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1.
Brain Nerve ; 72(10): 1105-1111, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33051400

RESUMO

Meningioma and glioma represent two common primary intracranial tumors. However, the coexistence of these two lesions in the same patient at the same location is rare. Here, we present a case of a fibroblastic meningioma with a secondary glioblastoma occurring at the same location. A 67-year-old woman underwent surgery for a left frontal parasagittal meningioma, and the tumor was subtotally removed. Two years and 11 months after the surgery, the patient had a tumor at the same location with invasion into the adjacent brain, suggesting recurrent meningioma with malignant transformation. The resected tumor was confirmed histopathologically as a glioblastoma. Genetic analysis revealed that the isocitrate dehydrogenase 1 and 2 genes were wild type, and the TERT promoter mutation was detected. The gene analysis suggests that the tumor was a de novo glioblastoma, not a secondary glioblastoma from a lower-grade glioma. (Received April 9, 2020; Accepted May 27, 2020; Published October 1, 2020).


Assuntos
Neoplasias Encefálicas , Glioblastoma , Neoplasias Meníngeas , Meningioma , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/genética , Feminino , Glioblastoma/diagnóstico por imagem , Glioblastoma/cirurgia , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Recidiva Local de Neoplasia/cirurgia
2.
Anticancer Res ; 40(11): 5989-5994, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109536

RESUMO

Glioblastoma (GB) is a highly aggressive and infiltrative brain tumor characterized by poor outcomes and a high rate of recurrence despite maximal safe resection, chemotherapy, and radiation. Superparamagnetic iron oxide nanoparticles (SPIONs) are a novel tool that can be used for many applications including magnetic targeting, drug delivery, gene delivery, hyperthermia treatment, cell tracking, or multiple simultaneous functions. SPIONs are studied as a magnetic resonance imaging tumor contrast agent by targeting tumor cell proteins or tumor vasculature. Drug delivery to GB tumor has been targeted with SPIONs in murine models. In addition to targeting tumor cells for imaging or drug-delivery, SPION has also been shown to be effective at targeting for hyperthermia. Along with animal models, human trials have been conducted for a number of different modes of SPION utilization, with important findings and lessons for further preclinical and clinical experiments. SPIONs are opening up several new avenues for monitoring and treatment of GB tumors; here, we review the current research and a variety of possible clinical applications.


Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Glioblastoma/tratamento farmacológico , Nanopartículas de Magnetita/uso terapêutico , Animais , Neoplasias Encefálicas/diagnóstico por imagem , Ensaios Clínicos como Assunto , Meios de Contraste/química , Sistemas de Liberação de Medicamentos , Glioblastoma/diagnóstico por imagem , Humanos
3.
No Shinkei Geka ; 48(10): 921-926, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071228

RESUMO

We report a case of glioblastoma due to putaminal hemorrhage. Notably, the glioblastoma was located at some distance from the hematoma. A 42-year-old right-handed man presented with a sudden-onset headache, motor aphasia, and right hemiplegia. CT showed left putaminal hemorrhage and a mass lesion with a slightly high density in the midbrain away from the hematoma. Conservative treatment was initiated for the patient. Initially, we suspected a benign tumor-like cavernous malformation based on the CT findings. However, MRI showed ring enhancement of the mass lesion on contrast-enhanced MRI and hyperintensity on arterial spin labeling(ASL). A part of the wall of the putaminal hemorrhage also exhibited hyperintensity on ASL. Since we suspected a malignant brainstem tumor and a secondary intracerebral hemorrhage caused by this tumor, we performed a stereotactic brain biopsy. Histological examination revealed that the tumor was a wild-type IDH-1 glioblastoma. In the acute phase, the intracerebral hemorrhage presented as a hyperintensity on T1-weighted imaging. Therefore, it was difficult to distinguish hemorrhagic glioblastoma from an intracerebral hemorrhage. Even if an intracerebral hemorrhage is observed at common sites, it is important to consider the possibility of a malignant brain tumor and complete a prompt examination. In addition, ASL imaging may be useful in detecting hemorrhagic malignant brain tumors.


Assuntos
Neoplasias Encefálicas , Glioblastoma , Hemorragia Putaminal , Adulto , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/complicações , Glioblastoma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Hemorragia Putaminal/complicações , Hemorragia Putaminal/diagnóstico por imagem , Tomografia Computadorizada por Raios X
4.
No Shinkei Geka ; 48(10): 941-947, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071231

RESUMO

The 2016 World Health Organization brain tumor classification update may change the clinical approach toward treatment of diffuse astrocytoma(DA). Thus, more information about such cases is required. We report a case of DA, which was previously diagnosed as oligoastrocytoma. The tumor showed malignant progression after long-term temozolomide monotherapy. A 78-year-old woman presented with forgetfulness and decreased activity 12 years ago. MRI identified a T2-hyperintense lesion in the right frontal lobe. Histological diagnosis following partial resection was oligoastrocytoma. The residual tumor shrank after 65 courses of maintenance temozolomide monotherapy, which was terminated five years ago. The remaining lesion started enlarging gradually two years ago, showing enhancement on post-contrast T1WI and hyperintensity on arterial spin labeling, indicating malignant progression. The patient underwent maximum resection. The primary and the recurrent tumors were histologically reviewed. The former comprised of oligodendroglial and astrocytic tumor cells positive for IDH1R132H mutations and negative for ATRX mutations. The Ki67 index was 2.6%. Using the MethylationEPIC array, we generated a copy number profile and confirmed that the 1p/19q status was intact. The patient was ultimately diagnosed with IDH-mutant DA. The recurrent tumor showed marked proliferation of atypical glial cells with microvascular proliferation and the same immunophenotype as the primary tumor, with a Ki67 index of 13.1%. Thus, it was diagnosed as an IDH-mutant anaplastic astrocytoma and was treated with postoperative radiochemotherapy. Currently, multimodal therapy selection may be performed during initial treatment. Thus, an integrated diagnostic approach based on both histological and molecular findings is essential to identify the optimal treatment.


Assuntos
Astrocitoma , Neoplasias Encefálicas , Idoso , Astrocitoma/diagnóstico por imagem , Astrocitoma/tratamento farmacológico , Astrocitoma/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Feminino , Humanos , Isocitrato Desidrogenase , Recidiva Local de Neoplasia , Temozolomida/uso terapêutico
5.
Medicine (Baltimore) ; 99(41): e22478, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031279

RESUMO

RATIONALE: Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial neoplasm of the central nervous system, which is difficult to distinguish from other neoplastic and non-neoplastic entities. Herein, we report 2 cases of PXA that had been misdiagnosed as an inflammatory granuloma. PATIENT CONCERNS: The first case was a 22-year-old man who originally presented with a generalized seizure 7 years previously. Magnetic resonance imaging (MRI) revealed a lesion in the right parietal lobe, leading to a diagnosis of inflammatory granuloma. The second case was a 43-year-old man who presented with repeated generalized seizures. MRI revealed a nodular lesion in the left temporal lobe. The magnetic resonance spectrum showed elevated Cho and NAA peaks and a decreased Cr peak. An inflammatory granuloma was suspected. DIAGNOSIS: After surgical treatment, histopathological examination revealed PXA. INTERVENTIONS: In the first case, after 10 months of anti-inflammatory treatment, the lesion was significantly reduced in size. During the following 7 years, the patient experienced generalized seizures 3 to 4 times annually. To control intractable epilepsy, the lesion was resected. In the second case, conservative treatment provided no benefit, and then the lesion was resected. OUTCOMES: In the first case, during a follow-up period of 14 months, the patient was seizure-free with no tumor recurrence. In the second case, after a 6 months of follow-up, the patient remained seizure-free with no tumor recurrence. LESSONS: The preoperative differential diagnosis of PXA is challenging due to the nonspecific symptoms and imaging manifestations. Considering the potential risk of malignant transformation of PXA, early surgery should be highlighted, and gross total resection is associated with a favorable prognosis.


Assuntos
Astrocitoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Adulto , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Cérebro , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Convulsões/etiologia , Adulto Jovem
6.
Artigo em Russo | MEDLINE | ID: mdl-33095531

RESUMO

OBJECTIVE: To compare monopolar and bipolar mapping in point-by-point fashion by using of threshold amperage, frequency of positive motor responses and the number of muscles involved in response. MATERIAL AND METHODS: A prospective non-randomized study included 14 patients with supratentorial tumors who underwent surgery in 2018-2019. All neoplasms were localized within 2 cm from the motor cortex and pyramidal tract. Age of patients ranged from 25 to 74 years. There were 9 women and 5 men. Eight patients had malignant glioma (grade III - 4, grade IV - 4), 6 patients - meningioma. Motor functions were assessed in all patients before and after surgery (1, 7 days and 3 months later) by using of a 5-point scale. In addition to routine neurophysiological monitoring, comparative mono- and bipolar mapping of the pyramidal tract within the bed of excised tumor was carried out at the end of surgery. The points of motor responses were marked. Comparative analysis of mono- and bipolar stimulation at identical points included threshold amperage, frequency of positive motor responses and the number of muscles involved in response (leg, forearm, hand, facial muscles). Brain MRI was performed in early postoperative period for assessment of resection quality. RESULTS: There were 64 points of motor responses in 14 patients. The number of these points ranged from 2 to 8 per a patient (mean 5 points). Motor responses were recorded in 57 points during monopolar and bipolar stimulation, in other 7 points - only during monopolar stimulation. Amperage of monopolar stimulation was 3-15 mA, bipolar stimulation - 2.5-25 mA. Threshold amperage (7.37 mA for monopolar stimulation and 8.88 mA for bipolar stimulation; p=0.12), frequency of positive motor responses and the number of muscles involved in response (p=0.1 and p=0.73) were similar. Seven (50%) patients had neurological deterioration in early postoperative period (4 patients with glial tumors and 3 patients with meningiomas). At the same time, only 2 patients (14.3%) had persistent neurological deficit (both patients with infiltrative meningioma). According to postoperative MRI in T1+C mode, resection volume was 100% in 1 patient with contrast-enhanced glioma and 94% in another one. According to FLAIR MRI data, resection volume exceeded 70% in 2 patients with non-enhancing glioma and less than 70% in 2 patients. Meningioma resection volume was estimated according to postoperative T1+C MRI data and made up over 90% in 4 patients. CONCLUSION: Monopolar stimulation is a reliable method of pyramidal tract identification in supratentorial brain tumor surgery.


Assuntos
Transtorno Bipolar , Neoplasias Encefálicas , Neoplasias Meníngeas , Córtex Motor , Neoplasias Supratentoriais , Mapeamento Encefálico , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Potencial Evocado Motor , Feminino , Humanos , Masculino , Monitorização Intraoperatória , Córtex Motor/diagnóstico por imagem , Estudos Prospectivos , Tratos Piramidais/diagnóstico por imagem , Neoplasias Supratentoriais/diagnóstico por imagem , Neoplasias Supratentoriais/cirurgia
8.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1063-1066, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018169

RESUMO

Radiation therapy is a major treatment option for brain metastasis. For radiation treatment planning and outcome evaluation, magnetic resonance (MR) images are acquired before and at multiple sessions after the treatment. Accurate segmentation of brain tumors on MR images is crucial for treatment planning, response evaluation, and developing data-driven models for outcome prediction. Due to the high volume of imaging data acquired from each patient at multiple follow-up sessions, manual tumor segmentation is resource- and time-consuming in clinic, hence developing an automatic segmentation framework is highly desirable. In this work, we proposed a cascaded 2D-3D Unet framework to segment brain tumors automatically on contrast-enhanced T1- weighted images acquired before and at multiple scan sessions after radiotherapy. 2D Unet is a well-known structure for medical image segmentation. 3D Unet is an extension of 2D Unet with a volumetric input image to provide richer spatial information. The limitation of 3D Unet is that it is memory consuming and cannot process large volumetric images. To address this limitation, a large volumetric input of 3D Unet is often patched to smaller volumes which leads to loss of context. To overcome this problem, we proposed using two cascaded 2D Unets to crop the input volume around the tumor area and reduce the input size of the 3D Unet, obviating the need to patch the input images. The framework was trained using images acquired from 96 patients before radiation therapy and tested using images acquired from 10 patients before and at four follow-up scans after radiotherapy. The segmentation results for the images of independent test set demonstrated that the cascaded framework outperformed the 2D and 3D Unets alone, with an average Dice score of 0.9 versus 0.86 and 0.88 for the baseline, and 0.87 versus 0.83 and 0.84 for the first followup. Similar results were obtained for the other follow-up scans.


Assuntos
Neoplasias Encefálicas , Radiocirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Aprendizado Profundo , Humanos
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1067-1070, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018170

RESUMO

Accurate segmentation of brain tumors is a challenging task and also a crucial step in diagnosis and treatment planning for cancer patients. Magnetic resonance imaging (MRI) is the standard imaging modality for detection, characterization, treatment planning and outcome evaluation of brain tumors. MRI scans are usually acquired at multiple sessions before and after the treatment. An automatic segmentation framework is highly desirable to segment brain tumors in MR images as it streamlines the image-guided radiation therapy workflow considerably. Automatic segmentation of brain tumors also facilitates an incremental development of data-driven systems for therapy outcome prediction based on radiomics analysis. In this study, an outlier-detection-based segmentation framework is proposed to delineate brain tumors in magnetic resonance (MR) images automatically. The proposed method considers the tumor and edema pixels in an MR image as outliers compared to the pixels associated with the healthy tissue. The framework generates two outlier masks using independent one-class support vector machines that operate on post-contrast T1-weighted (T1w) and T2-weighted-fluid-attenuation-inversion-recovery (T2-FLAIR) images. The outlier masks are subsequently refined and fused using a number of morphological and logical operators to estimate a tumor mask for each image slice. The framework was constructed and evaluated using the MRI data acquired from 35 and 5 patients with brain metastasis, respectively. The obtained results demonstrated an average Dice similarity coefficient and Hausdorff distance of 0.84 ± 0.06 and 1.85 ± 0.48 mm, respectively, between the manual (ground truth) and automatic tumor contours, on the independent test set.


Assuntos
Neoplasias Encefálicas , Máquina de Vetores de Suporte , Algoritmos , Neoplasias Encefálicas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1323-1326, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018232

RESUMO

Despite recent advances in cancer treatment, the prognosis of patients diagnosed with brain metastasis is still poor. The median survival is limited to months even for patients undergoing treatment. Radiation therapy is a main component of treatment for brain metastasis. However, radiotherapy cannot control local progression in up to 20% of the metastatic brain tumours. An early prediction of radiotherapy outcome for individual patients could facilitate therapy adjustments to improve its efficacy. This study investigated the potential of quantitative CT biomarkers in conjunction with machine learning methods to predict local failure after radiotherapy in brain metastasis. Volumetric CT images were acquired for radiation treatment planning from 120 patients undergoing stereotactic radiotherapy. Quantitative features characterizing the morphology and texture were extracted from different regions of each lesion. A feature reduction/selection framework was adapted to define a quantitative CT biomarker of radiotherapy outcome. Different machine learning methods were applied and evaluated to predict the local failure outcome at pre-treatment. The optimum biomarker consisting of two features in conjunction with an AdaBoost with decision tree could predict the local failure outcome with 71% accuracy on an independent test set (20 patients, 31 lesions). This study is a step forward towards prediction of radiotherapy outcome in brain metastasis using quantitative imaging and machine learning.


Assuntos
Neoplasias Encefálicas , Radiocirurgia , Encéfalo , Neoplasias Encefálicas/diagnóstico por imagem , Humanos , Aprendizado de Máquina , Prognóstico , Radiocirurgia/efeitos adversos
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1750-1753, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018336

RESUMO

Gliomas are the most dominant and lethal type of brain tumors. Growth prediction is significant to quantify tumor aggressiveness, improve therapy planning, and estimate patients' survival time. This is commonly addressed in literature using mathematical models guided by multi-time point scans of multi/single-modal data for the same subject. However, these models are mechanism-based and heavily rely on complicated mathematical formulations of partial differential equations with few parameters that are insufficient to capture different patterns and other characteristics of gliomas. In this paper, we propose a 3D generative adversarial networks (GANs) for glioma growth prediction. Specifically, we stack 2 GANs with conditional initialization of segmented feature maps. Furthermore, we employ Dice loss in our objective function and devised 3D U-Net architecture for better image generation. The proposed method is trained and validated using 3D patch-based strategy on real magnetic resonance images of 9 subjects with 3 time points. Experimental results show that the proposed method can be successfully used for glioma growth prediction with satisfactory performance.


Assuntos
Neoplasias Encefálicas , Glioma , Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética
12.
PLoS One ; 15(10): e0232500, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33052913

RESUMO

BACKGROUND AND PURPOSE: Genetic classifications are crucial for understanding the heterogeneity of glioblastoma. Recently, perfusion MRI techniques have demonstrated associations molecular alterations. In this work, we investigated whether perfusion markers within infiltrated peripheral edema were associated with proneural, mesenchymal, classical and neural subtypes. MATERIALS AND METHODS: ONCOhabitats open web services were used to obtain the cerebral blood volume at the infiltrated peripheral edema for MRI studies of 50 glioblastoma patients from The Cancer Imaging Archive: TCGA-GBM. ANOVA and Kruskal-Wallis tests were carried out in order to assess the association between vascular features and the Verhaak subtypes. For assessing specific differences, Mann-Whitney U-test was conducted. Finally, the association of overall survival with molecular and vascular features was assessed using univariate and multivariate Cox models. RESULTS: ANOVA and Kruskal-Wallis tests for the maximum cerebral blood volume at the infiltrated peripheral edema between the four subclasses yielded false discovery rate corrected p-values of <0.001 and 0.02, respectively. This vascular feature was significantly higher (p = 0.0043) in proneural patients compared to the rest of the subtypes while conducting Mann-Whitney U-test. The multivariate Cox model pointed to redundant information provided by vascular features at the peripheral edema and proneural subtype when analyzing overall survival. CONCLUSIONS: Higher relative cerebral blood volume at infiltrated peripheral edema is associated with proneural glioblastoma subtype suggesting underlying vascular behavior related to molecular composition in that area.


Assuntos
Edema Encefálico/fisiopatologia , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Angiografia por Ressonância Magnética/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Edema Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/fisiopatologia , Volume Sanguíneo Cerebral , Feminino , Glioblastoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
13.
J Comput Assist Tomogr ; 44(5): 699-703, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936577

RESUMO

OBJECTIVE: This study evaluated the efficacy of 3-dimensional fluid-attenuated inversion recovery (3D FLAIR) for detecting intradural ecchordosis physaliphora (EP). METHODS: We retrospectively determined the presence or absence of intradural EP on 3D FLAIR for 3888 consecutive patients, classifying the EP as "classical" or "possible" and analyzing the prevalence, size, and presence or absence of an intraosseous stalk. Where available, magnetic resonance cisternography images were compared with the 3D FLAIR images. RESULTS: Intradural EP was identified in 50 patients (1.3%): 36 (0.9%) classical and 14 (0.4%) possible. The classical EPs were significantly larger than the possible EPs (P < 0.01). Nine EPs (18.0%) showed an osseous stalk. Magnetic resonance cisternography was performed for 19 EPs (16 classical, 3 possible), detecting all 16 classical EPs but none of the possible EPs. CONCLUSIONS: Classical EPs were detected by 3D FLAIR as with magnetic resonance cisternography. The 3D FLAIR findings suggested a new type of possible EP variant previously unreported.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Hamartoma/diagnóstico por imagem , Imageamento Tridimensional/métodos , Imagem por Ressonância Magnética/métodos , Adulto , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 99(33): e21628, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32872023

RESUMO

RATIONABLE: Large cell neuroendocrine carcinoma of the lung is rare, especially in the area of the foramen magnum. No previous studies have reported metastatic large cell neuroendocrine lung cancer to the foramen magnum. This paper will be the first time to report this special case. PATIENT CONCERNS: A case of a 37-year-old woman presented with headache that had developed 20 days previously. Imaging examination revealed a circular abnormal signal at the posterior margin of the foramen magnum. DIAGNOSES: The patient we report was diagnosed with a metastatic intracranial tumor. INTERVENTIONS: The patient underwent occipital craniotomy. Pathological results showed metastatic neuroendocrine carcinoma of the brain. Whole body PET-CT examination showed that fusiform soft tissue shadows could be seen near the hilum of the lower lobe of the left lung. OUTCOMES: The final bronchoscopy pathological results showed the large cell neuroendocrine carcinoma of the lung. The patient underwent further chemotherapy and radiotherapy in the oncology department. LESSONS: Diagnosis and treatment of large cell neuroendocrine carcinoma of the lung are difficult. The prognosis is poorer, and effective treatment is urgently needed.


Assuntos
Neoplasias Encefálicas/secundário , Carcinoma Neuroendócrino/patologia , Forame Magno/patologia , Neoplasias Pulmonares/patologia , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Carcinoma Neuroendócrino/diagnóstico por imagem , Carcinoma Neuroendócrino/terapia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X
15.
BMC Bioinformatics ; 21(Suppl 8): 325, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938360

RESUMO

BACKGROUND: Positron Emission Tomography (PET) is increasingly utilized in radiomics studies for treatment evaluation purposes. Nevertheless, lesion volume identification in PET images is a critical and still challenging step in the process of radiomics, due to the low spatial resolution and high noise level of PET images. Currently, the biological target volume (BTV) is manually contoured by nuclear physicians, with a time expensive and operator-dependent procedure. This study aims to obtain BTVs from cerebral metastases in patients who underwent L-[11C]methionine (11C-MET) PET, using a fully automatic procedure and to use these BTVs to extract radiomics features to stratify between patients who respond to treatment or not. For these purposes, 31 brain metastases, for predictive evaluation, and 25 ones, for follow-up evaluation after treatment, were delineated using the proposed method. Successively, 11C-MET PET studies and related volumetric segmentations were used to extract 108 features to investigate the potential application of radiomics analysis in patients with brain metastases. A novel statistical system has been implemented for feature reduction and selection, while discriminant analysis was used as a method for feature classification. RESULTS: For predictive evaluation, 3 features (asphericity, low-intensity run emphasis, and complexity) were able to discriminate between responder and non-responder patients, after feature reduction and selection. Best performance in patient discrimination was obtained using the combination of the three selected features (sensitivity 81.23%, specificity 73.97%, and accuracy 78.27%) compared to the use of all features. Secondly, for follow-up evaluation, 8 features (SUVmean, SULpeak, SUVmin, SULpeak prod-surface-area, SUVmean prod-sphericity, surface mean SUV 3, SULpeak prod-sphericity, and second angular moment) were selected with optimal performance in discriminant analysis classification (sensitivity 86.28%, specificity 87.75%, and accuracy 86.57%) outperforming the use of all features. CONCLUSIONS: The proposed system is able i) to extract 108 features for each automatically segmented lesion and ii) to select a sub-panel of 11C-MET PET features (3 and 8 in the case of predictive and follow-up evaluation), with valuable association with patient outcome. We believe that our model can be useful to improve treatment response and prognosis evaluation, potentially allowing the personalization of cancer treatment plans.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Neoplasias Encefálicas/secundário , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Prognóstico
16.
Medicine (Baltimore) ; 99(35): e21844, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871907

RESUMO

RATIONALE: The heart transplantation is the most important treatment for patients with end-stage severe heart disease who failed to conventional therapy. Post-transplant lymphoproliferative disorder is the second most common malignancy in heart transplant recipients. However, primary central nervous system lymphoma (PCNSL) after heart transplantation is an extremely rare condition. PATIENTS CONCERNS: This report described a 53-year-old male who was diagnosed as PCNSL 17 months after heart transplantation. DIAGNOSES: The patient was admitted to the local hospital presenting with dizziness, headache, and reduced left-sided power and sensation for 1 week. He had a medical history of heart transplantation because of the dilated cardiomyopathy 17 months ago and had a 17-month history of immunosuppressive therapy with tacrolimus. A computed tomography scan of the brain revealed a bulky mass in the right temporal lobe. The emergency intracranial mass resection and cerebral decompression were performed in our hospital. The histopathology of the brain lesions showed diffuse large B-cell lymphoma. A further FDG positron emission tomography-computed tomography scan of the whole body showed no significantly increased metabolic activity in other regions. The final diagnosis of this patient was PCNSL after heart transplantation. INTERVENTIONS: Given the poor health condition, with the patient's consent, the whole brain radiotherapy was performed with supportive care. OUTCOMES: The disease deteriorated rapidly during the period of receiving radiotherapy, and he died within 2 months from the diagnosis. LESSONS: PCNSL after heart transplantation is an extremely rare phenomenon with extremely poor prognosis. We should pay close attention to the heart recipients, especially when the patients present with neurological symptoms and signs. The available treatment options for PCNS-post-transplant lymphoproliferative disorder include the reduction of immunosuppressive drugs, immune-chemotherapy, operation, radiotherapy. However, individual treatments for heart transplant recipients with PCNSL should be based on the performance status and tolerance to treatment, combined with the doctor's experience and supportive care.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Transplante de Coração , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Humanos , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Tacrolimo/uso terapêutico , Tomografia Computadorizada por Raios X
17.
Br J Radiol ; 93(1115): 20200661, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32877208

RESUMO

OBJECTIVES: To determine the performance of pretreatment structural and arterial spin labelling (ASL) MRI in predicting p53 mutation in patients with high-grade gliomas (HGGs). METHODS: Pre-treatment structural and ASL MRI were performed in 57 patients with histologically confirmed HGGs and information of p53 status. Whole-lesion histogram analysis of cerebral blood flow (CBF) images of the enhancing tumour and the peritumoral oedema in the HGGs were performed. Visually AcceSAble Rembrandt Images features were used as qualitative analysis. The differences of ASL histogram parameters and Visually AcceSAble Rembrandt Images features between HGGs with or without p53 mutation were analyzed with post hoc correction for multiple comparisons. LASSO regression was performed to select the optimal features that could predict p53 mutation, followed by receiver operating characteristic analysis to determine the predictive efficacy. RESULTS: A total of 33 HGGs with p53 mutation and 24 without p53 mutation were included. HGGs with mutant p53 showed lower CBFpercentile5 and CBFuniformity of the enhancing tumour (p < 0.05) and higher prevalence of the qualitative MRI feature of enhancing tumour crossing midline (ETCM) (p < 0.05) as compared with HGGs with wild-type p53. LASSO regression showed that the CBFuniformity of the enhancing tumour and ETCM were predictive features for p53 mutation. CBFuniformity showed an acceptable performance in predicting p53 mutation (area under the curve = 0.721), when combined with the feature of ETCM, its predictive efficacy was significantly improved (area under the curve = 0.814, p = 0.012). CONCLUSION: An integrated pre-treatment structural and ASL MRI can help to predict p53 mutation in HGGs.


Assuntos
Neoplasias Encefálicas/genética , Imagem Ecoplanar/métodos , Genes p53/genética , Glioma/genética , Mutação , Adulto , Área Sob a Curva , Edema Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/irrigação sanguínea , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Circulação Cerebrovascular , Feminino , Glioma/irrigação sanguínea , Glioma/diagnóstico por imagem , Glioma/patologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Período Pré-Operatório , Curva ROC , Marcadores de Spin , Proteína Supressora de Tumor p53/análise
18.
Nat Commun ; 11(1): 4803, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32968068

RESUMO

Meningiomas are the most common primary intracranial tumors, but the molecular drivers of meningioma tumorigenesis are poorly understood. We hypothesized that investigating intratumor heterogeneity in meningiomas would elucidate biologic drivers and reveal new targets for molecular therapy. To test this hypothesis, here we perform multiplatform molecular profiling of 86 spatially-distinct samples from 13 human meningiomas. Our data reveal that regional alterations in chromosome structure underlie clonal transcriptomic, epigenomic, and histopathologic signatures in meningioma. Stereotactic co-registration of sample coordinates to preoperative magnetic resonance images further suggest that high apparent diffusion coefficient (ADC) distinguishes meningioma regions with proliferating cells enriched for developmental gene expression programs. To understand the function of these genes in meningioma, we develop a human cerebral organoid model of meningioma and validate the high ADC marker genes CDH2 and PTPRZ1 as potential targets for meningioma therapy using live imaging, single cell RNA sequencing, CRISPR interference, and pharmacology.


Assuntos
Neoplasias Encefálicas/genética , Neoplasias Encefálicas/metabolismo , Perfilação da Expressão Gênica/métodos , Heterogeneidade Genética , Imagem por Ressonância Magnética/métodos , Neoplasias Meníngeas/genética , Neoplasias Meníngeas/metabolismo , Idoso , Antígenos CD/genética , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Caderinas/genética , Imagem de Difusão por Ressonância Magnética/métodos , Epigenômica , Feminino , Marcadores Genéticos , Genômica , Humanos , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/patologia , Proteínas Tirosina Fosfatases Classe 5 Semelhantes a Receptores/genética , Transcriptoma
20.
Medicine (Baltimore) ; 99(31): e21333, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756119

RESUMO

This study aimed to evaluate the imaging findings and prognostic factors after whole-brain radiotherapy in patients with carcinomatous meningitis from breast cancer.A retrospective analysis of imaging data and prognostic factors was performed in patients treated with whole-brain radiotherapy or whole-brain/spine radiotherapy immediately after the first diagnosis of carcinomatous meningitis from breast cancer at our hospital from January 1, 2010 to December 31, 2018. Statistical significance was set at P < .05 (two-tailed).All patients (n = 31) were females with the mean age of 58.0 ±â€Š11.0 years. The breast cancer subtypes were luminal (n = 14, 45.1%), human epidermal growth factor receptor 2 (HER2)-positive (n = 9, 29.0%), and triple-negative (n = 8, 26.0%) breast cancer. Brain metastasis and abnormal contrast enhancement in the sulci were observed in 21 (67.7%) and 24 (80.6%) patients, respectively. The median survival time after cancerous meningitis diagnosis was 62 (range, 6-657) days. Log-rank test showed significant differences in median survival time after cancerous meningitis diagnosis: 18.0 days for subjects treated with 30 Gy in < 10 fractions (n = 7) vs 78.5 days for subjects treated with 30 Gy in ≥10 fractions (n = 24) (P < .01) and 23.0 days for the triple-negative subtype vs 78.5 days for the other subtype (P < .01) groups. Univariate analysis using the Cox regression model showed significant differences in median survival time after cancerous meningitis diagnosis between the group treated with 30 Gy in <10 fractions and the group treated in ≥10 fractions (hazard ratio [HR] 0.08, 95% confidence interval [CI], 0.03-0.26; P < .01), and between the triple-negative subtype and the other subtypes (HR = 5.48; 95% CI, 1.88-16.0; P < .01) groups.Discontinuation of whole-brain radiotherapy and the presence of triple-negative breast cancer were indicators of poor prognosis.


Assuntos
Neoplasias Encefálicas/secundário , Carcinomatose Meníngea/secundário , Neoplasias de Mama Triplo Negativas/mortalidade , Idoso , Biomarcadores Tumorais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Relação Dose-Resposta à Radiação , Feminino , Humanos , Imagem por Ressonância Magnética , Carcinomatose Meníngea/diagnóstico por imagem , Carcinomatose Meníngea/radioterapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Neoplasias de Mama Triplo Negativas/patologia
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