Volumetric analysis: Rethinking brain metastases response assessment.

Background: The Response Assessment in Neuro-Oncology for Brain Metastases (RANO-BM) criteria are the gold standard for assessing brain metastases (BMs) treatment response. However, they are limited by their reliance on 1D, despite the routine use of high-resolution T1-weighted MRI scans for BMs, which allows for 3D measurements. Our study aimed to investigate whether volumetric measurements could improve the response assessment in patients with BMs. Methods: We retrospectively evaluated a dataset comprising 783 BMs and analyzed the response of 185 of them from 132 patients who underwent stereotactic radiotherapy between 2007 and 2021 at 5 hospitals. We used T1-weighted MRIs to compute the volume of the lesions. For the volumetric criteria, progressive disease was defined as at least a 30% increase in volume, and partial response was characterized by a 20% volume reduction. Results: Our study showed that the proposed volumetric criteria outperformed the RANO-BM criteria in several aspects: (1) Evaluating every lesion, while RANO-BM failed to evaluate 9.2% of them. (2) Classifying response effectively in 140 lesions, compared to only 72 lesions classified by RANO-BM. (3) Identifying BM recurrences a median of 3.3 months earlier than RANO-BM criteria. Conclusions: Our study demonstrates the superiority of volumetric criteria in improving the response assessment of BMs compared to the RANO-BM criteria. Our proposed criteria allow for evaluation of every lesion, regardless of its size or shape, better classification, and enable earlier identification of progressive disease. Volumetric criteria provide a standardized, reliable, and objective tool for assessing treatment response.

A comprehensive dataset of annotated brain metastasis MR images with clinical and radiomic data.

Brain metastasis (BM) is one of the main complications of many cancers, and the most frequent malignancy of the central nervous system. Imaging studies of BMs are routinely used for diagnosis of disease, treatment planning and follow-up. Artificial Intelligence (AI) has great potential to provide automated tools to assist in the management of disease. However, AI methods require large datasets for training and validation, and to date there have been just one publicly available imaging dataset of 156 BMs. This paper publishes 637 high-resolution imaging studies of 75 patients harboring 260 BM lesions, and their respective clinical data. It also includes semi-automatic segmentations of 593 BMs, including pre- and post-treatment T1-weighted cases, and a set of morphological and radiomic features for the cases segmented. This data-sharing initiative is expected to enable research into and performance evaluation of automatic BM detection, lesion segmentation, disease status evaluation and treatment planning methods for BMs, as well as the development and validation of predictive and prognostic tools with clinical applicability.

Neuroplasticity and Epilepsy Surgery in Brain Eloquent Areas: Case Report.

Introduction: Neuronal plasticity includes changes in any component of the central nervous system in response to intrinsic or extrinsic stimuli. Brain functions that depend on the epileptogenic cortex pose a challenge in epilepsy surgery because many patients are excluded from pre-surgical evaluation for fear of the possible sequelae. Some of these patients may be rescued by enhancing neuronal plasticity with brain neuromodulation techniques. Case Report: We describe a 6-year-old child with refractory focal motor seizures symptomatic to a neuroepithelial dysembryoblastic tumor in the left temporo-parietal region. He underwent limited resection of the lesion in order to avoid sequelae in his language function. A functional study at age of 17 years revealed an overlap of Wernicke's area with the tumor and areas of incipient language reorganization in the contralateral hemisphere. An invasive neuromodulation procedure was designed to enhance neuroplasticity. After craniotomy, he underwent language training and simultaneous electrical inhibition of language using an electrode grid placed over the lesion. The intensity of the language inhibitory stimulus was increased every day to force the use of accessory language areas in the right hemisphere by neuroplasticity. Results: The language of the patient improved for six consecutive days until he was able to speak and understand while undergoing maximum electrical inhibition. The tumor was resected using a cortical mapping guide. Discussion: Application of direct cortical stimulation techniques and language pre-habilitation before epilepsy surgery can be useful to rescue patients excluded from resective surgery, especially young patients with long-term lesions.

Ruptura testicular traumática: papel de la exploración quirúrgica / Traumatic testicular rupture: the role of surgical exploration

Se presenta un hombre de 20 años de edad que sufre lesión traumática testicular durante práctica de artes marciales. Se discute el papel de la ecografía y de la exploración quirúrgica.

We present a man 20 years of age that suffered a traumatic testicular injury during the practice of martial arts. The role of echography and surgical exploration are discussed.