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1.
Medicine (Baltimore) ; 99(36): e22029, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899058

RESUMO

This study aims to describe the role of open surgical treatment for focal brainstem gliomas (FBSGs) with the assistance of multimodal neuronavigation and intraoperative neurophysiological monitoring (IOM) in children to investigate the efficacy of microsurgical treatment in pediatric FBSGs. Also the prognostic factors related to the overall survival (OS) of FBSGs to describe the patient and tumor characteristics relevant to prognosis/outcome were focused on. Clinical data of 63 pediatric patients below 16 years of age with FBSGs admitted to the Neurosurgical Unit of Beijing Tiantan Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients underwent initial surgical treatment, followed by magnetic resonance diffusion tensor imaging (DTI), neuronavigation and IOM. Gross or near total resection (GTR or NTR) was achieved in 57/63 (90.5%) cases, and subtotal resection (STR) was achieved in 6/63 (9.5%) cases. Postoperative adjuvant therapy was received by 27/63 (42.9%) cases. Postoperative pathological examination revealed that 36/63 (57.1%) cases had grade I gliomas, 22/63 (34.9%) had grade II, and 5/63 (8.0%) had grade III-IV gliomas according to the WHO classification. The mean Karnofsky score preoperatively was 60, and at the time of follow-up was 90. Consecutively, 6 cases demonstrated disease progression, and 5 of these were deceased. The OS in all patients was 81.2% at 5 years. Histological grade (P < .001) and age at diagnosis (P = .023) showed significant association with prolonged OS. Multimodal neuronavigation and IOM allow very precise intracranial surgery, contributing to a maximally safe resection that might decrease the postoperative disability and mortality rate. This study also showed that pediatric FBSGs were mostly low-grade tumors with excellent surgical outcomes. Consequently, it is suggested that microsurgery can be used to treat FBSGs in children in order to provide better prognosis and survival outcomes.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Glioma/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neuronavegação/métodos , Adolescente , Quimioterapia Adjuvante , Criança , Pré-Escolar , China/epidemiologia , Imagem de Tensor de Difusão/métodos , Progressão da Doença , Feminino , Glioma/diagnóstico por imagem , Humanos , Lactente , Avaliação de Estado de Karnofsky , Masculino , Microcirurgia/métodos , Gradação de Tumores , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
2.
Clin Imaging ; 67: 194-197, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32862127

RESUMO

We report an unusual case of radiation-induced glioma with a very long latent period. The patient had a history of brain stem glioma diagnosed 40 years earlier treated by radiotherapy. For treatment of radiation-induced glioma, radiotherapy was utilized again. Following therapy, the patient presented with an acute pontine infarct. To the best of our knowledge this may be the first report of radiation-induced glioma and radiation-induced stroke occurring within the same patient.


Assuntos
Neoplasias do Tronco Encefálico/diagnóstico por imagem , Glioma/diagnóstico por imagem , Neoplasias Encefálicas , Neoplasias do Tronco Encefálico/etiologia , Neoplasias do Tronco Encefálico/radioterapia , Glioma/etiologia , Glioma/radioterapia , Humanos , Infarto/complicações , Radioterapia/efeitos adversos
3.
Lancet Oncol ; 21(6): e305-e316, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502457

RESUMO

Paediatric low-grade gliomas (also known as pLGG) are the most common type of CNS tumours in children. In general, paediatric low-grade gliomas show clinical and biological features that are distinct from adult low-grade gliomas, and the developing paediatric brain is more susceptible to toxic late effects of the tumour and its treatment. Therefore, response assessment in children requires additional considerations compared with the adult Response Assessment in Neuro-Oncology criteria. There are no standardised response criteria in paediatric clinical trials, which makes it more difficult to compare responses across studies. The Response Assessment in Pediatric Neuro-Oncology working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop consensus recommendations for response assessment in paediatric low-grade gliomas. Final recommendations were based on literature review, current practice, and expert opinion of working group members. Consensus recommendations include imaging response assessments, with additional guidelines for visual functional outcomes in patients with optic pathway tumours. As with previous consensus recommendations, these recommendations will need to be validated in prospective clinical trials.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/terapia , Determinação de Ponto Final/normas , Glioma/diagnóstico por imagem , Glioma/terapia , Neuroimagem/normas , Idade de Início , Neoplasias do Sistema Nervoso Central/epidemiologia , Neoplasias do Sistema Nervoso Central/patologia , Criança , Consenso , Feminino , Glioma/epidemiologia , Glioma/patologia , Humanos , Imagem por Ressonância Magnética/normas , Masculino , Gradação de Tumores , Imagem de Perfusão/normas , Tomografia por Emissão de Pósitrons/normas , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
4.
Nat Commun ; 11(1): 3169, 2020 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-32576825

RESUMO

Understanding tumor metabolism holds the promise of new insights into cancer biology, diagnosis and treatment. To assess human cancer metabolism, here we report a method to collect intra-operative samples of blood from an artery directly upstream and a vein directly downstream of a brain tumor, as well as samples from dorsal pedal veins of the same patients. After performing targeted metabolomic analysis, we characterize the metabolites consumed and produced by gliomas in vivo by comparing the arterial supply and venous drainage. N-acetylornithine, D-glucose, putrescine, and L-acetylcarnitine are consumed in relatively large amounts by gliomas. Conversely, L-glutamine, agmatine, and uridine 5-monophosphate are produced in relatively large amounts by gliomas. Further we verify that D-2-hydroxyglutarate (D-2HG) is high in venous plasma from patients with isocitrate dehydrogenases1 (IDH1) mutations. Through these paired comparisons, we can exclude the interpatient variation that is present in plasma samples usually taken from the cubital vein.


Assuntos
Biomarcadores Tumorais/sangue , Vasos Sanguíneos/metabolismo , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/metabolismo , Glioma/sangue , Glioma/metabolismo , Metabolômica , Acetilcarnitina/sangue , Adulto , Idoso , Agmatina/sangue , Sangue , Análise Química do Sangue , Glicemia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Feminino , Glioma/diagnóstico por imagem , Glioma/genética , Glucose , Glutamina/sangue , Glutaratos/sangue , Humanos , Isocitrato Desidrogenase/sangue , Isocitrato Desidrogenase/genética , Isocitrato Desidrogenase/metabolismo , Masculino , Pessoa de Meia-Idade , Ornitina/análogos & derivados , Ornitina/sangue , Putrescina/sangue , Uridina Monofosfato/sangue , Adulto Jovem
5.
Medicine (Baltimore) ; 99(23): e20270, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501974

RESUMO

OBJECTIVE: The accurate differentiation of glioma recurrence from pseudoprogression (PSP) after therapy remains a considerable clinical challenge. Several studies have shown that diffusion magnetic resonance imaging (MRI) has potential value in distinguishing these 2 outcomes. The current meta-analysis examined the diagnostic accuracy of diffusion MRI with the apparent diffusion coefficient (ADC) in the differentiation of glioma recurrence from PSP. METHOD: PubMed, Embase, Cochrane Library, and Chinese Biomedical databases were reviewed to identify studies that fulfilled our inclusion/exclusion criteria and were published on or before May 5, 2019. Threshold effects; heterogeneity; pooled sensitivity (SENS), specificity, positive likelihood ratio, and negative likelihood ratio; and diagnostic odds ratio were calculated. The overall diagnostic usefulness of diffusion MRI-derived ADC values was assessed by calculating the area under the curve (AUC) following summary receiver operating characteristic (SROC) analysis. RESULTS: Six eligible studies examined a total of 214 patients. Calculation of pooled values indicated the SENS was 0.95 (95% confidence interval [CI] = 0.89-0.98), specificity was 0.83 (95% CI = 0.72-0.91), positive likelihood ratio was 4.82 (95% CI = 2.93-7.93), negative likelihood ratio was 0.08 (95% CI = 0.04-0.17), and diagnostic odds ratio was 59.63 (95% CI = 22.63-157.37). The SROC AUC was 0.9322. Publication bias was not significant, and SENS analysis indicated the results were relatively stable. CONCLUSIONS: Our meta-analysis indicated that diffusion MRI with quantitative ADC is an effective approach for differentiation of glioma recurrence from PSP, and can be used as an auxiliary tool to diagnose glioma progression.


Assuntos
Neoplasias Encefálicas/patologia , Imagem de Difusão por Ressonância Magnética/métodos , Glioma/patologia , Recidiva Local de Neoplasia/patologia , Neoplasias Encefálicas/diagnóstico por imagem , Estudos de Coortes , Diagnóstico Diferencial , Progressão da Doença , Glioma/diagnóstico por imagem , Humanos , Recidiva Local de Neoplasia/diagnóstico por imagem , Razão de Chances , Curva ROC , Sensibilidade e Especificidade
6.
Lancet Oncol ; 21(6): e317-e329, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502458

RESUMO

Response criteria for paediatric high-grade glioma vary historically and across different cooperative groups. The Response Assessment in Neuro-Oncology working group developed response criteria for adult high-grade glioma, but these were not created to meet the unique challenges in children with the disease. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop response assessment criteria for paediatric high-grade glioma. Current practice and literature were reviewed to identify major challenges in assessing the response of paediatric high-grade gliomas to various treatments. For areas in which scientific investigation was scarce, consensus was reached through an iterative process. RAPNO response assessment recommendations include the use of MRI of the brain and the spine, assessment of clinical status, and the use of corticosteroids or antiangiogenics. Imaging standards for brain and spine are defined. Compared with the recommendations for the management of adult high-grade glioma, for paediatrics there is inclusion of diffusion-weighted imaging and a higher reliance on T2-weighted fluid-attenuated inversion recovery. Consensus recommendations and response definitions have been established and, similar to other RAPNO recommendations, prospective validation in clinical trials is warranted.


Assuntos
Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/terapia , Imagem de Difusão por Ressonância Magnética/normas , Determinação de Ponto Final/normas , Glioma/diagnóstico por imagem , Glioma/terapia , Neuroimagem/normas , Adolescente , Idade de Início , Neoplasias do Sistema Nervoso Central/epidemiologia , Neoplasias do Sistema Nervoso Central/patologia , Criança , Consenso , Feminino , Glioma/epidemiologia , Glioma/patologia , Humanos , Masculino , Gradação de Tumores , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral
7.
PLoS One ; 15(5): e0228972, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413034

RESUMO

Accuracy of glioma grading is fundamental for the diagnosis, treatment planning and prognosis of patients. The purpose of this work was to develop a low-cost and easy-to-implement classification model which distinguishes low-grade gliomas (LGGs) from high-grade gliomas (HGGs), through texture analysis applied to conventional brain MRI. Different combinations of MRI contrasts (T1Gd and T2) and one segmented glioma region (necrotic and non-enhancing tumor core, NCR/NET) were studied. Texture features obtained from the gray level size zone matrix (GLSZM) were calculated. An under-sampling method was proposed to divide the data into different training subsets and subsequently extract complementary information for the creation of distinct classification models. The sensitivity, specificity and accuracy of the models were calculated, and the best model explicitly reported. The best model included only three texture features and reached a sensitivity, specificity and accuracy of 94.12%, 88.24% and 91.18%, respectively. According to the features of the model, when the NCR/NET region was studied, HGGs had a more heterogeneous texture than LGGs in the T1Gd images, and LGGs had a more heterogeneous texture than HGGs in the T2 images. These novel results partially contrast with results from the literature. The best model proved to be useful for the classification of gliomas. Complementary results showed that the heterogeneity of gliomas depended on the MRI contrast studied. The chosen model stands out as a simple, low-cost, easy-to-implement, reproducible and highly accurate glioma classifier. Importantly, it should be accessible to populations with reduced economic and scientific resources.


Assuntos
Neoplasias Encefálicas/patologia , Glioma/patologia , Imagem por Ressonância Magnética/métodos , Modelos Teóricos , Gradação de Tumores/métodos , Idoso , Neoplasias Encefálicas/classificação , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Glioma/classificação , Glioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética/normas , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/normas
8.
Brain Tumor Pathol ; 37(3): 89-94, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451719

RESUMO

Here, we report on a 28-year old male patient presenting with neck and shoulder pain, dysesthesia of all four limbs and hypesthesia of both hands, without motor deficits. Magnetic resonance imaging showed an intradural, intramedullary mass of the cervical spinal cord of 6.4 cm length and 1.7 cm diameter. The patient underwent surgical resection. Histological and immunohistochemical evaluation showed pleomorphic glial tumor cells, mitoses, calcifications, and atypical ganglioid cells compatible with the morphology of anaplastic ganglioglioma (WHO Grade III). Extensive molecular workup revealed H3F3A K27M, TERT C228T and PDGFRα Y849C mutations indicating poor prognosis. The H3F3A K27M mutation assigned the tumor to the molecular group of diffuse midline glioma (WHO Grade IV). Epigenome-wide methylation profiling confirmed the methylation class of diffuse midline glioma. Thus, this is a very rare case of malignant glioma with H3 K27M genotype phenotypically mimicking anaplastic ganglioglioma. This case emphasizes the importance of comprehensive morphological and molecular workup including methylome profiling for advanced patient care.


Assuntos
Genótipo , Glioma/genética , Glioma/patologia , Histonas/genética , Neoplasias da Medula Espinal/genética , Neoplasias da Medula Espinal/patologia , Adulto , Vértebras Cervicais , Imagem de Difusão por Ressonância Magnética , Ganglioglioma , Glioma/diagnóstico por imagem , Humanos , Masculino , Neoplasias da Medula Espinal/diagnóstico por imagem
9.
Int J Comput Assist Radiol Surg ; 15(6): 1053-1062, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32451814

RESUMO

PURPOSE: A real-time intra-operative imaging modality is required to update the navigation systems during neurosurgery, since precise localization and safe maximal resection of gliomas are of utmost clinical importance. Different intra-operative imaging modalities have been proposed to delineate the resection borders, each with advantages and disadvantages. This preliminary study was designed to simulate the photoacoustic imaging (PAI) to illustrate the brain tumor margin vessels for safe maximal resection of glioma. METHODS: In this study, light emitting diode (LED)-based PAI was selected because of its lower cost, compact size and ease of use. We developed a simulation framework based on multi-wavelength LED-based PAI to further facilitate PAI during neurosurgery. This framework considers a multilayer model of the tumoral and normal brain tissue. The simulation of the optical fluence and absorption map in tissue at different depths was computed by Monte Carlo. Then, the propagation of initial photoacoustic pressure was simulated by using k-wave toolbox. RESULTS: To evaluate the LED-based PAI, we used three evaluation criteria: signal-to-noise ratio (SNR), contrast ratio (CR) and full width of half maximum (FWHM). Results showed that by using proper wavelengths, the vessels were recovered with the same axial and lateral FWHM. Furthermore, by increasing the wavelength from 532 to 1064 nm, SNR and CR were increased in the deep region. The results showed that vessels with larger diameters at same wavelength have a higher CR with average improvement 28%. CONCLUSION: Multi-wavelength LED-based PAI provides detailed images of the blood vessels which are crucial for detection of the residual glioma: The longer wavelengths like 1064 nm can be used for the deeper tumor margins, and the shorter wavelengths like 532 nm for tumor margins closer to the surface. LED-based PAI may be considered as a promising intra-operative imaging modality to delineate tumor margins.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Encéfalo/patologia , Glioma/diagnóstico por imagem , Glioma/cirurgia , Técnicas Fotoacústicas/métodos , Algoritmos , Simulação por Computador , Meios de Contraste , Humanos , Processamento de Imagem Assistida por Computador , Período Intraoperatório , Luz , Margens de Excisão , Modelos Teóricos , Método de Monte Carlo , Fótons , Estudo de Prova de Conceito , Razão Sinal-Ruído , Análise Espectral , Cirurgia Assistida por Computador
10.
Eur J Radiol ; 129: 109049, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32464580

RESUMO

PURPOSE: To evaluate the efficacy of optimized T1-Perfusion MRI protocol (protocol-2) with whole brain coverage and improved spatial resolution using Compressed-SENSE (CSENSE) to differentiate high-grade-glioma (HGG) and low-grade-glioma (LGG) and to compare it with the conventional protocol (protocol-1) with partial brain coverage used in our center. METHODS: This study included MRI data from 5 healthy volunteers, a phantom and 126 brain tumor patients. Current study had two parts: To analyze the effect of CSENSE on 3D-T1-weighted (W) fast-field-echo (FFE) images, T1-W, dual-PDT2-W turbo-spin-echo images and T1 maps, and to evaluate the performance of high resolution T1-Perfusion MRI protocol with whole brain coverage optimized using CSENSE. Coefficient-of-Variation (COV), Relative-Percentage-Error (RPE), Normalized-Mean-Squared-Error (NMSE) and qualitative scoring were used for the former study. Tracer-kinetic (Ktrans,ve,vp) and hemodynamic (rCBV,rCBF) parameters computed from both protocols were used to differentiate LGG and HGG. RESULTS: The image quality of all structural images was found to be of diagnostic quality till R = 4. NMSE in healthy T1-W-FFE images and COV in phantom images increased with-respect-to R and images provided optimum quality till R = 4. Structural images and maps exhibited artefacts from R = 6. All parameters in tumor tissue and hemodynamic parameters in healthy gray matter tissue computed from both protocols were not significantly different. Parameters computed from protocol-2 performed better in terms of glioma grading. For both protocols, rCBF performed least (AUC = 0.759 and 0.851) and combination of all parameters performed best (AUC = 0.890 and 0.964). CONCLUSION: CSENSE (R = 4) can be used to improve the resolution and brain coverage for T1-Perfusion analysis used to differentiate gliomas.


Assuntos
Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Glioma/diagnóstico por imagem , Glioma/patologia , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Criança , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Imagens de Fantasmas , Estudos Prospectivos , Estudos Retrospectivos , Adulto Jovem
11.
J Clin Neurosci ; 77: 41-48, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32409219

RESUMO

Hypnosis could extend the time of Intraoperative Neuropsychological Testing and Brain Mapping in Awake Surgery. A clinical validation for the Hypnosis aided AS (HAs) is still ongoing and further evidences are required. The objective of the present study is to compare two homogeneous cohorts of patients undergoing AS, the first with the aid of the hypnosis and the second according to a standard AS (SAs) protocols. The clinical, radiological and surgical data of two comparable procedures cohorts were retrospectively examined for the present study. All surgeries in Group A were performed with a HAs protocol. Procedures belonging to Group B were performed with a SAs protocol. Endpoints: to compare 1. Incidence of complications in the immediate postoperative period, 2. Clinical and neurological status in the immediate postoperative period and 30 days after surgery, 3. Duration of surgical interventions, 4. Extent of Resection (EOR). The final cohort is composed of 15 procedures; 6 belonging to Group A and 9 to Group B. The different methods outline statistically comparable results from the clinical (Neurological outcomes) both in the postoperative period and one month after surgery and from the surgical point of view (comparable EOR). The incidence of complications is comparable either. The duration of the procedures was significantly longer in HAs group. Hypnosis is a promising approach to increasing the duration of intraoperative "testability" of patients at the price of a longer operative time. A specific professional is needed to induce hypnosis in the difficult intraoperative setting.


Assuntos
Neoplasias Encefálicas/cirurgia , Gerenciamento Clínico , Glioma/cirurgia , Hipnose/métodos , Monitorização Intraoperatória/métodos , Vigília , Adulto , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/psicologia , Estudos de Coortes , Craniotomia/métodos , Feminino , Glioma/diagnóstico por imagem , Glioma/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Testes Neuropsicológicos , Duração da Cirurgia , Estudos Retrospectivos
12.
Cancer Radiother ; 24(5): 453-462, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32278653

RESUMO

Neuroimaging and especially MRI has emerged as a necessary imaging modality to detect, measure, characterize and monitor brain tumours. Advanced MRI sequences such as perfusion MRI, diffusion MRI and spectroscopy as well as new post-processing techniques such as automatic segmentation of tumours and radiomics play a crucial role in characterization and follow up of brain tumours. The purpose of this review is to provide an overview on anatomical and functional MRI use for brain tumours boundaries determination and tumour characterization in the specific context of radiotherapy. The usefulness of anatomical and functional MRI on particular challenges posed by radiotherapy such as pseudo progression and pseudo esponse and new treatment strategies such as dose painting is also described.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuroimagem/métodos , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/secundário , Meios de Contraste/administração & dosagem , Progressão da Doença , Glioblastoma/diagnóstico por imagem , Glioblastoma/radioterapia , Glioma/diagnóstico por imagem , Glioma/radioterapia , Humanos , Espectroscopia de Ressonância Magnética/métodos , Gradação de Tumores , Técnica de Subtração , Resultado do Tratamento
13.
World Neurosurg ; 139: e345-e354, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298824

RESUMO

BACKGROUND: Laser interstitial thermal therapy (LITT) is a novel, minimally invasive alternative to craniotomy, and as with any new technology, comes with a learning curve. OBJECTIVE: We present our experience detailing the evolution of this technology in our practice in one of the largest patient cohorts to date regarding LITT in neuro-oncology. METHODS: We reviewed 238 consecutive patients with brain tumor treated with LITT at our institution. Data on patient, surgery and tumor characteristics, and follow-up were collected. Patients were categorized into 2 cohorts: early (<2014, 100 patients) and recent (>2015, 138 patients). Median follow-up for the entire cohort was 8.4 months. RESULTS: The indications for LITT included gliomas (70.2%), radiation necrosis (21.0%), and metastasis (8.8%). Patient demographics stayed consistent between the 2 cohorts, with the exception of age (early, 54.3; recent, 58.4; P = 0.04). Operative time (6.6 vs. 3.5; P < 0.001) and number of trajectories (53.1% vs. 77.9% with 1 trajectory; P < 0.001) also decreased in the recent cohort. There was a significant decrease in permanent motor deficits over time (15.5 vs. 4.4%; P = 0.005) and 30-day mortality (4.1% vs. 1.5%) also decreased (not statistically significant) in the recent cohort. In terms of clinical outcomes, poor preoperative Karnofsky Performance Status (≤70) were significantly correlated with increased permanent deficits (P = 0.001) and decreased overall survival (P < 0.001 for all time points). CONCLUSIONS: We observed improvement in operative efficiency and permanent deficits over time and also patients with poor preoperative Karnofsky Performance Status achieved suboptimal outcomes with LITT. As many other treatment modalities, patient selection is important in this procedure.


Assuntos
Neoplasias Encefálicas/terapia , Terapia a Laser/métodos , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Estudos de Coortes , Terapia Combinada , Feminino , Seguimentos , Glioma/diagnóstico por imagem , Glioma/cirurgia , Glioma/terapia , Humanos , Avaliação de Estado de Karnofsky , Terapia a Laser/mortalidade , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Transtornos dos Movimentos/etiologia , Metástase Neoplásica , Duração da Cirurgia , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Análise de Sobrevida , Resultado do Tratamento
14.
Clin Nucl Med ; 45(6): e290-e293, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32332306

RESUMO

In the present case, we report the first experience of a patient with high-grade glioma who underwent dual F-FAZA PET/CT imaging for intratumoral hypoxia assessment, before treatment, and for therapy monitoring in the suspicious of recurrence, as part of a clinical research protocol. In addition, despite the diagnosis of glioblastoma, the patient at 3 years from diagnosis was alive and underwent C-methionine simultaneous PET/MRI for disease monitoring after treatment, showing stability of disease. The multitracer capability of PET in assessing different and complementary metabolic features along with the use of a last-generation scanner as PET/MRI in brain oncology are here enlighten.


Assuntos
Aminoácidos/metabolismo , Glioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Metionina , Nitroimidazóis , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Hipóxia Tumoral , Adulto , Feminino , Glioma/metabolismo , Glioma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores
15.
Top Magn Reson Imaging ; 29(2): 71-82, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32271284

RESUMO

Recent advances in the understanding of the genetic makeup of gliomas have led to a paradigm shift in the diagnosis and classification of these tumors. Driven by these changes, the World Health Organization (WHO) introduced an update to its classification system of central nervous system (CNS) tumors in 2016. The updated glioma classification system incorporates molecular markers into tumor subgrouping, which has been shown to better correlate with tumor biology and behavior as well as patient prognosis than the previous purely histology-based classification system. Familiarity with this new classification scheme, the individual molecular markers, and corresponding imaging findings is critical for the radiologists who play an important role in diagnostic and surveillance imaging of patients with CNS tumors. The goals of this article are to review these updates to the WHO classification of CNS tumors with a focus on adult gliomas, provide an overview of key genomic markers of gliomas, and review imaging features pertaining to various genomic subgroups of adult gliomas.


Assuntos
Neoplasias Encefálicas/classificação , Neoplasias Encefálicas/genética , Glioma/classificação , Glioma/genética , Imagem por Ressonância Magnética/métodos , Adulto , Biomarcadores Tumorais , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Genômica , Glioma/diagnóstico por imagem , Humanos , Prognóstico , Radiologistas , Organização Mundial da Saúde
16.
Top Magn Reson Imaging ; 29(2): 83-94, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32271285

RESUMO

Malignant gliomas constitute a smaller portion of brain tumors in children compared with adults. Nevertheless, they can be devastating tumors with poor prognosis. Recent advances and improved understanding of the genetic and molecular characterization of pediatric brain tumors, including those of malignant gliomas, have led to the reclassification of many pediatric brain tumors and new entities have been defined. In this paper, we will present some of the more recent characterization and pertinent changes in pediatric high-grade gliomas, along with the conventional and advanced imaging features associated with these entities. Implications of the recent changes in pediatric malignant glioma classifications will also be discussed.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Pediatria/métodos , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Criança , Glioma/patologia , Humanos
17.
Top Magn Reson Imaging ; 29(2): 103-114, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32271287

RESUMO

Magnetic resonance imaging (MRI) has been the cornerstone of imaging of brain tumors in the past 4 decades. Conventional MRI remains the workhorse for neuro-oncologic imaging, not only for basic information such as location, extent, and navigation but also able to provide information regarding proliferation and infiltration, angiogenesis, hemorrhage, and more. More sophisticated MRI sequences have extended the ability to assess and quantify these features; for example, permeability and perfusion acquisitions can assess blood-brain barrier disruption and angiogenesis, diffusion techniques can assess cellularity and infiltration, and spectroscopy can address metabolism. Techniques such as fMRI and diffusion fiber tracking can be helpful in diagnostic planning for resection and radiation therapy, and more sophisticated iterations of these techniques can extend our understanding of neurocognitive effects of these tumors and associated treatment responses and effects. More recently, MRI has been used to go beyond such morphological, physiological, and functional characteristics to assess the tumor microenvironment. The current review highlights multiple recent and emerging approaches in MRI to characterize the tumor microenvironment.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Microambiente Tumoral , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Glioma/patologia , Humanos
18.
J Clin Neurosci ; 76: 46-52, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32312627

RESUMO

Primary and metastatic brain tumors can overlap in traditional imaging features detected on preoperative conventional magnetic resonance imaging (MRI). The research objective was to determine whether morphological vascular characteristics present in routine preoperative imaging using traditional MRI sequences are predictive of primary versus metastatic brain tumors; secondarily to determine association of conventional and vascular-related imaging parameters with intraoperative blood loss, pathological invasion, and World Health Organization (WHO) tumor grade. A retrospective review analyzed 100 consecutive intracranial tumor surgeries, 50 WHO grade II-IV gliomas and 50 intracranial metastases. Two blinded expert readers independently evaluated preoperative MRIs, obtained via standard morphological imaging sequences, for adjacent or intra-tumoral arterial aneurysm, peritumoral venous ectasia, prominence, or engorgement ("aberrant peritumoral vessels"), and prominent intra-tumoral flow voids. Multivariate analysis was performed to develop models predictive of glioma and glioblastoma (GBM). Aberrant peritumoral vessels and prominent intra-tumoral flow voids were statistically significant predictors of glioma in univariate analyses (p = 0.048, p = 0.001, respectively) and when combined in multivariate analysis (OR = 5.23, p = 0.001), particularly for GBM (OR = 9.08, p < 0.001). Multivariate modeling identified prominent intra-tumoral flow voids and FLAIR invasion as the strongest combined predictors of gliomas and GBM. Aberrant peritumoral vessels and larger tumor volume predicted higher intraoperative blood loss in all analyses. No vascular-related parameters predicted pathological invasion on multivariate analysis. Aberrant peritumoral vessels and prominent intra-tumoral flow voids were predictive of gliomas, specifically GBM. These vascular characteristics, evaluated on routine clinical preoperative MRI imaging, may aid in distinguishinggliomafrom brainmetastases andmay predict intraoperative blood loss.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico , Glioblastoma/diagnóstico por imagem , Glioma/diagnóstico por imagem , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Diagnóstico Diferencial , Feminino , Glioblastoma/patologia , Glioma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
19.
Clin Nucl Med ; 45(6): 448-450, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32349093

RESUMO

Postoperative assessment is crucial in the imaging follow-up and prognosis in patients with glioma. Whereas grade of resection is defined attending to the gadolinium enhancement in early postoperative MRI, no metabolical criteria exist for postoperative PET interpretation. Based on our prospective and multicenter FuMeGA (Functional and Metabolic Glioma Analysis) ongoing study, we propose criteria for the visual interpretation of F-fluorocholine PET scans in patients undergoing brain tumor resection. The different imaging characteristics between MRI and PET may explain the discordances regarding to the postresection status with both techniques.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Colina/análogos & derivados , Glioma/diagnóstico por imagem , Glioma/metabolismo , Tomografia por Emissão de Pósitrons , Adulto , Idoso , Neoplasias Encefálicas/metabolismo , Neoplasias Encefálicas/patologia , Feminino , Glioma/patologia , Glioma/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Período Pós-Operatório
20.
Clin Nucl Med ; 45(5): 394-397, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32209884

RESUMO

Gliomas are characterized by intratumoral histological heterogeneity, coexisting foci of low and high grade. First, in low-grade gliomas, neoangiogenesis has not yet developed and cellularity is low, so alterations on perfusion MRI may not be present. Second, a non-negligible number of high-grade gliomas show none, patchy, or weak contrast enhancement on MRI, so they can be misdiagnosed as low-grade glioma, preventing their correct management. We present 4 cases of patients in which F-fluorocholine PET defined the anaplastic tumor component and therefore the tumor aggressiveness, solving the limitations of MRI.


Assuntos
Colina/análogos & derivados , Glioma/diagnóstico por imagem , Glioma/patologia , Tomografia por Emissão de Pósitrons , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Humanos , Imagem por Ressonância Magnética , Gradação de Tumores , Neovascularização Patológica
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