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1.
Int J Radiat Oncol Biol Phys ; 106(3): 604-611, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32014151

RESUMO

PURPOSE: Steep dose falloff outside of tumors is a hallmark of stereotactic radiosurgery (SRS) and radiation therapy (SRT). Dose gradient index (DGI) quantifies the dose drop off. Tables of DGIs versus target volumes have been published for body sites, but none is available for brain. This study recommends guidelines for DGIs for brain SRS/SRT treatments based on clinical CyberKnife (CK) cases. METHODS AND MATERIALS: Four hundred ninety-five plans for patients with central nervous system tumors treated with CK at our institution between March 2015 and May 2018 were analyzed. The CK treatment planning system MultiPlan was used for planning. SRS/SRT plans were stratified into 6 groups by tumor size (Group I [0-1 cm3], II [1.0-3.0 cm3], III [3.0-5.0 cm3], IV [5.0-10.0 cm3], V [10.0-15.0 cm3], and VI [15.0-40.0 cm3]). Ideal and minimally acceptable DGIs were determined for each size group. To evaluate the effect of target shape on DGI criteria, the plans were divided into 4 target shape groups: (1) homogeneous shape (circular), (2) adjacent to radiosensitive organs at risk (adjacent), (3) irregularly shaped (irregular), and (4) multiple target plans (multilesion). The mean for each target size group was defined as the ideal DGI. Minimally acceptable DGI criteria are specified to reject the lowest 10% of cases. RESULTS: The minimal acceptable DGIs were 83 (Group I), 72 (II), 65 (III), 58 (IV), 52 (V), and 35 (VI). The ideal DGI is designated to evaluate SRS/SRT plans for homogeneous circular lesions, whereas minimal DGI is chosen to assess the plans for irregular, adjacent to organs at risk, and multilesions. SRS/SRT plans with higher DGI values are correlated with lower irradiated normal tissue volumes. CONCLUSIONS: This study provides a table of DGIs for brain SRS/SRT treatments as a tool for assessing the quality of intracranial SRS/SRT plans. DGI guidelines support SRS/SRT planning that results in lower risk of radionecrosis.


Assuntos
Neoplasias Encefálicas/radioterapia , Órgãos em Risco/efeitos da radiação , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Conformacional/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Guias como Assunto , Humanos , Órgãos em Risco/diagnóstico por imagem , Tolerância a Radiação , Radiocirurgia/efeitos adversos , Dosagem Radioterapêutica , Radioterapia Conformacional/efeitos adversos , Espalhamento de Radiação
2.
Isr Med Assoc J ; 22(1): 22-26, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927801

RESUMO

BACKGROUND: Prophylactic cranial irradiation (PCI) exclusion in favor of brain magnetic resonance imaging (MRI) staging and surveillance in the management of small cell lung cancer (SCLC) is controversial yet accepted by some centers. The use of MRI suggests performing stereotactic radiosurgery (SRS) treatment for limited brain metastases. Data regarding SRS efficacy in this setting is limited. OBJECTIVES: To assess intracranial objective response rate (iORR), progression-free survival (iPFS), intracranial failure patterns, overall survival (OS) and time-to-whole-brain radiation therapy (WBRT)/death, whichever occurred first (TTWD) with SRS in SCLC. METHODS: The study comprised 10 consecutive SCLC patients with brain metastases treated with SRS and followed-up at Davidoff Cancer center between Aug 2012 and March 2019. Brain MRI images were reviewed by a neuro-radiology specialist. RESULTS: iORR was 57% as assessed by response assessment in neuro-oncology brain metastases. Intracranial progression developed in 8 patients. Median iPFS was 4.0 months (95% confidence interval [95%CI] 1.7-7.2). In-site, off-site and combined pattern of intracranial failure was seen in 0, 5, and 3 patients, respectively; median number of new brain lesions following SRS was 4 (range, 1-12). SRS was performed 10 additional times in 6 patients (median number of lesions irradiated per round was 1, range 1-5). WBRT was administered in 3 patients. Median TTWD was 20.9 months (95% CI, 1.9-26.8). Median OS since SRS administration was 23.2 months (95% CI, 4.2-not reached). CONCLUSIONS: MRI surveillance with multiple rounds of SRS may serve a reasonable alternative to PCI or therapeutic WBRT in SCLC.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Pulmonares/patologia , Radiocirurgia , Carcinoma de Pequenas Células do Pulmão/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neuroimagem , Intervalo Livre de Progressão , Radiocirurgia/métodos , Resultado do Tratamento
3.
World Neurosurg ; 133: 196-200, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31606508

RESUMO

BACKGROUND: Rosette-forming glioneuronal tumors (RGNTs) with multifocal growth throughout the ventricular system are extremely rare, and only 1 case of RGNT with dissemination limited to supratentorial ventricles has previously been reported. Recent evidence based on molecular data suggest that low-grade glioneuronal tumors (GNT) involving the septum pellucidum and the lateral ventricles, with either dysembryoplastic neuroepithelial tumor-like or RGNT-like features, may belong to a neuropathologic entity distinct from cortical dysembryoplastic neuroepithelial tumor and "typical" fourth ventricle RGNT, respectively. Given their rarity, the classification of these neoplasms is still uncertain and their clinicopathological and radiological aspects are only partially known. CASE DESCRIPTION: A 24-year-old male presented a GNT with RGNT-like morphological features centered in the septum pellucidum with multifocal masses occupying the lateral ventricles and the third ventricle with extraventricular infiltration of the frontal lobe. The patient underwent subtotal resection and 4 years follow-up. The clinicopathological and radiological features of the neoplasm are discussed. CONCLUSIONS: Advanced magnetic resonance imaging (magnetic resonance spectroscopy and perfusion-weighted imaging) may provide valuable information in the differential diagnosis between rare GNTs and other more frequent intraventricular neoplasms. In the present case, the enhancing remnant portion of the tumor showed remarkable contrast enhancement variability during the follow-up with slow in situ progression. However, available data suggest that spontaneous contrast enhancement "fluctuations" over time in RGNT may not represent a reliable indicator of tumor behavior.


Assuntos
Neoplasias Encefálicas/cirurgia , Glioma/cirurgia , Septo Pelúcido/cirurgia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Craniotomia , Glioma/diagnóstico por imagem , Glioma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Septo Pelúcido/diagnóstico por imagem , Septo Pelúcido/patologia , Resultado do Tratamento , Adulto Jovem
4.
World Neurosurg ; 133: 49-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562973

RESUMO

BACKGROUND: Subdural lymphomas are a rare subtype of primary central nervous system lymphomas that can radiographically mimic epidural blood and pose a diagnostic challenge. They can complicate treatment if not preemptively identified. METHODS: We present a case report of a subdural lymphoma that mimicked a compressive subdural hematoma, and we review the PubMed database for similar cases. RESULTS: A 77-year-old woman presented with a transient left facial droop and what appeared to be a subdural hematoma on computed tomography scan. The patient underwent surgery, during which grossly abnormal solid epicortical adherent tissue was noted instead of the expected appearance of a subdural hematoma. An intraoperative biopsy was suggestive of lymphoma, and the surgery was converted to a craniectomy. Pathology confirmed the diagnosis of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. The patient underwent radiotherapy with no complications or recurrence. Magnetic resonance imaging demonstrated complete resolution of the mass at 3 months after treatment, at which time the patient underwent a synthetic cranioplasty. Seven case reports of primary dural lymphomas mimicking subdural blood were found, with variable pathologic subclassifications. CONCLUSIONS: Although rare, a primary dural lymphoma can be mistaken for a subdural hematoma on computed tomography scan. The most common subtype is low-grade extranodal marginal zone lymphomas. It is important to keep these diseases in the differential diagnosis, especially when there is incongruence between imaging and the clinical picture, as earlier detection correlates to a stronger therapeutic response.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Paralisia Facial/diagnóstico por imagem , Hematoma Subdural/diagnóstico por imagem , Linfoma de Células B/diagnóstico por imagem , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/cirurgia , Craniotomia , Diagnóstico Diferencial , Paralisia Facial/etiologia , Paralisia Facial/cirurgia , Feminino , Humanos , Linfoma de Células B/complicações , Linfoma de Células B/cirurgia , Imagem por Ressonância Magnética , Espaço Subdural/diagnóstico por imagem , Espaço Subdural/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
World Neurosurg ; 133: 205-211, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31525480

RESUMO

BACKGROUND: Diverse clinical manifestations have characterized reports of central nervous system involvement in Behcet disease. There is a limited number of published case reports of neuro-Behcet disease mimicking brain tumor. CASE DESCRIPTION: We present a rare case of neuro-Behcet disease exhibiting mixed systemic and neurological symptoms mimicking malignant lymphoma. Delayed presentation of oral aphthae and rapid improvement of symptoms with steroid treatment led to a diagnosis of neuro-Behcet disease without brain biopsy. The patient also underwent surgery for the resection of an arterio-venous fistula. CONCLUSIONS: We recommend management of neuro-Behcet disease based on perceived natural history risks, with the understanding that no data exist on this within patients population. A multidisciplinary team approach is always recommended because neuro-Behcet disease is an uncommon condition, especially in neurosurgical practice.


Assuntos
Síndrome de Behçet/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Malformações Vasculares do Sistema Nervoso Central/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Adulto , Síndrome de Behçet/complicações , Malformações Vasculares do Sistema Nervoso Central/complicações , Diagnóstico Diferencial , Humanos , Masculino , Tomografia Computadorizada por Raios X
6.
World Neurosurg ; 133: 308-313, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31525486

RESUMO

BACKGROUND: Intravascular papillary endothelial hyperplasia (IPEH) is a benign vascular lesion that is uncommon in the central nervous system. To our knowledge, there has been only one previous report of occurrence in the pineal region. We present a second case and a review of the literature. CASE DESCRIPTION: A 28-year-old woman presented with 1 month of headaches and visual auras. Brain magnetic resonance imaging scan demonstrated a 2.6- × 1.8- × 1.3-cm nonenhancing T1-hypointense, T2-/fluid-attenuated inversion recovery-hyperintense pineal region mass with cerebral aqueduct obstruction and hydrocephalus. She underwent placement of a right extraventricular drain followed by complete surgical resection. Histologic analysis was consistent with IPEH. CONCLUSIONS: Although rare, IPEH is an entity that should be considered in the differential diagnosis for intracranial masses with radiographic features characteristic of vascular lesions. Tissue sampling is imperative for distinction from more malignant entities. Complete resection is curative and is the standard of care when feasible. Given the risk of local progression and neurologic compromise with subtotal resection of central nervous system lesions, further study regarding adjuvant treatment options is warranted.


Assuntos
Neoplasias Encefálicas/cirurgia , Glândula Pineal/cirurgia , Neoplasias Vasculares/cirurgia , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Drenagem , Feminino , Humanos , Hiperplasia/diagnóstico por imagem , Hiperplasia/cirurgia , Imagem por Ressonância Magnética , Procedimentos Neurocirúrgicos , Glândula Pineal/diagnóstico por imagem , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem
9.
J Oncol Pharm Pract ; 26(1): 244-251, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31068087

RESUMO

BACKGROUND: Nivolumab is an immune checkpoint inhibitor that selectively blocks the programmed cell death-1. Nowadays, immune checkpoint inhibitors such as nivolumab are used in the treatment of many different types of cancer. Treatment responses of these agents may be different from standard chemotherapy, and hyperprogression is a new entity that occurs with immune checkpoint inhibitors. We present a case of hyperprogressive disease precipitated by anti-programmed cell death-1 immunotherapy. CASE REPORT: A 25-year-old woman was treated with ipilimumab, dabrafenib plus trametinib, and nivolumab, respectively, for stage IV melanoma. Palliative whole brain radiotherapy was completed due to brain metastases before the administration of nivolumab. After the fourth cycle of nivolumab, the patient's general condition deteriorated and control positron emission tomography/computed tomography confirmed hyperprogression. Also, brain magnetic resonance imaging indicated the hyperprogression of the metastatic lesions. MANAGEMENT AND OUTCOME: After brain magnetic resonance imaging and positron emission tomography/computed tomography showed the hyperprogressive disease, nivolumab was discontinued. Cisplatin and dacarbazine were initiated for melanoma. DISCUSSION: Anti-programmed cell death-1 immunotherapy is effective in cancers. These agents can precipitate hyperprogressive disease. As the use of anti-programmed cell death-1 agents is expected to rise, physicians should be educated about the potential possibility of hyperprogression during the immunotherapy.


Assuntos
Antineoplásicos Imunológicos/efeitos adversos , Melanoma/tratamento farmacológico , Nivolumabe/efeitos adversos , Adulto , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Feminino , Humanos , Imagem por Ressonância Magnética , Melanoma/patologia , Receptor de Morte Celular Programada 1/antagonistas & inibidores
10.
Br J Radiol ; 93(1105): 20190543, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31617743

RESUMO

OBJECTIVE: MR-perfusion post-processing still lacks standardization. This study evaluates the results of perfusion analysis with two established software solutions in a large series of patients with different diseases when a highly standardized processing workflow is ensured. METHODS: Multicenter data of 260 patients (80 with brain tumors, 124 with cerebrovascular disease and 56 with dementia examined with the same MR protocol) were analyzed. Raw data sets were processed with two software suites: Olea sphere and NordicICE. Group differences were analyzed with paired t-tests and one-way ANOVA. RESULTS: Perfusion metrics were significantly different for all examined diseases in the unaffected brain for both software suites [ratio cortex/white matter left hemisphere: mean transit time (MTT) 0.991 vs 0.847, p < 0.05; relative cerebral bloodflow (rBF) 3.23 vs 4.418, p < 0.001; relative cerebral bloodvolume (rBVc) 2.813 vs 3.884, p < 0.001; right hemisphere: MTT 1.079 vs 0.854, p < 0.05; rBF 3.262 vs 4.378, p < 0.001; rBVc 2.762 vs 3.935, p < 0.001)]. Perfusion results were also significantly different in patients with stroke (ratio cortex/white matter affected hemisphere: MTT 1.058 vs 0.784; p < 0.001), dementia (ratio cortex/white matter left hemisphere: rBVc 1.152 vs 1.795, p < 0.001; right hemisphere: rBVc 1.396 vs 1.662, p < 0.05) and brain tumors (ratio cortex/whole tumor rBVc: 0.778 vs 0.919, p < 0.001 and ratio cortex/tumor hotspot rBVc: 0.529 vs 0.512, p < 0.05). CONCLUSION: Despite a highly standardized workflow, parametric perfusion maps are depended on the chosen software. Radiologists should consider software related variances when using dynamic susceptibility contrast perfusion for clinical imaging and research. ADVANCES IN KNOWLEDGE: This multicenter study compared perfusion parameters calculated by two commercial dynamic susceptibility contrast perfusion post-processing software solutions in different central nervous system disorders with a large sample size and a highly standardized processing workflow. Despite, parametric perfusion maps are depended on the chosen software which impacts clinical imaging and research.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Transtornos Cerebrovasculares/diagnóstico por imagem , Demência/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Angiografia por Ressonância Magnética/métodos , Software , Circulação Cerebrovascular , Meios de Contraste , Feminino , Humanos , Masculino , Compostos Organometálicos , Perfusão
11.
Int J Radiat Oncol Biol Phys ; 106(1): 194-205, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610250

RESUMO

PURPOSE: To develop and validate combined ion-beam with constant relative biological effectiveness (RBE) (CICR) particle therapy in single field arrangements for improved treatment efficacy, robustness, and normal tissue sparing. METHODS AND MATERIALS: The PRECISE (PaRticle thErapy using single and Combined Ion optimization StratEgies) treatment planning system was developed to investigate clinical viability of CICR treatments. Single-field uniform dose (SFUD) with a single ion (proton [p], helium [He], or carbon [C]) and CICR (C-p and C-He) treatments were generated for 3 patient cases with a clinically prescribed dose of 3 Gy (RBE) per fraction. Spread-out Bragg peak plans were irradiated in homogenous and clinical-like settings using an anthropomorphic head phantom. A dosimetric and biological verification of CICRC-p treatments using a murine glioma cell line (GL261) was performed. RESULTS: CICR treatment plans for the 3 patients presented highly uniform physical dose while reducing high dose-averaged linear energy transfer gradients compared with carbon ions alone. When considering uncertainty in tissue parameter (α/ß)x assignment and RBE modeling, the CICRC-p treatment exhibited enhanced biophysical stability within the target volume, similar to protons alone. CICR treatments reduced dose to normal tissue surrounding the target, exhibiting similar or improved dosimetric features compared with SFUDHe. For both CICRC-p and SFUD treatments, measurements verified the planned dose in the target within ∼3%. Planned versus measured target RBE values were 1.38 ± 0.02 and 1.39 ± 0.07 (<1% deviation), respectively, for the CICRC-p treatment in heterogenous settings. CONCLUSIONS: Here, we demonstrate that by combining 2 (or more) ions in a single field arrangement, more robust biological and more conformal dose distributions can be delivered compared with conventional particle therapy treatment planning. This work constitutes the first dosimetric and biological verification of multi-ion particle therapy in homogeneous as well as heterogenous settings.


Assuntos
Neoplasias Encefálicas/radioterapia , Carcinoma Adenoide Cístico/radioterapia , Cordoma/radioterapia , Glioma/radioterapia , Radioterapia com Íons Pesados/métodos , Tratamentos com Preservação do Órgão/métodos , Neoplasias da Coluna Vertebral/radioterapia , Animais , Neoplasias Encefálicas/diagnóstico por imagem , Carbono/uso terapêutico , Carcinoma Adenoide Cístico/diagnóstico por imagem , Linhagem Celular Tumoral , Cordoma/diagnóstico por imagem , Terapia Combinada/métodos , Fracionamento da Dose de Radiação , Glioma/diagnóstico por imagem , Hélio/uso terapêutico , Humanos , Transferência Linear de Energia , Camundongos , Órgãos em Risco , Imagens de Fantasmas , Terapia com Prótons/métodos , Lesões por Radiação/prevenção & controle , Planejamento da Radioterapia Assistida por Computador , Eficiência Biológica Relativa , Sacro , Neoplasias da Coluna Vertebral/diagnóstico por imagem
12.
Radiol Clin North Am ; 57(6): 1147-1162, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582041

RESUMO

In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.


Assuntos
Neoplasias Encefálicas/classificação , Neoplasias Encefálicas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Organização Mundial da Saúde , Adulto , Encéfalo/diagnóstico por imagem , Humanos
13.
Radiol Clin North Am ; 57(6): 1163-1175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582042

RESUMO

Primary brain tumors are the most common solid malignancy of childhood and constitute the most common cause of cancer-related death in children. It is important for the radiologist to understand the differences between pediatric and adult brain tumors. For instance, tumor type varies significantly with age; many histologic subtypes occur exclusively in childhood. An anatomic approach to pediatric brain tumors helps narrow the differential diagnosis; however, information from this approach must be considered in conjunction with recent advances in molecular subtyping of these tumors. This article emphasizes relevant clinical, molecular, and imaging features that are unique to pediatric brain tumors.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Neuroimagem/métodos , Tomografia Computadorizada por Raios X
14.
Radiol Clin North Am ; 57(6): 1177-1188, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582043

RESUMO

Advances in imaging techniques, such as MR perfusion and spectroscopy, are increasingly indispensable in the management and treatment plans of brain neoplasms: from diagnosing, molecular/genetic typing and grading neoplasms, augmenting biopsy results and improving accuracy, to ultimately directing and monitoring treatment and response. New developments in treatment methods have resulted in new diagnostic challenges for conventional MR imaging, such as pseudoprogression, where MR perfusion has the widest current application. MR spectroscopy is showing increasing promise in noninvasively determining genetic subtypes and, potentially, susceptibility to molecular targeted therapies.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Encéfalo/diagnóstico por imagem , Humanos , Imagem de Perfusão/métodos
15.
Radiol Clin North Am ; 57(6): 1199-1216, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582045

RESUMO

Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Diagnóstico por Imagem/métodos , Glioblastoma/diagnóstico por imagem , Glioblastoma/radioterapia , Lesões por Radiação/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/patologia , Progressão da Doença , Glioblastoma/patologia , Humanos , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Imagem Multimodal , Necrose , Tomografia por Emissão de Pósitrons , Lesões por Radiação/patologia
17.
Cancer Imaging ; 19(1): 68, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31639060

RESUMO

OBJECTIVE: To predict vascular endothelial growth factor (VEGF) expression in patients with diffuse gliomas using radiomic analysis. MATERIALS AND METHODS: Preoperative magnetic resonance images were retrospectively obtained from 239 patients with diffuse gliomas (World Health Organization grades II-IV). The patients were randomly assigned to a training group (n = 160) or a validation group (n = 79) at a 2:1 ratio. For each patient, a total of 431 radiomic features were extracted. The minimum redundancy maximum relevance (mRMR) algorithm was used for feature selection. A machine-learning model for predicting VEGF status was then developed using the selected features and a support vector machine classifier. The predictive performance of the model was evaluated in both groups using receiver operating characteristic curve analysis, and correlations between selected features were assessed. RESULTS: Nine radiomic features were selected to generate a VEGF-associated radiomic signature of diffuse gliomas based on the mRMR algorithm. This radiomic signature consisted of two first-order statistics or related wavelet features (Entropy and Minimum) and seven textural features or related wavelet features (including Cluster Tendency and Long Run Low Gray Level Emphasis). The predictive efficiencies measured by the area under the curve were 74.1% in the training group and 70.2% in the validation group. The overall correlations between the 9 radiomic features were low in both groups. CONCLUSIONS: Radiomic analysis facilitated efficient prediction of VEGF status in diffuse gliomas, suggesting that using tumor-derived radiomic features for predicting genomic information is feasible.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Fator A de Crescimento do Endotélio Vascular/metabolismo , Neoplasias Encefálicas/metabolismo , Feminino , Glioma/metabolismo , Humanos , Aprendizado de Máquina , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Distribuição Aleatória , Fator A de Crescimento do Endotélio Vascular/genética
18.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(5): 763-768, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31631624

RESUMO

Focus on the inconsistency of the shape, location and size of brain glioma, a dual-channel 3-dimensional (3D) densely connected network is proposed to automatically segment brain glioma tumor on magnetic resonance images. Our method is based on a 3D convolutional neural network frame, and two convolution kernel sizes are adopted in each channel to extract multi-scale features in different scales of receptive fields. Then we construct two densely connected blocks in each pathway for feature learning and transmission. Finally, the concatenation of two pathway features was sent to classification layer to classify central region voxels to segment brain tumor automatically. We train and test our model on open brain tumor segmentation challenge dataset, and we also compared our results with other models. Experimental results show that our algorithm can segment different tumor lesions more accurately. It has important application value in the clinical diagnosis and treatment of brain tumor diseases.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Glioma/diagnóstico por imagem , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Humanos
19.
World Neurosurg ; 132: 239-244, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520753

RESUMO

BACKGROUND: Malignant transformation of a mature intracranial teratoma into an adenocarcinoma is an extremely rare event and portends a poor prognosis. The clinical progression, radiographic changes, histopathological findings, and immunohistochemistry findings from these unique cases might provide clues regarding this transformation. Caudal homeobox gene-2 (CDX-2) is a specific and robust marker for colonic adenocarcinomas and can also be used to identify differentiation of mature intracranial teratoma into colonic-type adenocarcinoma. To the best of our knowledge, this is the first case report of the use of this specific marker for an intracranial malignancy. CASE DESCRIPTION: We present the case of a 55-year-old right-handed Hispanic-American woman with progressive headaches who was found to have a left posterior parietotemporal tumor with intraventricular extension. Surgical debulking was performed, and the pathologic examination revealed a mature teratoma. Despite surgical resection and radiotherapy, the teratoma progressed to a malignant mature intracranial teratoma both radiographically and histologically. Histological analysis of the third specimen revealed a moderately differentiated adenocarcinoma. The tumor cells were positive for CDX-2 and cytokeratin 20 and negative for cytokeratin 7 and thyroid transcription factor-1, consistent with an enteric/colonic-type adenocarcinoma, demonstrating progressive atypia and malignancy. CONCLUSIONS: Malignant transformation of a mature intracranial teratoma portends a poor prognosis. The exact histopathological diagnosis can facilitate treatment of these patients. CDX-2 is a specific robust marker for identifying differentiation of a mature intracranial teratoma into a colonic adenocarcinoma. This positive staining can also be observed in primary colonic and other adenocarcinomas. To the best of our knowledge, this is the first report of the use of CDX-2 in the diagnosis of an intracranial malignancy. The triangulation of clinical progression, radiographic findings, and histopathological and immunohistochemistry findings provided clues regarding this unique transformation.


Assuntos
Adenocarcinoma/metabolismo , Neoplasias Encefálicas/metabolismo , Fator de Transcrição CDX2/metabolismo , Neoplasias do Colo/metabolismo , Teratoma/metabolismo , Adenocarcinoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , Diferenciação Celular , Procedimentos Cirúrgicos de Citorredução , Progressão da Doença , Feminino , Humanos , Queratina-20/metabolismo , Queratina-7/metabolismo , Pessoa de Meia-Idade , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Fator Nuclear 1 de Tireoide/metabolismo
20.
World Neurosurg ; 132: 347-355, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520766

RESUMO

BACKGROUND: Polymorphous low-grade neuroepithelial tumor of the young (PLNTY) is a recently recognized epileptogenic neuroepithelial tumor. Despite its distinctiveness, its polymorphous histology and the nature of its oligodendrocyte-like cells remain unclear. CASE DESCRIPTION: A 30-year-old, right-handed man was diagnosed with intractable epilepsy since 22 years of age. Magnetic resonance imaging revealed T2 signal hyperintensity and corresponding T1 signal hypointensity within the subcortical white matter of the right middle temporal gyrus. Positron emission tomography scan demonstrated hypometabolism in the right anterior temporal region. Electroencephalography and stereo-electroencephalography monitoring localized seizures to the right temporal lobe, allowing the patient to undergo right temporal lobectomy. Histologic sections demonstrated cortical dysplasia, white matter heterotopia, and hippocampal reactive gliosis without neuronal loss. Interestingly, an approximately 6-mm subcortical neoplasm was identified in the temporal lobectomy. It was composed of well-differentiated oligodendroglial-like cells but exhibited mild-to-moderate nuclear variability and pleomorphism, and mild infiltration into the overlying cortex without perineuronal satellitosis. No mitotic activity, microvascular proliferation, or necrosis was identified, and Ki-67 labeling index was less than 1%. The tumor was diffusely CD34 positive with moderate glial fibrillary acidic protein and retained ATRX staining, and demonstrated the presence of the BRAF V600E mutation. The tumor was negative for reticulin condensation, synaptophysin, SMI31, neuronal nuclei immunostains, and both the IDH1 mutation and 1p19q codeletion. Overall histologic findings were most consistent with PLNTY. CONCLUSIONS: The correct diagnosis of PLNTY and its distinction from closely resembling low-grade neuroepithelial tumors is important. We hope our proposed diagnostic features will aid in its proper diagnosis and management.


Assuntos
Neoplasias Encefálicas/genética , Neoplasias Encefálicas/cirurgia , Neoplasias Neuroepiteliomatosas/genética , Neoplasias Neuroepiteliomatosas/cirurgia , Adulto , Lobectomia Temporal Anterior/métodos , Biomarcadores Tumorais/análise , Neoplasias Encefálicas/diagnóstico por imagem , Diagnóstico Diferencial , Epilepsia Resistente a Medicamentos/complicações , Epilepsia Resistente a Medicamentos/diagnóstico por imagem , Epilepsia Resistente a Medicamentos/cirurgia , Eletroencefalografia , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética , Masculino , Neoplasias Neuroepiteliomatosas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons
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