Early Postoperative Magnetic Resonance Imaging Findings Related to Electrocauterization for Cerebellar Reduction During Chiari Decompression Surgery.

BACKGROUND: Cerebellar tonsillar reduction or resection can be performed as part of the surgical management of Chiari type 1 malformation when it is accompanied by symptomatic brainstem compression or syringomyelia. The purpose of this study is to characterize the early postoperative magnetic resonance imaging (MRI) findings in patients with Chiari type 1 malformations who undergo cerebellar tonsillar reduction via electrocautery. METHODS: The extent of cytotoxic edema and microhemorrhages demonstrated on MRI scans obtained within 9 days following surgery was assessed and correlated with neurological symptoms. RESULTS: Cytotoxic edema was found on all postoperative MRI examinations included in this series, with superimposed hemorrhage in 12 of 16 patients (75%) and was primarily located along the margins of the cauterized inferior cerebellum. Cytotoxic edema was present beyond the margins of the cauterized cerebellar tonsils in 5 of 16 patients (31%) and was associated with new focal neurological deficits in 4 of 5 patients (80%). CONCLUSION: Cytotoxic edema and hemorrhages along the cerebellar tonsil cautery margins can be expected findings in early postoperative MRI in patients who undergo Chiari decompression accompanied by tonsillar reduction. However, the presence of cytotoxic edema beyond these regions can be associated with new focal neurological symptoms.

Advances in the Radiological Evaluation of and Theranostics for Glioblastoma.

Imaging is essential for evaluating patients with glioblastoma. Traditionally a multimodality undertaking, CT, including CT cerebral blood profusion, PET/CT with traditional fluorine-18 fluorodeoxyglucose (18F-FDG), and MRI have been the mainstays for diagnosis and post-therapeutic assessment. However, recent advances in these modalities, in league with the emerging fields of radiomics and theranostics, may prove helpful in improving diagnostic accuracy and treating the disease.

MRI radiomics and potential applications to glioblastoma.

MRI plays an important role in the evaluation of glioblastoma, both at initial diagnosis and follow up after treatment. Quantitative analysis via radiomics can augment the interpretation of MRI in terms of providing insights regarding the differential diagnosis, genotype, treatment response, and prognosis. The various MRI radiomic features of glioblastoma are reviewed in this article.

A preliminary diagnostic accuracy study of quantitative MRI biomarkers for differentiating parotid tumor types.

Background: Differentiating among the different types of parotid tumors on imaging is useful for guiding clinical disposition, which ultimately may lead to surgical management. The goal of this study was to determine whether quantitative T2 signal characteristics and morphologic features on magnetic resonance imaging (MRI) can serve as predictive biomarkers for distinguishing between tumor types. Methods: A retrospective review of T2-weighted MRIs in patients with pathology-proven parotid tumors was performed. Quantitative T2 maps and surface regularity measurements of the tumors were obtained via semi-automated regions of interest (ROI). Linear Discriminant Analysis was used to populate the receiver operating characteristics (ROCs) curves for these variables. A P value of <0.05 was considered to be significant. Results: A total of 35 tumors (21 benign and 14 malignant neoplasms) were included in this analysis. For differentiating the benign versus malignant classes of parotid tumors, T2 signal and surface regularity combined yielded an area under the curve of 0.62 (P value: 0.2) through the ROC analysis. However, for the pleomorphic adenomas versus other types of parotid tumors, using both T2 signal and surface regularity yielded an area under the curve of 0.81 (P value: 0.007) through the ROC analysis. Conclusions: T2 signal and surface regularity combined can significantly differentiate pleomorphic adenomas from other types of parotid tumors and can potentially be used as a predictive imaging biomarker.