Evaluation of Standard Response Assessment in Neuro-Oncology, Modified Response Assessment in Neuro-Oncology, and Immunotherapy Response Assessment in Neuro-Oncology in Newly Diagnosed and Recurrent Glioblastoma.

PURPOSE: The Response Assessment in Neuro-Oncology (RANO) criteria are widely used in high-grade glioma clinical trials. We compared the RANO criteria with updated modifications (modified RANO [mRANO] and immunotherapy RANO [iRANO] criteria) in patients with newly diagnosed glioblastoma (nGBM) and recurrent GBM (rGBM) to evaluate the performance of each set of criteria and inform the development of the planned RANO 2.0 update. MATERIALS AND METHODS: Evaluation of tumor measurements and fluid-attenuated inversion recovery (FLAIR) sequences were performed by blinded readers to determine disease progression using RANO, mRANO, iRANO, and other response assessment criteria. Spearman's correlations between progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS: Five hundred twenty-six nGBM and 580 rGBM cases were included. Spearman's correlations were similar between RANO and mRANO (0.69 [95% CI, 0.62 to 0.75] v 0.67 [95% CI, 0.60 to 0.73]) in nGBM and rGBM (0.48 [95% CI, 0.40 to 0.55] v 0.50 [95% CI, 0.42 to 0.57]). In nGBM, requirement of a confirmation scan within 12 weeks of completion of radiotherapy to determine progression was associated with improved correlations. Use of the postradiation magnetic resonance imaging (MRI) as baseline scan was associated with improved correlation compared with use of the pre-radiation MRI (0.67 [95% CI, 0.60 to 0.73] v 0.53 [95% CI, 0.42 to 0.62]). Evaluation of FLAIR sequences did not improve the correlation. Among patients who received immunotherapy, Spearman's correlations were similar among RANO, mRANO, and iRANO. CONCLUSION: RANO and mRANO demonstrated similar correlations between PFS and OS. Confirmation scans were only beneficial in nGBM within 12 weeks of completion of radiotherapy, and there was a trend in favor of the use of postradiation MRI as the baseline scan in nGBM. Evaluation of FLAIR can be omitted. The iRANO criteria did not add significant benefit in patients who received immune checkpoint inhibitors.

Clinical applications of dual-energy computed tomography in neuroradiology.

Dual-energy computed tomography (DECT) has developed into a robust set of techniques with increasingly validated clinical applications in neuroradiology. We review some of the most common applications in neuroimaging along with demonstrative case examples that showcase the use of this technology in intracranial hemorrhage, stroke imaging, trauma imaging, artifact reduction, and tumor characterization.

Multidetector CT of Laryngeal Injuries: Principles of Injury Recognition.

Blunt laryngeal trauma is associated with high morbidity and mortality. However, owing to their relatively rare occurrence, laryngeal injuries may be missed or underdiagnosed. Even subtle abnormalities at multidetector CT may correspond to significant functional abnormalities. It is important to understand normal CT laryngeal anatomy and develop a systematic review of the cervical soft tissues and laryngeal skeleton in patients who undergo screening CT cervical spine or other neck examinations in the setting of trauma, such as CT angiography. Multidetector CT findings of the normal larynx are reviewed, and blunt laryngeal injuries including soft-tissue edema, hematoma, mucosal lacerations, cartilage fracture, cricoarytenoid dislocation, and vocal fold paralysis are presented. The radiologist plays an important role in diagnosis and may be the first to identify laryngeal injuries that are not evident at physical examination. This article reviews normal laryngeal anatomy, presents various blunt laryngeal injuries at multidetector CT with case examples, discusses the role of multidetector CT in acute management, and describes pitfalls of diagnosis. ©RSNA, 2019.

Spectrum of diagnostic errors in cervical spine trauma imaging and their clinical significance.

PURPOSE: To describe and categorize diagnostic errors in cervical spine CT (CsCT) interpretation performed for trauma and to assess their clinical significance. METHODS: All CsCTs performed for trauma with diagnostic errors that came to our attention based on clinical or imaging follow-up or quality assurance peer review from 2004 to 2017 were included. The number of CsCTs performed at our institution during the same time interval was calculated. Errors were categorized as spinal/extraspinal, involving osseous/soft tissue structures, by anatomical site and level. Images were reviewed by a radiologist and two spine surgeons. For each error, the need for surgery, immobilization, CT angiogram of the neck, and MRI was assessed; if any of these were needed, the error was considered clinically significant. RESULTS: Of an approximate total 59,000 CsCTs, 56 reports containing diagnostic errors were included. Twelve were extraspinal, and 44 were spinal (26 fractures, 15 intervertebral disc protrusions, two subluxations, one lytic bone lesion). The most common sites of spinal fractures were vertebral body (n = 10) and transverse process (n = 8); the most common levels were C5 (n = 8) and C7 (n = 6). All (n = 26) fractures and two atlantooccipital subluxations were considered clinically significant, including three patients who would have required urgent surgical stabilization (two subluxations and one facet fracture). Two transverse processes fractures did not alter the need for surgical intervention/surgical approach, immobilization, or MRI. CONCLUSIONS: In our study, 66% of spinal diagnostic errors on CsCT were considered clinically significant, potentially altering clinical management. Transverse process and vertebral body fractures were commonly missed.

Emergent Neuroimaging in the Oncologic and Immunosuppressed Patient.

Neuroimaging in the emergency department increasingly involves patients at increased risk for acute neurologic complications from malignancy and immunosuppression, including patients with organ transplantation, diabetes mellitus, treatment of chronic disease, and HIV positivity. These patients are susceptible to the same infections and emergencies as immunocompetent patients, but may present differently with common illnesses and are susceptible to a variety of other diseases. This article reviews important patient risk factors, emergent central nervous system abnormalities, and their imaging findings. Detailed knowledge of risk factors and specific complications in these complex patients is essential for optimal image acquisition, interpretation, diagnosis, and treatment.

BWH emergency radiology-surgical correlation: torsion of Meckel's diverticulum.

We present the radiologic findings and intraoperative correlation of a torsed Meckel's diverticulum leading to small-bowel obstruction in a 65-year-old male without prior abdominal surgery. As this is a rare entity and difficult to diagnose, an understanding of the clinical presentation and radiologic findings correlated with this pathology can help to expedite diagnosis and treatment.

Redox-responsive in vitro modulation of the signalling state of the isolated PrrB sensor kinase of Rhodobacter sphaeroides NCIB 8253.

Prr is a global regulatory system that controls a large and diverse range of genes in Rhodobacter sphaeroides in response to changing conditions of environmental redox potential. PrrB is the membrane-bound sensor kinase and previously we showed that the purified, detergent-solubilised intact membrane protein is functional in autophosphorylation, phosphotransfer and phosphatase activities. Here we confirm that it also senses and responds directly to its environmental signal, redox potential; strong autophosphorylation of PrrB occurred in response to dithiothreitol (DTT)-induced reducing conditions (and levels increased in response to a wide 0.1-100 mM DTT range), whilst under oxidising conditions, PrrB exhibited low, just detectable levels of autophosphorylation. The clear response of PrrB to changes in reducing conditions confirmed its suitability for in vitro studies to identify modulators of its phosphorylation signalling state, and was used here to investigate whether PrrB might sense more than one redox-related signal, such as signals of cell energy status. NADH, ATP and AMP were found to exert no detectable effect on maintenance of the PrrB-P signalling state. By contrast, adenosine diphosphate produced a very strong increase in PrrB-P dephosphorylation rate, presumably through the back-conversion of PrrB-P to PrrB.