Randomized Phase III Trial of Prophylactic Cranial Irradiation With or Without Hippocampal Avoidance for Small-Cell Lung Cancer (PREMER): A GICOR-GOECP-SEOR Study.

PURPOSE: Radiation dose received by the neural stem cells of the hippocampus during whole-brain radiotherapy has been associated with neurocognitive decline. The key concern using hippocampal avoidance-prophylactic cranial irradiation (HA-PCI) in patients with small-cell lung cancer (SCLC) is the incidence of brain metastasis within the hippocampal avoidance zone. METHODS: This phase III trial enrolled 150 patients with SCLC (71.3% with limited disease) to standard prophylactic cranial irradiation (PCI; 25 Gy in 10 fractions) or HA-PCI. The primary objective was the delayed free recall (DFR) on the Free and Cued Selective Reminding Test (FCSRT) at 3 months; a decrease of 3 points or greater from baseline was considered a decline. Secondary end points included other FCSRT scores, quality of life (QoL), evaluation of the incidence and location of brain metastases, and overall survival (OS). Data were recorded at baseline, and 3, 6, 12, and 24 months after PCI. RESULTS: Participants' baseline characteristics were well balanced between the two groups. The median follow-up time for living patients was 40.4 months. Decline on DFR from baseline to 3 months was lower in the HA-PCI arm (5.8%) compared with the PCI arm (23.5%; odds ratio, 5; 95% CI, 1.57 to 15.86; P = .003). Analysis of all FCSRT scores showed a decline on the total recall (TR; 8.7% v 20.6%) at 3 months; DFR (11.1% v 33.3%), TR (20.3% v 38.9%), and total free recall (14.8% v 31.5%) at 6 months, and TR (14.2% v 47.6%) at 24 months. The incidence of brain metastases, OS, and QoL were not significantly different. CONCLUSION: Sparing the hippocampus during PCI better preserves cognitive function in patients with SCLC. No differences were observed with regard to brain failure, OS, and QoL compared with standard PCI.

Motor abnormalities and basal ganglia in first-episode psychosis (FEP).

BACKGROUND: Motor abnormalities (MAs) are the primary manifestations of schizophrenia. However, the extent to which MAs are related to alterations of subcortical structures remains understudied. METHODS: We aimed to investigate the associations of MAs and basal ganglia abnormalities in first-episode psychosis (FEP) and healthy controls. Magnetic resonance imaging was performed on 48 right-handed FEP and 23 age-, gender-, handedness-, and educational attainment-matched controls, to obtain basal ganglia shape analysis, diffusion tensor imaging techniques (fractional anisotropy and mean diffusivity), and relaxometry (R2*) to estimate iron load. A comprehensive motor battery was applied including the assessment of parkinsonism, catatonic signs, and neurological soft signs (NSS). A fully automated model-based segmentation algorithm on 1.5T MRI anatomical images and accurate corregistration of diffusion and T2* volumes and R2* was used. RESULTS: FEP patients showed significant local atrophic changes in left globus pallidus nucleus regarding controls. Hypertrophic changes in left-side caudate were associated with higher scores in sensory integration, and in right accumbens with tremor subscale. FEP patients showed lower fractional anisotropy measures than controls but no significant differences regarding mean diffusivity and iron load of basal ganglia. However, iron load in left basal ganglia and right accumbens correlated significantly with higher extrapyramidal and motor coordination signs in FEP patients. CONCLUSIONS: Taken together, iron load in left basal ganglia may have a role in the emergence of extrapyramidal signs and NSS of FEP patients and in consequence in the pathophysiology of psychosis.

Anatomical variants of anterior communicating artery complex. A study by Computerized Tomographic Angiography.

Advances in imaging techniques have led to the identification of normal variations and abnormalities of cerebral arteries. Although the anterior communicating artery complex (ACAC) variations are usually asymptomatic, their description is essential in the radiologic report, since they can have clinical relevance. The aim of this study is to describe arterial anomalies of the ACAC and their prevalence. A retrospective observational descriptive analysis of ACAC variations in Computerized Tomographic Angiography (CTA) was performed. All CTA (426 studies) obtained in our center from 2015 to 2017 were included. Presence of aneurysm was recorded and its relationship with arterial variants was analyzed with a Chi-square test. The most common variants found in our study are linked to the A1 segment (42.3%) of the anterior cerebral artery (ACA): absence: 10.6%, hypoplasia: 31.2%, fenestration: 0.5%. A2 segment variants were present in 15.3% (absence: 0.2%; hypoplasia 8.5%; Azygos artery: 1.4%; triple ACA: 5.2%). Anterior Communicanting Artery was typical in 92.5%, absent in 4.7%, double/fenestrated in 0.9%, triple in 0.2%, X-shape in 1.2% and Y-shape in 0.2%. Aneurysms were present in 10.7%. Anterior circulation aneurysm involved the 50% of patients with aneurysm. Although the 60.9% of them showed artery variants, they did not reach statistical significance (p = 0.6). In conclusion, the Anterior Communicating Artery Complex presents variations in its anatomy. The most common anterior circulation vascular variants are the hypoplasia and the absence of the A1 segment. There does not appear to be a clear association between intracranial aneurysms and anatomical variations.

Histogram Analysis Parameters Apparent Diffusion Coefficient for Distinguishing High and Low-Grade Meningiomas: A Multicenter Study.

Low grade meningiomas have better prognosis than high grade meningiomas. The aim of this study was to measure apparent diffusion coefficient (ADC) histogram analysis parameters in different meningiomas in a large multicenter sample and to analyze the possibility of several parameters for predicting tumor grade and proliferation potential. Overall, 148 meningiomas from 7 institutions were evaluated in this retrospective study. Grade 1 lesions were diagnosed in 101 (68.2%) cases, grade 2 in 41 (27.7%) patients, and grade 3 in 6 (4.1%) patients. All tumors were investigated by MRI (1.5 T scanner) by using diffusion weighted imaging (b values of 0 and 1000 s/mm2). For every lesion, the following parameters were calculated: mean ADC, maximum ADC, minimum ADC, median ADC, mode ADC, ADC percentiles P10, P25, P75, P90, kurtosis, skewness, and entropy. The comparison of ADC values was performed by Mann-Whitney-U test. Correlation between different ADC parameters and KI 67 was calculated by Spearman's rank correlation coefficient. Grade 2/3 meningiomas showed statistically significant lower ADC histogram analysis parameters in comparison to grade 1 tumors, especially ADC median. A threshold value of 0.82 for ADC median to predict tumor grade was estimated (sensitivity = 82.2%, specificity = 63.8%, accuracy = 76.4%, positive and negative predictive values were 83% and 62.5%, respectively). All ADC parameters except maximum ADC showed weak significant correlations with KI 67, especially ADC P25 (P = -.340, P = .0001).

Motor abnormalities and cognitive impairment in first-episode psychosis patients, their unaffected siblings and healthy controls.

Motor abnormalities (MAs) may be already evidenced long before the beginning of illness and are highly prevalent in psychosis. However, the extent to which the whole range of MAs are related to cognitive impairment in psychosis remains understudied. This study aimed to examine comparatively the relationships between the whole range of motor abnormalities and cognitive impairments in the first-episode of psychosis (FEP), their unaffected siblings and healthy control subjects. Fifty FEP patients, 21 of their healthy siblings and 24 age- and sex matched healthy controls were included. Motor assessment included catatonic, extrapyramidal and neurological soft signs (NSS) by means of standardized instruments. An exhaustive neuropsychological battery was also performed to extract the 7 cognitive dimensions of MATRICS initiative. Higher scores on NSS but not on extrapyramidal and catatonic signs showed significant associations with worse cognitive performance in the three study groups. However, the pattern of associations regarding specific cognitive functions was different among the three groups. Moreover, extrapyramidal signs showed significant associations with cognitive impairment only in FEP patients but not in their unaffected siblings and healthy controls. Catatonic signs did not show any significant association with cognitive functioning in the three study groups. These findings add evidence to the associations between motor abnormalities, particularly NSS and extrapyramidal signs, and cognitive impairment in first-episode psychosis patients. In addition, our results suggest that the specific pattern of associations between MAs and cognitive functioning is different in FEP patients from those of the unaffected siblings and healthy subjects.

Basal ganglia and ventricle volume in first-episode psychosis. A family and clinical study.

Patients with first-episode psychosis (FEP) exhibit considerable heterogeneity in subcortical brain volumes. We sought to compare ventricle and basal ganglia volumes in FEP patients (n = 50) with those in unaffected relatives (n = 21) and healthy controls (n = 24). Participants were assessed with a semistructured interview and underwent structural magnetic resonance imaging (MRI). Patients had significantly larger left lateral, right lateral and third ventricle volumes than their siblings and larger third ventricle volumes than controls. Additionally, they showed a trend toward significance by having larger right caudate nuclei than controls. Moreover, FEP patients showed lower caudate and putamen laterality indexes (leftward shifts) than healthy controls but not regarding their siblings. Besides, negative dimension was directly associated with lateral and third ventricle volumes and positive dimension with thalamus and ventral diencephalon nuclei. Our findings added evidence to the associations between early enlargement of brain ventricles and negative symptoms, and between early enlargement of thalamic and ventral-diencephalon nuclei and positive symptoms. Moreover, the cumulative exposition to antipsychotics in FEP patients might be related to enlargement of certain subcortical structures, such as the right nucleus accumbens and third ventricle.

Use of Diffusion Weighted Imaging in Differentiating Between Maligant and Benign Meningiomas. A Multicenter Analysis.

BACKGROUND: Meningioma is the most frequent intracranial tumor and is often an incidental finding on imaging. Some imaging-based scores were suggested for differentiating low- and high-grade meningiomas. The purpose of this work was to compare diffusion-weighted imaging findings of different meningiomas in a large multicenter study by using apparent diffusion coefficient (ADC) values for predicting tumor grade and proliferation potential. METHODS: Data from 7 radiologic departments were acquired retrospectively. Overall, 389 patients were collected. All meningiomas were investigated by magnetic resonance imaging (1.5-T scanner) by using diffusion-weighted imaging (b values of 0 and 1000 s/mm(2)). The comparison of ADC values was performed by Mann-Whitney U test. RESULTS: World Health Organization grade I was diagnosed in 271 cases (69.7%), grade II in 103 (26.5%), and grade III in 15 patients (3.9%). Grade I meningiomas showed statistically significant higher ADC values (1.05 ± 0.39 × 10(-3) mm(2)s(-1)) in comparison with grade II (0.77 ± 0.15 × 10(-3) mm(2)s(-1); P = 0.001) and grade III tumors (0.79 ± 0.21 × 10(-3) mm(2)s(-1); P = 0.01). An ADC value of <0.85 × 10(-3) mm(2)s(-1) was determined as the threshold in differentiating between grade I and grade II/III meningiomas (sensitivity, 72.9%; specificity, 73.1%; accuracy, 73.0%). Ki67 was associated with ADC (r = -0.63, P < 0.001). The optimal threshold for the ADC was (less than) 0.85 × 10(-3) mm(2)s(-1) for detecting tumors with high proliferation potential (Ki67 ≥5%). CONCLUSIONS: The estimated threshold ADC value of 0.85 can differentiate grade I meningioma from grade II and III tumors. The same ADC value is helpful for detecting tumors with high proliferation potential.

Metastatic meningioma: The role of whole­body diffusion-weighted imaging.

We report the case of a 74-year-old male patient with a completely resected anaplastic meningioma who developed multiple metastases two years later (subcutaneous tissue near the surgical area, cervical lymph nodes, lung, pleura and bones). The primary tumor and all of the metastases showed a significant restricted diffusion. Whole­body diffusion-weighted imaging (DWI) was performed for assessment of the metastases. This case demonstrated the usefulness of this technique in screening extracranial metastases in patients with malignant meningiomas.