Radiomics: The New Promise for Differentiating Progression, Recurrence, Pseudoprogression, and Radionecrosis in Glioma and Glioblastoma Multiforme.

Glioma and glioblastoma multiform (GBM) remain among the most debilitating and life-threatening brain tumors. Despite advances in diagnosing approaches, patient follow-up after treatment (surgery and chemoradiation) is still challenging for differentiation between tumor progression/recurrence, pseudoprogression, and radionecrosis. Radiomics emerges as a promising tool in initial diagnosis, grading, and survival prediction in patients with glioma and can help differentiate these post-treatment scenarios. Preliminary published studies are promising about the role of radiomics in post-treatment glioma/GBM. However, this field faces significant challenges, including a lack of evidence-based solid data, scattering publication, heterogeneity of studies, and small sample sizes. The present review explores radiomics's capabilities in following patients with glioma/GBM status post-treatment and to differentiate tumor progression, recurrence, pseudoprogression, and radionecrosis.

Clinical decision rules in predicting computed tomography scan findings and need for neurosurgical intervention in mild traumatic brain injury: a prospective observational study.

PURPOSE: In this study, we will compare the diagnostic values of head CT decision rules in predicting the findings of CT scans in a prospective multicenter study in university emergency departments in Iran. METHODS: The primary outcome was any traumatic lesion findings in brain CT scans, and the secondary outcomes were death, the need for mechanical ventilation, and neurosurgical intervention. Decision rules including the Canadian CT Head Rule (CCHR), New Orleans Criteria (NOC), National Institute for Health and Clinical Excellence (NICE), National Emergency X-Radiography Utilization Study (NEXUS), and Neurotraumatology Committee of the World Federation of Neurosurgical Societies (NCWFNS) were compared for the main outcomes. RESULTS: In total, 434 mild TBI patients were enrolled in the study. The NCWFNS had the highest sensitivity (91.14%) and the lowest specificity (39.42%) for predicting abnormal finding in CT scan compared to other models. While the NICE obtained the lowest sensitivity (79.75%), it was associated with the highest specificity (66.67%). All model performances were improved when administered to predict neurosurgical intervention among patients with GCS 13-15. NEXUS (AUC 0.862, 95% CI 0.799-0.924) and NCWFNS (AUC 0.813, 95% CI 0.723-0.903) had the best performance among all evaluated models. CONCLUSION: The NCWFNS and the NEXUS decision rules performed better than the CCHR and NICE guidelines for predicting any lesion in the CT imaging and neurosurgical intervention among patients with mTBI with GCS 13-15. For a subset of mTBI patients with GCS 15, the NOC criteria have higher sensitivity for abnormal CT imaging, but lower specificity and more requested CTs.

Radiomics; A Potential Next "Omics" in Psychiatric Disorders; An Introduction.

Psychiatric disorders remain one of the most debilitating conditions; however, most patients are never diagnosed and do not seek treatment. Despite its massive burden on modern society and the health system, many hurdles prevent proper diagnosis and management of these disorders. The diagnosis is primarily based on clinical symptoms, and efforts to find appropriate biomarkers have not been practical. Through the past years, researchers have put a tremendous effort into finding biomarkers in "omics" fields: genomics, transcriptomics, proteomics, metabolomics, and epigenomics. This article reviews the evolving field of radiomics and its role in diagnosing psychiatric disorders as the sixth potential "omics." The first section of this paper elaborates on the definition of radiomics and its potential to provide a detailed structural study of the brain. Following that, we have provided the latest promising results of this novel approach in a broad range of psychiatric disorders. Radiomics fits well within the concept of psychoradiology. Besides volumetric analysis, radiomics takes advantage of many other features. This technique may open a new field in psychiatry for diagnosing and classifying psychiatric disorders and treatment response prediction in the era of precision and personalized medicine. The initial results are encouraging, but radiomics in psychiatry is still in its infancy. Despite the extensive burden of psychiatric disorders, there are very few published studies in this field, with small patient populations. The lack of prospective multi-centric studies and heterogeneity of studies in design are the significant barriers against the clinical adaptation of radiomics in psychoradiology.

ALK-positive histiocytosis involving the cavernous sinus: A deceptive radiologic mimic of meningioma.

Anaplastic lymphoma kinase (ALK)-positive histiocytosis is an uncommon condition, recently considered a separate condition from other histiocytosis by WHO 5th edition. It can involve intracranial structures. This manuscript describes a case of ALK-positive histiocytosis of the cavernous sinus, focusing on the radiologic and pathologic presentation of the entity. Our case had MRI manifestations mimicking meningioma, metastasis, and Langerhans histiocytosis. On CT imaging, benign osseous remodeling of the cavernous sinus was detected, which can be helpful in differentiating it from more common meningioma.

Serum Glial Fibrillary Acidic Protein in Detecting Intracranial Injuries Following Minor Head Trauma; a Systematic Review and Meta-Analysis.

Introduction: Developing novel diagnostic and screening tools for exploring intracranial injuries following minor head trauma is a necessity. This study aimed to evaluate the diagnostic value of serum glial fibrillary acidic protein (GFAP) in detecting intracranial injuries following minor head trauma. Methods: An extensive search was performed in Medline, Embase, Scopus, and Web of Science databases up to the end of April 2022. Human observational studies were chosen, regardless of sex and ethnicity of their participants. Pediatrics studies, report of diagnostic value of GFAP combined with other biomarkers (without reporting the GFAP alone), articles including patients with all trauma severity, defining minor head trauma without intracranial lesions as the outcome of the study, not reporting sensitivity/specificity or any other values essential for computation of true positive, true negative, false positive and false-negative, being performed in the prehospital setting, assessing the prognostic value of GFAP, duplicated reports, preclinical studies, retracted articles, and review papers were excluded. The result was provided as pooled sensitivity, specificity, diagnostic score and diagnostic odds ratio, and area under the summary receiver operating characteristic (SROC) curve with a 95% confidence interval (95% CI). Results: Eventually, 11 related articles were introduced into the meta-analysis. The pooled analysis implies that the area under the SROC curve for serum GFAP level in minor traumatic brain injuries (TBI) was 0.75 (95% CI: 0.71 to 0.78). Sensitivity and specificity of this biomarker in below 100 pg/ml cut-off were 0.83 (95% CI: 0.78 to 0.89) and 0.39 (95% CI: 0.24 to 0.53), respectively. The diagnostic score and diagnostic odds ratio of GFAP in detection of minor TBI were 1.13 (95% CI: 0.53 to 1.74) and 3.11 (95% CI: 1.69 to 5.72), respectively. The level of evidence for the presented results were moderate. Conclusion: The present study's findings demonstrate that serum GFAP can detect intracranial lesions in mild TBI patients. The optimum cut-off of GFAP in detection of TBI was below 100 pg/ml. As a result, implementing serum GFAP may be beneficial in mild TBI diagnosis for preventing unnecessary computed tomography (CT) scans and their related side effects.

Magnetic Resonance Imaging (MRI) Findings in COVID-19 Associated Encephalitis.

We conducted this study to investigate the scope of the MRI neuroimaging manifestations in COVID-19-associated encephalitis. From January 2020 to September 2021, patients with clinical diagnosis of COVID-19-associated encephalitis, as well as concomitant abnormal imaging findings on brain MRI, were included. Two board-certified neuro-radiologists reviewed these selected brain MR images, and further discerned the abnormal imaging findings. 39 patients with the clinical diagnosis of encephalitis as well as abnormal MRI findings were included. Most (87%) of these patients were managed in ICU, and 79% had to be intubated-ventilated. 15 (38%) patients died from the disease, while the rest were discharged from the hospital. On MRI, FLAIR hyperintensities in the insular cortex were the most common finding, seen in 38% of the patients. Micro-hemorrhages on the SWI images were equally common, also seen in 38% patients. FLAIR hyperintensities in the medial temporal lobes were seen in 30%, while FLAIR hyperintensities in the posterior fossa were evident in 20%. FLAIR hyperintensities in basal ganglia and thalami were seen in 15%. Confluent FLAIR hyperintensities in deep and periventricular white matter, not explained by microvascular angiopathy, were detected in 7% of cases. Cortical-based FLAIR hyperintensities in 7%, and FLAIR hyperintensity in the splenium of the corpus callosum in 7% of patients. Finally, isolated FLAIR hyperintensity around the third ventricle was noted in 2% of patients.

Subcortical signal alteration of corticospinal tracts. A radiologic manifestation of ARIA: A case report.

Patients with Alzheimer's disease who have been given monoclonal antibodies targeting amyloid-ß (Aß) (eg, gantenerumab, donanemab, lecanemab, and aducanumab) for scientific purposes may have a spectrum of imaging findings known as amyloid-related imaging abnormalities (ARIA), shown on brain magnetic resonance imaging (MRI) scans. These neuroimaging abnormalities are caused by antibody-mediated destruction of accumulated Aß aggregates in cerebral blood vessels and brain parenchyma. ARIA may demonstrate as brain edema or sulcal effusion (ARIA-E) or as hemosiderin deposits caused by brain parenchymal or pial hemorrhage (ARIA-H). The current study explores 2 cases with interval development of FLAIR hyper signal intensity along the bilateral corticospinal tracts in the motor cortex/precentral gyri after treatment by aducanumab. We believe this manifestation is a subtype of ARIA-A that has not been explored earlier. Our first case was a 72-year-old woman with a history of HTN and kidney transplant (polycystic kidney) who presented with mild cognitive impairment with clinical findings consistent with early Alzheimer's disease. After receiving 3 doses of aducunumab and experiencing cognition improvement, she underwent a brain MRI because of dizziness and vertigo. The brain MRI demonstrated new FLAIR hyper signal intensity in subcortical regions of precentral gyri (motor cortex) symmetrically as well as trace subarachnoid hemorrhage at the vertex compatible with ARIA-E and ARIA-H. Our second case was an 85-year-old woman with a history of small lymphocytic leukemia which was treated 20 years earlier. After orthopedic surgery 2 years ago, she developed dementia with anterograde amnesia. Since then, Aricept and Namenda have been started, but there have been no improvements in her subjective condition. The initial Amyloid PET/MR imaging showed diffuse cerebral Amyloid deposition. After tolerating 6 doses of aducanumab a safety MRI revealed new bilateral symmetric FLAIR hyper signal intensity in the subcortical motor cortex. Results of our study suggest that the subcortical corticospinal tract is another hotspot for ARIA findings. Hence, these regions might be an unknown site for both the action and adverse effects of aducanumab on amyloid plaques with secondary inflammation. In addition, radiologists must take this phenomenon into the account, and be cognizant that the FLAIR hyper signal intensities should not be misinterpreted as motor neuron disease (eg, amyotrophic lateral sclerosis).

Imaging spectrum of amyloid-related imaging abnormalities associated with aducanumab immunotherapy.

Alzheimer's Disease (AD) is a leading cause of morbidity. Management of AD has traditionally been aimed at symptom relief rather than disease modification. Recently, AD research has begun to shift focus towards disease-modifying therapies that can alter the progression of AD. In this context, a class of immunotherapy agents known as monoclonal antibodies target diverse cerebral amyloid-beta (Aß) epitopes to inhibit disease progression. Aducanumab was authorized by the US Food and Drug Administration (FDA) to treat AD on June 7, 2021. Aducanumab has shown promising clinical and biomarker efficacy but is associated with amyloid-related imaging abnormalities (ARIA). Neuroradiologists play a critical role in diagnosing ARIA, necessitating familiarity with this condition. This pictorial review will appraise the radiologic presentation of ARIA in patients on aducanumab.

Evaluating the correlation between migraine and subclinical atherosclerosis.

BACKGROUNDS AND AIMS: Migraine is known to be associated with vascular dysfunction. However, sufficient evidence has not been reported in this regard. This study aims to assess subclinical atherosclerosis and endothelial function via Doppler Sonography in migraine patients. METHODS: In this case control study, Subjects were divided into two groups; Patients with migraine, and Healthy controls. Migraine was diagnosed according to the International Classification of Headache Disorders criteria. Participants were evaluated for carotid intima-media thickness (IMT) and flow-mediated dilation (FMD) indices, and the findings were compared between the two groups. RESULTS: In the study population, 64.9 % were female, and the mean age was 34.63 ± 6.06 years. Of the 47 people with migraine, 12 suffered from migraine with aura. Increased IMT was more in migraine with and without aura compared to control (p = 0.247), and FMD was lower in these groups than the control group (p = 0.311). There was a significant correlation between the duration of headache with the duration of migraine (p = 0.007, 0.389) and IMT (p = 0.038, 0.303). No statistically significant differences were observed between NSAID, acetaminophen, and ergotamine groups with IMT (p = 0.532) and FMD (p = 0.834). CONCLUSION: Migraine and its related medications do not affect vascular changes in favor of atherosclerosis. However, these findings might be valid for patients with acute migraines only.