multivariate analysis revealed significant differences between the groups in terms of age at the time of volumetric analysis (p = 0.002), peritumoral edema (p &lt; 0.001), and tumor volume (p &lt; 0.001). The receiver operating characteristic curve revealed a threshold tumor volume of 21.1 ml for predicting whether a patient would develop symptoms (sensitivity 0.843, specificity 0.880, an area under the curve 0.919 [95% confidence interval: 0.887–0.951]).Conclusion: We identified factors predictive of clinical symptoms in patients with convexity, parasagittal, and falx meningiomas and determined the first-ever threshold tumor volume for predicting symptomatic progression in such patients.

scholarly journals Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

2018 ◽  
Vol 128 (4) ◽  
pp. 1032-1036 ◽  
Author(s):  
Ha Son Nguyen ◽  
Luyuan Li ◽  
Mohit Patel ◽  
Shekar Kurpad ◽  
Wade Mueller
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Intraventricular Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Area Under The Curve ◽  
Ventricular System ◽  
Fisher Grade ◽  
Gcs Score

OBJECTIVEThe presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores.METHODSThe authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1–3 and 4–5 subgroups for analysis.RESULTSOn univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895–0.979), GCS score (OR 3.422, 95% CI 1.9–6.164), and ventricular density (OR 0.937, 95% CI 0.878–0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1–3 and 4–5.CONCLUSIONSThis study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

CRANIOPHARYNGIOMA IN THE ELDERLY: A MULTICENTER AND NATION-WIDE STUDY IN SPAIN

2020 ◽  
Author(s):  
Pedro Iglesias ◽  
Ignacio Nocete ◽  
María Dolores Moure Rodríguez ◽  
Eva Venegas-Moreno ◽  
Jessica Ares ◽  
...  
Keyword(s):  
Visual Field ◽  
Clinical Symptoms ◽  
The Elderly ◽  
National Study ◽  
Visual Field Defects ◽  
Subtotal Resection ◽  
Similar Distribution ◽  
Tumor Diameter ◽  
Maximum Tumor Diameter ◽  
Field Defects

Background. Craniopharyngioma (CP) is a rare tumor in the elderly whose clinical features and prognosis are not well known in this population. Aim. To evaluate the clinicopathological features and therapeutic outcomes of CP diagnosed in the elderly. Patients and Methods. A retrospective, multicenter, national study of CP patients diagnosed over the age of 65 years and surgically treated was performed. Results. From a total of 384 adult CP patients, we selected 53 (13.8%) patients [27 women (50.9%), mean age 72.3 ± 5.1 years (range 65-83 yr)] diagnosed after the age of 65 years. The most common clinical symptoms were visual field defects (71.2%) followed by headache (45.3%). Maximum tumor diameter was 2.9 ± 1.1 cm. In most patients, the tumor was suprasellar (96.2%) and mixed (solid-cystic) (58.5%). The surgical approach most commonly used was transcranial surgery (52.8%) and more than half of the patients (54.7%) underwent subtotal resection (STR). Adamantinomatous CP (ACP) and papillary CP (PCP) were present in 51% and 45.1%, respectively, with mixed forms in the remaining. Surgery was accompanied by an improvement in visual field defects and in headaches; however, pituitary hormonal hypofunction increased, mainly at the expense of an increase in the prevalence of diabetes insipidus (DI) (from 3.9% to 69.2%). Near-total resection (NTR) was associated with a higher prevalence of DI compared with subtotal resection (87.5 vs 53.6%, p=0.008). Patients were followed for 46.7±40.8 months. Mortality rate was 39.6% with a median survival time of 88 (95% CI, 57-118) months. DI at last visit was associated with a lower survival. Conclusion. CP diagnosed in the elderly shows a similar distribution by sex and histologic forms than that diagnosed at younger ages. At presentation visual field alterations and headaches are the main clinical symptoms which improve substantially with surgery. However, surgery, mainly NTR, is accompanied by worsening of pituitary function, especially DI, which seems to be a predictor of mortality in this population.

scholarly journals The Value of Serum Midkine Level in Diagnosis of Hepatocellular Carcinoma

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Karim Y. A. Shaheen ◽  
Abeer I. Abdel-Mageed ◽  
Eslam Safwat ◽  
Ashraf M. AlBreedy
Keyword(s):  
Healthy Subjects ◽  
Operating Characteristic ◽  
Diagnostic Marker ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Tumor Diameter ◽  
Control Groups ◽  
Tumor Number ◽  
Healthy Control ◽  
Operating Characteristic Curve

Background and Aim. Identification of sensitive biomarkers to improve early diagnosis of HCC is needed. We aimed to evaluate serum midkine (MDK) as a biomarker for HCC diagnosis.Patients and Methods. 40 HCCs, 30 liver cirrhosis patients, and 30 healthy subjects were enrolled. Serum MDK using ELISA was measured in all included subjects.Results. Serum MDK was significantly elevated in HCC group compared to cirrhotic and healthy control groups (0.625 versus 0.15 and 0.125 ng/mL), respectively. No significant association was found between MDK and either BCLC stage, tumor diameter, tumor number, or AFP level. Receiver operating characteristic curve showed that best cutoff for MDK and AFP was 0.387 and 88.5 ng/mL, respectively. Area under the curve of MDK was significantly larger than that of AFP (0.941 versus 0.671). The sensitivity of MDK at 0.387 ng/mL for HCC diagnosis was significantly higher than that of AFP at cutoffs 20, 88.5, and 200 ng/mL (92.5 versus 62.5, 40, and 25%), respectively. Sensitivity of MDK reached 93.3% in patients with AFP <20 ng/mL. Moreover, MDK at 0.387 ng/mL had significant better sensitivity than AFP at 20 ng/mL in distinguishing HCC from BCLC 0/A (90 versus 40%).Conclusion. Serum MDK might be a potential diagnostic marker for HCC particularity in its early stages.

scholarly journals Role of Blood Stasis Syndrome of Kampo Medicine in the Early Pathogenic Stage of Atherosclerosis: A Retrospective Cross-Sectional Study

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Akira Morita ◽  
Takao Namiki ◽  
Toshiya Nakaguchi ◽  
Kazunari Murai ◽  
Yuki Watanabe ◽  
...  
Keyword(s):  
Glucose Tolerance ◽  
Characteristic Curve ◽  
Multiple Logistic Regression Analysis ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Blood Stasis ◽  
Area Under The Curve ◽  
Kampo Medicine ◽  
Blood Stasis Syndrome ◽  
History Of

In Kampo medicine, blood stasis (BS) syndrome is strongly associated with microangiopathy and can lead to atherosclerosis. Vascular endothelial dysfunction (VED), evaluated through flow-mediated dilation (FMD), plays an important role in the early stages of atherosclerosis. However, the association of BS syndrome with VED, as determined using FMD, has not been reported. This study investigated the association between BS syndrome and VED using FMD. Forty-one patients with normal glucose tolerance or impaired glucose tolerance (IGT) and without macrovascular complications were evaluated using FMD from May 2017 to August 2017. Based on the BS score, the patients were divided into the non-BS (n = 19) and BS syndrome (n = 22) groups. Physical and background characteristics, physiological function test results, and laboratory data were compared. Univariate analysis revealed that FMD and a history of dyslipidemia/IGT were significantly different between the two groups ( p < 0.05 ). Multiple logistic regression analysis showed that BS syndrome was significantly associated with FMD (odds ratio: 6.26; p = 0.03 ) after adjusting for the history of dyslipidemia/IGT. The receiver operating characteristic curve showed that the area under the curve for BS syndrome (0.74; p < 0.001 ) and history of IGT ( p < 0.007 ) provided good diagnostic accuracy for FMD. The area under the curve for “BS syndrome + IGT” showed very good accuracy (0.80; p < 0.0001 ) and was higher than that for BS syndrome or IGT alone. In conclusion, the results of this study suggest that the BS score in Kampo medicine could be a useful tool for detecting the early pathogenic stages of atherosclerosis.

scholarly journals Changes in perfusion can detect changes in the cardiac index in patients with septic shock

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093167
Author(s):  
Hui Lian ◽  
Xiaoting Wang ◽  
Qing Zhang ◽  
Hongmin Zhang ◽  
Dawei Liu
Keyword(s):  
Septic Shock ◽  
Cardiac Index ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Treatment Phase ◽  
Cardiac Output Monitoring ◽  
Fluid Loading ◽  
Output Monitoring

Objective The perfusion index (PI) is usually used to assess peripheral perfusion, which can be influenced by the cardiac index (CI). CI monitoring is often needed during the treatment of patients with shock. We investigated the relationship between changes in the PI (ΔPI) and changes in the CI (ΔCI) in patients with septic shock. Methods This retrospective study included patients with septic shock who underwent pulse-induced continuous cardiac output monitoring. We measured the CI and PI before and after fluid loading during the first 6 hours of intensive care unit admission. Fluid responsiveness was defined as a ≥10% ΔCI after fluid loading. Other hemodynamic and oxygen-derived parameters were also collected at the exact time of each CI measurement. Results Fifty-five patients were included in the study (29 fluid responders, 26 fluid non-responders). In the univariate analysis, ΔPI was positively correlated with ΔCI. In the multivariable analysis, ΔPI was independently associated with ΔCI. The receiver operating characteristic curve showed that ΔPI was an appropriate marker with which to discriminate a CI increase with an area under the curve of 0.776. Conclusion This study showed a positive correlation between ΔPI and ΔCI during the early treatment phase of septic shock.

scholarly journals Large volume re-irradiation with bevacizumab is a feasible salvage option for patients with refractory high-grade glioma

2014 ◽  
Vol 2 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Michael Back ◽  
Cecelia E. Gzell ◽  
Marina Kastelan ◽  
Linxin Guo ◽  
Helen R. Wheeler
Keyword(s):  
Median Survival ◽  
Large Volume ◽  
Small Volume ◽  
Tumor Volume ◽  
High Grade Glioma ◽  
Target Volume ◽  
Tumor Diameter ◽  
High Grade ◽  
Kaplan Meier ◽  
Maximum Tumor Diameter

AbstractBackgroundClinical studies of re-irradiation (ReRT) for relapsed high-grade glioma (HGG) have generally reported the use of small volume ReRT techniques such as stereotactic radiosurgery in selected patients with isolated focal relapse. This study reports the outcome with large-volume ReRT to manage the more common mescenario of extensive diffuse relapse of HGG.MethodsAll HGG patients managed with an overlapping second course of radiation therapy (RT) for refractory progression of HGG between October 2009 and April 2013 were included. ReRT was initially used with bevacizumab (BEV), then used when disease was refractory to BEV, and finally used upfront with BEV-naïve patients. Tumor volume (GTV) and specific RT dosimetry factors, including the target volume treated (PTV), and cumulative RT dose maximum (Dmax), were analyzed. Median survival post ReRT was calculated using the Kaplan-Meier method and SPPS v19 software.ResultsEighteen HGG participants with refractory, bulky contrast-enhancing disease received ReRT. Thirteen participants had a maximum tumor diameter &gt;5 cm, and median GTV was 54 cm3. Seven participants had BEV-refractory disease, and 8 participants were BEV naïve. ReRT dose was 35–40 Gy in 15 fractions; median PTV was 133 cm3, and median Dmax was 98.2 Gy. Median survival post ReRT for all participants was 8 months (95%CI, 5.8–10.2 months); with 10 months and 3 months for the BEV-naïve and BEV-refractory participants, respectively (P = .024). Two early participants, who were managed without BEV, were later salvaged with BEV, including one who required craniotomy for radiation necrosis at 6 weeks post RT. No other significant morbidity was reported.ConclusionReRT combined with BEV is a feasible salvage treatment option for diffuse refractory HGG.

scholarly journals Efficacy of prophylactic selective arterial embolization for renal angiomyolipomas: identifying predictors of 50% volume reduction

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Hidenari Hongyo ◽  
Hiroki Higashihara ◽  
Keigo Osuga ◽  
Eiji Kashiwagi ◽  
Shinya Kosai ◽  
...  
Keyword(s):  
Tumor Volume ◽  
Univariate Analysis ◽  
Mammalian Target Of Rapamycin ◽  
Arterial Embolization ◽  
Mtor Inhibitors ◽  
Volume Reduction ◽  
Tumor Diameter ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Tumor Volume Reduction

Abstract Background Transcatheter arterial embolization (TAE) has been widely performed for renal angiomyolipomas (AMLs) as prophylaxis or emergency treatment. On the other hand, mammalian target of rapamycin (mTOR) inhibitors have recently been used for tuberous sclerosis (TSC)-related AMLs, and no comparison between the effectiveness of mTOR inhibitors versus prophylactic selective TAE has yet been performed. Therefore, the purpose of this study was to evaluate the efficacy of TAE for AML tumor volume reduction and predictors of tumor volume decrease over 50%, with reference to the EXIST-2 trial. Methods A total of 44 patients who underwent 48 prophylactic embolization procedures for 50 AMLs in a single institution between 2004 and 2018 were included. Indications for TAE of AMLs were tumor size ≥4 cm or aneurysm ≥5 mm in diameter on contrast-enhanced computed tomography (CECT). Microspheres, ethanol, and micro-coils were used as embolic agents. The percentage volume reduction from before TAE to the minimum volume during follow-up after TAE was calculated, and predictors for 50% volume reduction were identified by univariate and multivariate binary logistic regression analyses. Results The technical success rate was 100% (50 of 50). No severe acute complications related to the procedure were encountered. Tumor volume reduction of ≥50% was observed in 35/50 AMLs. There was a significant difference in the rate of tumor volume reduction of 50% between the presence and absence of an aneurysm ≥5 mm and between tumor diameter ≥ 70 mm and < 70 mm on univariate analysis. On multivariate analysis, tumor diameter < 70 mm was the only independent predictor of significant tumor volume reduction after TAE. Conclusion Prophylactic selective TAE for AMLs has good tumor-reduction effects, especially for AMLs with tumor diameter < 70 mm.

scholarly journals Platelet-to-Lymphocyte Ratio and C-Reactive Protein as Markers for Colorectal Polyp Histological Type

2020 ◽  
Author(s):  
Rui Chen ◽  
Liguang Wang ◽  
Qi Zhao ◽  
Zhen Li ◽  
Man Chen ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Univariate Analysis ◽  
Colorectal Polyp ◽  
Colorectal Polyps ◽  
Histological Type ◽  
Endoscopic Polypectomy ◽  
Tumor Diameter ◽  
Reactive Protein ◽  
Tumor Number ◽  
Maximum Tumor Diameter

Abstract Background: The PLR and CRP level are markers that have been reported to predict the histological type of various tumors, and here, we evaluated their utility in predicting colorectal polyp histological types.Methods: We retrospectively reviewed 172 patients with colorectal polyps who underwent endoscopic polypectomy. The associations between histological type and clinicopathologic parameters were assessed by multivariate analysis. Results: The optimal PLR and CRP cut-off values were 113.32 and 0.39, respectively. The PLR (P=0.002) and CRP (P= 0.009) values were associated with the histological type according to the univariate analysis, whereas low PLR (P ≤0.001) and CRP (P =0.017) values were independent risk factors in the multivariate analysis together with maximum tumor diameter (P ≤0.001) and tumor number (P =0.0014).Conclusions: Preoperative PLR and CRP are correlated with the colorectal polyp histological type.

scholarly journals Clinical, Pathological, Laboratory Characteristics, and Treatment Regimens of Kimura Disease and Their Relationships With Tumor Size and Recurrence

2021 ◽  
Vol 8 ◽  
Author(s):  
Lina Fan ◽  
Shiyan Mo ◽  
Yanyan Wang ◽  
Jian Zhu
Keyword(s):  
Surgical Treatment ◽  
Combination Therapy ◽  
Tumor Size ◽  
Clinical Symptoms ◽  
Disease Recurrence ◽  
Tumor Diameter ◽  
Kimura Disease ◽  
Treatment Regimens ◽  
Significant Difference ◽  
Maximum Tumor Diameter

Objective: As of date, Kimura disease (KD) has an unclear etiology, no accepted diagnostic standard, and no definite treatment regimen. In this study, clinical and pathological laboratory characteristics and treatment regimens of patients with KD with different tumor sizes and status of tumor recurrence were analyzed. This was performed to identify the factors, which determine tumor size and recurrence, and to identify effective treatment methods for patients with KD.Methods: A total of 33 hospitalized patients with a definite diagnosis of KD were enrolled in this study.Results: There were 15 patients (45.5%) with a maximum tumor diameter of &lt;3 cm. There were no statistically significant differences in age, gender, clinical symptoms, lesion sites, laboratory indicators, and treatment regimens among patients with a maximum tumor diameter &lt;3 cm or ≥3 cm (P &gt; 0.05). Among the 25 patients who completed the follow-up, there were 18 patients (72%) who had a recurrence of KD. There were no statistically significant differences in age, gender, clinical symptoms, the maximum tumor diameter, lesion sites, laboratory indicators, and initial treatment regimens between patients with or without the recurrence of KD (P &gt; 0.05). There was a statistically significant difference in systolic blood pressure (SBP) between patients with or without the recurrence of KD (P &lt; 0.05). All patients who received only surgical treatment had disease recurrence, 33.3% of patients who received prednisone therapy had no disease recurrence, and 37.5% of patients who received combination therapy showed recurrence.Conclusion: The current study summarized clinical manifestations, pathological features, laboratory indicators, and treatment regimens of patients with KD. There were no significant differences in these aspects among patients with different tumor sizes, and there was no significant difference in these aspects except in the SBP between patients with or without the recurrence of KD, indicating that SBP is a significant clinical factor affecting disease recurrence in patients. Combination therapy with prednisone was found to be superior to surgical treatment.

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