scholarly journals Brain Tumor Radiotherapy Role and Variation

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Eyad Lutfi Abu Nahlah ◽  
Raed M. Aljubour ◽  
Zuhair Abu Salma ◽  
Rakan A. Lozi ◽  
Hamzeh M. Alkhawaldeh ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Malignant Tumors ◽  
Performance Status ◽  
Palliative Therapy ◽  
Management Plan ◽  
Neurosurgical Department ◽  
Radiological Images ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Crucial Part

Objectives: We report our experiences of brain tumors management by surgery and radiotherapyWhether It has been used as adjuvant, radical or palliative therapy belonging to benign or malignant tumors over 2 years period at ENT,  neurosurgery and radiotherapy departments royal medical services. Methods: We used a retrospective study design to review all brain tumor patients(benign, malignant or metastatic) operated in neurosurgical department and referred to radiotherapy after discussing each case in multidisciplinary clinic in 2018 and 2019. Patient files, radiological images computed tomography (CT) or magnetic resonance imaging (MRI) scans), histo-pathological reports and radiotherapy management plan were reviewed for patients. Results: In total, 137 patients with brain tumor managed byradiotherapy 64 patients were metastatic, 37 patients high grad glioma, 12 patients atypical meningioma, 7 patients medulloblastoma, rest of cases discussed in the study  . Conclusions: Radiotherapy has been fulfilling crucial part in the treatment of CNS tumors, where it has been implemented as adjuvant therapy or even being the solitary resort where surgery is inapplicable or used as palliative therapy in different regimens according to histopathology, performance status and different sites.

scholarly journals IMG-17. RADIOMICS CHARACTERIZATION OF FOUR PEDIATRIC BRAIN TUMOR SUBTYPES IN PDX MOUSE MODELS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii358-iii358
Author(s):  
Natalie Serkova ◽  
Marina Stukova ◽  
Samuel Henehan ◽  
Jenna Steiner ◽  
Angela Pierce ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Spinal Metastases ◽  
Pediatric Brain Tumor ◽  
Distant Metastases ◽  
Lesion Size ◽  
Small Lesion ◽  
Anatomical Location ◽  
Tumor Subtypes ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND Previously, we have reported on the development of advanced magnetic resonance imaging (MRI) protocols for mouse brain tumors. The goal of this follow-up pre-clinical study was to develop a machine-learning MRI classifier (radiomics) for four subtypes of childhood brain tumor in patient-derived xenograft (PDX) mice. METHODS MRI scans on orthotopic medulloblastoma, ependymoma, ATRT and DIPG PDX (each n=12 animals) were performed on the animal 9.4 Tesla scanner with an in-plane resolution of 47 microns. Image segmentation, as well as shape and texture based radiomics descriptors were modeled using a modified COLIAGE software for tumor classification and to characterize tumor habitat of each tumor subtype. RESULTS The mean tumor volumes were 11.2 mm3. Each MRI scan was segmented into three regions: (i) well defined tumor (including distant metastases); (ii) peritumoral edema; (iii) tumor necrosis. 360 radiomics features (capturing co-occurrence, grey-level dependence and directional gradients) were obtained for each region. The model classified four subtypes with high accuracy while achieving sufficient segmentation accuracy despite the small lesion size. A subset of fourteen tumoral, six peritumoral and five distant MRI radiomics features were found to be predictive of the tumor sub-type (p=0.0017) independently of tumor anatomical location. CONCLUSIONS MRI protocols followed by radiomics feature analysis discriminated among specific radiological features for four distinct orthotopic PDX models: medulloblastomas exhibit low ADC values, high angiogenesis and cortical metastases as compared to ependymomas (high levels of edema and olfactory bulb metastases), ATRT (the highest level of necrosis) and DIPG (highest T2 signal intensities and spinal metastases).

scholarly journals Regional medical practice variation in high-cost healthcare services

2021 ◽  
Author(s):  
Michael Berger ◽  
Thomas Czypionka
Keyword(s):  
Medical Practice ◽  
Regional Variation ◽  
Multivariate Regression ◽  
Healthcare Services ◽  
Practice Variation ◽  
District Level ◽  
Healthcare Data ◽  
Regional Medical ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

AbstractMagnetic resonance imaging (MRI) is a popular yet cost-intensive diagnostic measure whose strengths compared to other medical imaging technologies have led to increased application. But the benefits of aggressive testing are doubtful. The comparatively high MRI usage in Austria in combination with substantial regional variation has hence become a concern for its policy makers. We use a set of routine healthcare data on outpatient MRI service consumption of Austrian patients between Q3-2015 and Q2-2016 on the district level to investigate the extent of medical practice variation in a two-step statistical analysis combining multivariate regression models and Blinder–Oaxaca decomposition. District-level MRI exam rates per 1.000 inhabitants range from 52.38 to 128.69. Controlling for a set of regional characteristics in a multivariate regression model, we identify payer autonomy in regulating access to MRI scans as the biggest contributor to regional variation. Nevertheless, the statistical decomposition highlights that more than 70% of the regional variation remains unexplained by differences between the observable district characteristics. In the absence of epidemiological explanations, the substantial regional medical practice variation calls the efficiency of resource deployment into question.

scholarly journals A detailed analysis of anatomical plausibility of crossed and uncrossed streamline rendition of the dentato-rubro-thalamic tract (DRT(T)) in a commercial stereotactic planning system

2021 ◽  
Author(s):  
Volker A. Coenen ◽  
Bastian E. Sajonz ◽  
Peter C. Reinacher ◽  
Christoph P. Kaller ◽  
Horst Urbach ◽  
...  
Keyword(s):  
Surgical Planning ◽  
Ground Truth ◽  
Planning System ◽  
Single Subject ◽  
Fiber Structure ◽  
Native Space ◽  
Volume Of Interest ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
The Individual

Abstract Background An increasing number of neurosurgeons use display of the dentato-rubro-thalamic tract (DRT) based on diffusion weighted imaging (dMRI) as basis for their routine planning of stimulation or lesioning approaches in stereotactic tremor surgery. An evaluation of the anatomical validity of the display of the DRT with respect to modern stereotactic planning systems and across different tracking environments has not been performed. Methods Distinct dMRI and anatomical magnetic resonance imaging (MRI) data of high and low quality from 9 subjects were used. Six subjects had repeated MRI scans and therefore entered the analysis twice. Standardized DICOM structure templates for volume of interest definition were applied in native space for all investigations. For tracking BrainLab Elements (BrainLab, Munich, Germany), two tensor deterministic tracking (FT2), MRtrix IFOD2 (https://www.mrtrix.org), and a global tracking (GT) approach were used to compare the display of the uncrossed (DRTu) and crossed (DRTx) fiber structure after transformation into MNI space. The resulting streamlines were investigated for congruence, reproducibility, anatomical validity, and penetration of anatomical way point structures. Results In general, the DRTu can be depicted with good quality (as judged by waypoints). FT2 (surgical) and GT (neuroscientific) show high congruence. While GT shows partly reproducible results for DRTx, the crossed pathway cannot be reliably reconstructed with the other (iFOD2 and FT2) algorithms. Conclusion Since a direct anatomical comparison is difficult in the individual subjects, we chose a comparison with two research tracking environments as the best possible “ground truth.” FT2 is useful especially because of its manual editing possibilities of cutting erroneous fibers on the single subject level. An uncertainty of 2 mm as mean displacement of DRTu is expectable and should be respected when using this approach for surgical planning. Tractographic renditions of the DRTx on the single subject level seem to be still illusive.

scholarly journals Brain atrophy and clinical characteristics predicting SDMT performance in multiple sclerosis: A 10-year follow-up study

2021 ◽  
Vol 7 (1) ◽  
pp. 205521732199239
Author(s):  
Cecilie Jacobsen ◽  
Robert Zivadinov ◽  
Kjell-Morten Myhr ◽  
Turi O Dalaker ◽  
Ingvild Dalen ◽  
...  
Keyword(s):  
Clinical Data ◽  
Grey Matter Volume ◽  
Lesion Volume ◽  
Information Processing Speed ◽  
Disability Status ◽  
Mri Scans ◽  
Patients At Risk ◽  
Magnetic Resonance Imaging Mri ◽  
Specific Volumes

Objectives To identify Magnetic Resonance Imaging (MRI), clinical and demographic biomarkers predictive of worsening information processing speed (IPS) as measured by Symbol Digit Modalities Test (SDMT). Methods Demographic, clinical data and 1.5 T MRI scans were collected in 76 patients at time of inclusion, and after 5 and 10 years. Global and tissue-specific volumes were calculated at each time point. For the primary outcome of analysis, SDMT was used. Results Worsening SDMT at 5-year follow-up was predicted by baseline age, Expanded Disability Status Scale (EDSS), SDMT, whole brain volume (WBV) and T2 lesion volume (LV), explaining 30.2% of the variance of SDMT. At 10-year follow-up, age, EDSS, grey matter volume (GMV) and T1 LV explained 39.4% of the variance of SDMT change. Conclusion This longitudinal study shows that baseline MRI-markers, demographic and clinical data can help predict worsening IPS. Identification of patients at risk of IPS decline is of importance as follow-up, treatment and rehabilitation can be optimized.

scholarly journals Cross-sectional analysis of follow-up chest MRI and chest CT scans in patients previously affected by COVID-19

2021 ◽  
Author(s):  
Martina Pecoraro ◽  
Stefano Cipollari ◽  
Livia Marchitelli ◽  
Emanuele Messina ◽  
Maurizio Del Monte ◽  
...  
Keyword(s):  
Chest Ct ◽  
Ct Scans ◽  
Imaging Biomarker ◽  
Cross Sectional ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Sectional Analysis ◽  
Ct And Mri ◽  
Interlobular Septal Thickening

Abstract Purpose The aim of the study was to prospectively evaluate the agreement between chest magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the diagnostic performance of chest MRI relative to that of CT during the follow-up of patients recovered from coronavirus disease 2019. Materials and methods Fifty-two patients underwent both follow-up chest CT and MRI scans, evaluated for ground-glass opacities (GGOs), consolidation, interlobular septal thickening, fibrosis, pleural indentation, vessel enlargement, bronchiolar ectasia, and changes compared to prior CT scans. DWI/ADC was evaluated for signal abnormalities suspicious for inflammation. Agreement between CT and MRI was assessed with Cohen’s k and weighted k. Measures of diagnostic accuracy of MRI were calculated. Results The agreement between CT and MRI was almost perfect for consolidation (k = 1.00) and change from prior CT (k = 0.857); substantial for predominant pattern (k = 0.764) and interlobular septal thickening (k = 0.734); and poor for GGOs (k = 0.339), fibrosis (k = 0.224), pleural indentation (k = 0.231), and vessel enlargement (k = 0.339). Meanwhile, the sensitivity of MRI was high for GGOs (1.00), interlobular septal thickening (1.00), and consolidation (1.00) but poor for fibrotic changes (0.18), pleural indentation (0.23), and vessel enlargement (0.50) and the specificity was overall high. DWI was positive in 46.0% of cases. Conclusions The agreement between MRI and CT was overall good. MRI was very sensitive for GGOs, consolidation and interlobular septal thickening and overall specific for most findings. DWI could be a reputable imaging biomarker of inflammatory activity.

scholarly journals Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

Cancers ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 2320
Author(s):  
Paolo Ferroli ◽  
Ignazio Gaspare Vetrano ◽  
Silvia Schiavolin ◽  
Francesco Acerbi ◽  
Costanza Maria Zattra ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Postoperative Complications ◽  
Elderly Patients ◽  
Performance Status ◽  
Tumor Resection ◽  
Patient Specific ◽  
Invasive Treatment ◽  
Tertiary Referral Center ◽  
Surgical Complexity

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up.

scholarly journals Magnetic resonance imaging (MRI) scans in patients with dorsal root ganglion stimulation

Pain Practice ◽  
2021 ◽  
Author(s):  
Marco Reining ◽  
Dirk Winkler ◽  
Joachim Boettcher ◽  
Juergen Meixensberger ◽  
Michael Kretzschmar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Resonance Imaging ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri

scholarly journals An improved framework for brain tumor analysis using MRI based on YOLOv2 and convolutional neural network

2021 ◽  
Author(s):  
Muhammad Irfan Sharif ◽  
Jian Ping Li ◽  
Javeria Amin ◽  
Abida Sharif
Keyword(s):  
Brain Tumor ◽  
Tumor Detection ◽  
Entropy Method ◽  
Feature Extraction And Selection ◽  
Tumor Region ◽  
Selection For ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
Complicated Task

AbstractBrain tumor is a group of anomalous cells. The brain is enclosed in a more rigid skull. The abnormal cell grows and initiates a tumor. Detection of tumor is a complicated task due to irregular tumor shape. The proposed technique contains four phases, which are lesion enhancement, feature extraction and selection for classification, localization, and segmentation. The magnetic resonance imaging (MRI) images are noisy due to certain factors, such as image acquisition, and fluctuation in magnetic field coil. Therefore, a homomorphic wavelet filer is used for noise reduction. Later, extracted features from inceptionv3 pre-trained model and informative features are selected using a non-dominated sorted genetic algorithm (NSGA). The optimized features are forwarded for classification after which tumor slices are passed to YOLOv2-inceptionv3 model designed for the localization of tumor region such that features are extracted from depth-concatenation (mixed-4) layer of inceptionv3 model and supplied to YOLOv2. The localized images are passed toMcCulloch'sKapur entropy method to segment actual tumor region. Finally, the proposed technique is validated on three benchmark databases BRATS 2018, BRATS 2019, and BRATS 2020 for tumor detection. The proposed method achieved greater than 0.90 prediction scores in localization, segmentation and classification of brain lesions. Moreover, classification and segmentation outcomes are superior as compared to existing methods.

scholarly journals Electrical stimulation to clinically identify position of the lingual nerve: results of 50 subjects with reliability and correlation with MRI

2021 ◽  
Author(s):  
Sanaa Aljamani ◽  
Callum Youngson ◽  
Fadi Jarad ◽  
Francis O’Neill
Keyword(s):  
Third Molar ◽  
Lingual Nerve ◽  
Observer Agreement ◽  
Electrical Nerve Stimulation ◽  
The Third ◽  
Mri Scans ◽  
Tingling Sensation ◽  
Magnetic Resonance Imaging Mri ◽  
Clinical Determination

Abstract Purpose Recently we described mapping of the lingual nerve clinically in patients using electrical nerve stimulation. This paper reports results of a larger study with inter- and intra-observer reliability and comparison with positional measurements from magnetic resonance imaging (MRI). Methods In 50 healthy participants, measurements were taken when subjects felt a tingling sensation in the tongue induced by a stimulation probe over the lingual nerve. Three positions were measured in relation to the third molar. Measurement reliability was tested for both inter-observer and intra-observer agreement and positional data of the lingual nerve measured clinically was also compared with nerve position as measured from MRI scans. Results Out of 50 participants, 96 nerves (49 = left/47 = right) were included in the study. The lingual nerve was identified in 90% (87) of this sample. The mean of height of the nerve in points A, B and C were 9.64 mm, 10.77 mm and 12.34 respectively. Inter-and intra-observer agreement was considered to be good to excellent (ICC = 0.8–0.96). Agreement between nerve mapping measured values and MRI measured values was good (ICC < 0.6). Conclusion This technique may prove useful for the clinical determination of lingual nerve position prior to procedures in the third molar region.

scholarly journals Multifocal glioblastoma multiform with “encephalitis-like presentation” : a case report

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Issam Sa’adeh ◽  
Mohamed Jamal Saadh
Keyword(s):  
Vasogenic Edema ◽  
Neurological Deficits ◽  
Herpes Simplex Virus 1 ◽  
Glioblastoma Multiform ◽  
Atypical Clinical Presentation ◽  
Mri Scans ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
Simplex Virus ◽  
Multifocal Glioblastoma

Abstract Background Glioblastoma multiform is the most common and aggressive type of primary malignant tumor that affects the central nervous system in adults. It clinically presents with seizures, headache, and/or progressive focal neurological deficits. Radiologically, glioblastoma multiform appears as a single distinguishable, large heterogeneous lesion affecting the cerebrum with characteristic central necrosis, marginal enhancement, and surrounding vasogenic edema. This article describes a patient that exhibited an atypical clinical presentation of multifocal glioblastoma multiform with misleading early radiological features that simulated herpetic encephalitis. Results A 66-year-old female that presented with left-sided hemiparesis and left partial motor seizures underwent multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) scans. A cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test was also performed to screen for herpes simplex virus 1 (HSV-1). Conclusions The early stages of glioblastoma may manifest as symptoms typical to encephalitis, which can delay diagnosis and treatment. Therefore, early diagnosis and identification of atypical glioblastoma multiform presentations, as reported in this article, are essential.

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