Brain cortical structural differences between non-central nervous system cancer patients treated with and without chemotherapy compared to non-cancer controls: a cross-sectional pilot MRI study using clinically-indicated scans.

BACKGROUND: Cognitive deficit associated with cancer and its treatment is called cancer-related cognitive impairment (CRCI). Increases in cancer survival have made understanding the basis of CRCI more important. CRCI neuroimaging studies have traditionally used dedicated research brain MRIs in breast cancer survivors after chemotherapy with small sample sizes; little is known about other non-central nervous system (CNS) cancers after chemotherapy as well as those not exposed to chemotherapy. However, there may be a wealth of unused data from clinically-indicated MRIs that could be used to study CRCI. OBJECTIVE: Evaluate brain cortical structural differences in those with various non-CNS cancers using clinically-indicated MRIs. DESIGN: Cross-sectional. PATIENTS: Adult non-CNS cancer and non-cancer control (C) patients who underwent clinically-indicated MRIs. METHODS: Brain cortical surface area and thickness were measured using 3D T1-weighted images. An age-adjusted linear regression model was used and the Benjamini and Hochberg false discovery rate (FDR) corrected for multiple comparisons. Group comparisons were: cancer cases with chemotherapy (Ch+), cancer cases without chemotherapy (Ch-) and subgroup of lung cancer cases with and without chemotherapy vs C. RESULTS: Sixty-four subjects were analyzed: 22 Ch+, 23 Ch- and 19 C patients. Subgroup analysis of 16 lung cancer (LCa) patients was also performed. Statistically significant decreases in either cortical surface area or thickness were found in multiple regions of interest (ROIs) primarily within the frontal and temporal lobes for all comparisons. Effect sizes were variable with the greatest seen in the left middle temporal surface area ROI (Cohen's d -0.690) in the Ch- vs C group comparison. LIMITATIONS: Several limitations were apparent including a small sample size that precluded adjustment for other covariates. CONCLUSIONS: Our preliminary results suggest that, in addition to breast cancer, other types of non-CNS cancers treated with chemotherapy may result in brain structural abnormalities. Similar findings also appear to occur in those not exposed to chemotherapy. These results also suggest that there is potentially a wealth of untapped clinical MRIs that could be used for future CRCI studies.

Predicting Meningioma Consistency on Preoperative Neuroimaging Studies.

This article provides an overview of the neuroimaging literature focused on preoperative prediction of meningioma consistency. A validated, noninvasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging may be helpful to predict meningioma consistency; however, further rigorous validation is necessary. Much less is known about advanced MRI techniques, such as diffusion MRI, MR elastography (MRE), and MR spectroscopy. Of these methods, MRE and diffusion tensor imaging appear particularly promising.

Concurrent intracranial and spinal subdural hematoma in a teenage athlete: a case report of this rare entity.

A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

MRI appearances of ovarian serous borderline tumor: pathological correlation.

PURPOSE: To investigate the spectrum of MRI appearances of ovarian serous borderline tumor (SBT). MATERIALS AND METHODS: Following ethics approval, 31 patients with 51 histologically proven ovarian SBTs underwent preoperative MRI. Images were evaluated, by two observers for the location, shape, size, internal architecture, signal intensity, and extent or stage of the tumors. The MRI findings were correlated with pathological findings. RESULTS: Twenty of 31 patients (65%) demonstrated bilateral ovarian SBTs on MRI. Three MRI morphological patterns of ovarian SBT were identified: (i) Mainly cystic mass with multiple intracystic papillary projections from the wall and septations was observed in 24 (47%) tumors. (ii) Solid mass with hierarchical branching papillary and fibrous stalk architecture was observed in 8 (16%) tumors. The branching papillary projections were hyperintensity on T2WI, intermediate intense on DWI, and enhanced intensely after the administration of Gd-DTPA. The internal branching fibrous stalks were hypointensity on T2WI and enhanced slightly. (iii) Mixed cystic-solid mass was observed in 19 (37%) tumors. The cystic and solid components had the architecture and signal intensity similar to those of cystic and solid SBTs. Papillary projections were the common architecture of all three types of tumors. CONCLUSION: On MRI, the ovarian SBT has some morphological distinguishing features. The solid papillary architecture with internal branching fibrous stalk is a somewhat more characteristic MRI appearance.

Image coregistration: quantitative processing framework for the assessment of brain lesions.

The quantitative, multiparametric assessment of brain lesions requires coregistering different parameters derived from MRI sequences. This will be followed by analysis of the voxel values of the ROI within the sequences and calculated parametric maps, and deriving multiparametric models to classify imaging data. There is a need for an intuitive, automated quantitative processing framework that is generalized and adaptable to different clinical and research questions. As such flexible frameworks have not been previously described, we proceeded to construct a quantitative post-processing framework with commonly available software components. Matlab was chosen as the programming/integration environment, and SPM was chosen as the coregistration component. Matlab routines were created to extract and concatenate the coregistration transforms, take the coregistered MRI sequences as inputs to the process, allow specification of the ROI, and store the voxel values to the database for statistical analysis. The functionality of the framework was validated using brain tumor MRI cases. The implementation of this quantitative post-processing framework enables intuitive creation of multiple parameters for each voxel, facilitating near real-time in-depth voxel-wise analysis. Our initial empirical evaluation of the framework is an increased usage of analysis requiring post-processing and increased number of simultaneous research activities by clinicians and researchers with non-technical backgrounds. We show that common software components can be utilized to implement an intuitive real-time quantitative post-processing framework, resulting in improved scalability and increased adoption of post-processing needed to answer important diagnostic questions.