Multi-parametric (ADC/PWI/T2-w) image fusion approach for accurate semi-automatic segmentation of tumorous regions in glioblastoma multiforme.

OBJECT: Glioblastoma multiforme (GBM) brain tumor is heterogeneous in nature, so its quantification depends on how to accurately segment different parts of the tumor, i.e. viable tumor, edema and necrosis. This procedure becomes more effective when metabolic and functional information, provided by physiological magnetic resonance (MR) imaging modalities, like diffusion-weighted-imaging (DWI) and perfusion-weighted-imaging (PWI), is incorporated with the anatomical magnetic resonance imaging (MRI). In this preliminary tumor quantification work, the idea is to characterize different regions of GBM tumors in an MRI-based semi-automatic multi-parametric approach to achieve more accurate characterization of pathogenic regions. MATERIALS AND METHODS: For this purpose, three MR sequences, namely T2-weighted imaging (anatomical MR imaging), PWI and DWI of thirteen GBM patients, were acquired. To enhance the delineation of the boundaries of each pathogenic region (peri-tumoral edema, viable tumor and necrosis), the spatial fuzzy C-means algorithm is combined with the region growing method. RESULTS: The results show that exploiting the multi-parametric approach along with the proposed semi-automatic segmentation method can differentiate various tumorous regions with over 80 % sensitivity, specificity and dice score. CONCLUSION: The proposed MRI-based multi-parametric segmentation approach has the potential to accurately segment tumorous regions, leading to an efficient design of the pre-surgical treatment planning.

Hypertrophic spinal pachymeningitis with thoracic myelopathy: the initial presentation of ANCA-related systemic vasculitis.

STUDY DESIGN: A retrospective case review combined with a review of current literature. OBJECTIVES: We describe a case of antineutrophil cytoplasmic antibodies (ANCA)-related systemic vasculitis, with nearly 4 years of clinical and radiographic follow-up, initially presenting as hypertrophic spinal pachymeningitis (HSP). The diagnosis, surgical, and medical treatment of HSP are discussed in the context of a literature review. SUMMARY OF BACKGROUND DATA: HSP is a rare disease characterized by hypertrophic inflammation of the dura mater and clinical symptoms that progress from local pain to myelopathy. HSP has been associated with infectious, inflammatory, autoimmune, and traumatic conditions. Surgical decompression and/or corticosteroid therapy have been shown effective at managing this disorder, but identifying associated diseases can be essential to a favorable patient outcome. METHODS: The medical, pathologic, and radiographic records of this case were reviewed. A computer-based search of the PubMed database was used to perform a comprehensive literature review of HSP. RESULTS: We report a 66-year-old male with a history of renal cell carcinoma and bladder cancer who presented with upper abdominal pain, thoracic myelopathy (progressive weakness and numbness of the lower extremities, and gait disturbances), and weight loss. A diagnosis of HSP was subsequently shown to be the initial presentation of ANCA-related systemic vasculitis. CONCLUSIONS: The possibility of an ANCA-related systemic vasculitis presenting as HSP without systemic signs is a diagnostic and therapeutic challenge for the spinal surgeon. The diagnosis of HSP should initiate a search for an associated disease process and close follow-up after initial treatment. With interdisciplinary collaboration between medicine, radiology, pathology, and orthopedics, the diagnosis was made and a treatment initiated which halted disease progression and has maintained remission for more than 4 years.