Enhancing Lesions Research Articles

MRI phenotypes of glioblastomas early after treatment are suggestive of overall patient survival.

Distinguishing true tumor progression (TP) from treatment-induced abnormalities (eg, pseudo-progression (PP) after radiotherapy) on conventional MRI scans remains challenging in patients with a glioblastoma. We aimed to establish brain MRI phenotypes of glioblastomas early after treatment by combined analysis of structural and perfusion tumor characteristics and assessed the relation with recurrence rate and overall survival time. Structural and perfusion MR images of 67 patients at 3 months post-radiotherapy were visually scored by a neuroradiologist. In total 23 parameters were predefined and used for hierarchical clustering analysis. Progression status was assessed based on the clinical course of each patient 9 months after radiotherapy (or latest available). Multivariable Cox regression models were used to determine the association between the phenotypes, recurrence rate, and overall survival. We established 4 subgroups with significantly different tumor MRI characteristics, representing distinct MRI phenotypes of glioblastomas: TP and PP rates did not differ significantly between subgroups. Regression analysis showed that patients in subgroup 1 (characterized by having mostly small and ellipsoid nodular enhancing lesions with some hyper-perfusion) had a significant association with increased mortality at 9 months (HR: 2.6 (CI: 1.1-6.3); P = .03) with a median survival time of 13 months (compared to 22 months of subgroup 2). Our study suggests that distinct MRI phenotypes of glioblastomas at 3 months post-radiotherapy can be indicative of overall survival, but does not aid in differentiating TP from PP. The early prognostic information our method provides might in the future be informative for prognostication of glioblastoma patients.

Contrast-enhanced fluid-attenuated inversion-recovery (FLAIR) versus contrast-enhanced T1 MRI in the evaluation of intracranial tumors: A comparative study

INTRODUCTION: At most institutions, the favored contrast MR sequence is T1-weighted imaging (T1WI). However, lesion enhancement is occasionally inconspicuous on T1WI.Objective: This study aims to evaluate the diagnostic value of contrast-enhanced FLAIR compared to contrast-enhanced T1WI for intracranial tumors and to offer data for further clinical judgment. METHODS: 88 consecutive cases of intracranial tumors referred for contrast-enhanced brain MRI were analyzed. FLAIR and T1 were used alternately in equal percentages as the first contrast-enhanced sequence to avoid delayed contrast-enhancement effects of the lesions. Six quantitative criteria were considered: lesion-to-white matter contrast ratio (CR) and contrast-to-noise ratio (CNR), lesion-to-gray matter CR and CNR, and lesion-to-cerebrospinal fluid CR and CNR. For qualitative evaluation, two experienced radiologists assessed lesion conspicuity on contrast-enhanced-T1WI and FLAIR sequences using the following three scales: 1, FLAIR superior; 2, sequences equal; 3, T1 superior. RESULTS: For quantitative measurement, the contrast enhanced-FLAIR lesion-to-white matter, lesion-to-cerebrospinal fluid CR, and CNR values were statistically superior to those of the contrast enhanced-T1 weighted images (p = 0.001 in all). However, lesion-to-gray matter CR and CNR were slightly higher on CE-FLAIR, but with no statistically significant difference (p = 0.159, 0.184, respectively). For qualitative evaluation, both radiologists assessed that contrast enhanced-FLAIR images were superior to contrast enhanced-T1 weighted images for the evaluation of lesion conspicuity, especially when it was performed as the second sequence. CONCLUSION: FLAIR sequence was superior or comparable to T1 sequence, especially when performed as a second post-contrast sequence. Using contrast enhanced-FLAIR as a routine MRI sequence will increase diagnostic confidence.

The Usefulness of MRI Dynamic Flow Sequences in Differentiating High- and Low-Flow Vascular Malformations.

Peripheral arteriovenous malformations (PVMs) can be classified into high-flow malformations (HFVMs) and low-flow malformations (LFVMs). Adequate distinguishment is crucial for therapeutic decision and can be done using dynamic contrast-enhanced MRI (DCE-MRI). The main aim of this retrospective study was to determine the diagnostic value of quantitative DCE-MRI ratios for differentiation between HFVM and LFVM, their optimal cut-off points, and predictive values. DCE-MRI time-resolved angiography with stochastic trajectory (TWIST) examinations of 90 patients with PVMs were included [28 HFVM (31%), 62 LFVM (69%)]. The measurements of artery-lesion time, maximum lesion enhancement, slope of the enhancement curve, and maximum percentage increase of signal intensity (SI) were obtained. The optimal cut-offs for HFVMs calculated using the Youden index were: for slope of enhancement curve < 8.7 s (sensitivity of 86%, specificity of 89%), artery-lesion time ≤ 5.6 s (sensitivity of 89%, specificity of 77%), time to maximum enhancement ≤ 30 s (sensitivity of 94%, specificity of 100%), and maximum percentage enhancement of the lesion > 662% (sensitivity of 68%, specificity of 69%). To summarize, DCE-MRI is very valuable for differentiation between HFVM and LFVM, especially if quantitative measurements are done.

Ultra-low-dose hepatic multiphase CT using deep learning-based image reconstruction algorithm focused on arterial phase in chronic liver disease: A non-inferiority study

PurposeThis study determined whether image quality and detectability of ultralow-dose hepatic multiphase CT (ULDCT, 33.3% dose) using a vendor-agnostic deep learning model(DLM) are noninferior to those of standard-dose CT (SDCT, 100% dose) using model-based iterative reconstruction(MBIR) in patients with chronic liver disease focusing on arterial phase. MethodsSixty-seven patients underwent hepatic multiphase CT using a dual-source scanner to obtain two different radiation dose CT scans (100%, SDCT and 33.3%, ULDCT). ULDCT using DLM and SDCT using MBIR were compared. A margin of −0.5 for the difference between the two protocols was pre-defined as noninferiority of the overall image quality of the arterial phase image. Quantitative image analysis (signal to noise ratio[SNR] and contrast to noise ratio[CNR]) was also conducted. The detectability of hepatic arterial focal lesions was compared using the Jackknife free-response receiver operating characteristic analysis. Non-inferiority was satisfied if the margin of the lower limit of 95%CI of the difference in figure-of-merit was less than –0.1. ResultsMean overall arterial phase image quality scores with ULDCT using DLM and SDCT using MBIR were 4.35 ± 0.57 and 4.08 ± 0.58, showing noninferiority (difference: −0.269; 95 %CI, −0.374 to −0.164). ULDCT using DLM showed a significantly superior contrast-to-noise ratio of arterial enhancing lesion (p < 0.05). Figure-of-merit for detectability of arterial hepatic focal lesion was 0.986 for ULDCT using DLM and 0.963 for SDCT using MBIR, showing noninferiority (difference: −0.023, 95 %CI: –0.016 to 0.063). ConclusionULDCT using DLM with 66.7% dose reduction showed non-inferior overall image quality and detectability of arterial focal hepatic lesion compared to SDCT using MBIR.

Cardiac Magnetic Resonance Findings in Patients Recovered from COVID-19 Pneumonia and Presenting with Persistent Cardiac Symptoms: The TRICITY-CMR Trial.

The prevalence and clinical consequences of coronavirus disease 2019 (COVID-19)-related non-ischemic cardiac injury are under investigation. The main purpose of this study was to determine the occurrence of non-ischemic cardiac injury using cardiac magnetic resonance (CMR) imaging in patients with persistent cardiac symptoms following recovery from COVID-19 pneumonia. We conducted a single-center, cross-sectional study. Between January 2021 and May 2021, we enrolled 121 patients with a recent COVID-19 infection and persistent cardiac symptoms. Study participants were divided into those who required hospitalization during the acute phase of SARS-CoV-2 infection (n = 58; 47.9%) and those non-hospitalized (n = 63; 52.1%). Non-ischemic cardiac injury (defined as the presence of late gadolinium enhancement (LGE) lesion and/or active myocarditis in CMR) was detected in over half of post-COVID-19 patients (n = 64; 52.9%). LGE lesions were present in 63 (52.1%) and active myocarditis in 10 (8.3%) post-COVID-19 study participants. The majority of LGE lesions were located in the left ventricle at inferior and inferolateral segments at the base. There were no significant differences in the occurrence of LGE lesions (35 (60.3%) vs. 28 (44.4%); p = 0.117) or active myocarditis (6 (10.3%) vs. 4 (6.3%); p = 0.517) between hospitalized and non-hospitalized post-COVID-19 patients. However, CMR imaging revealed lower right ventricular ejection fraction (RVEF; 49.5 (44; 54) vs. 53 (50; 58) %; p = 0.001) and more frequent presence of reduced RVEF (60.3% vs. 33.3%; p = 0.005) in the former subgroup. In conclusion, more than half of our patients presenting with cardiac symptoms after a recent recovery from COVID-19 pneumonia had CMR imaging abnormalities indicating non-ischemic cardiac injury. The most common finding was LGE, while active myocarditis was detected in the minority of patients. CMR imaging abnormalities were observed both in previously hospitalized and non-hospitalized post-COVID-19 patients. Further research is needed to determine the long-term cardiovascular consequences of COVID-19 infection and the optimal management of patients with suspected post-COVID-19 non-ischemic cardiac injury.

Diagnosis of Upper Urinary Tract Urothelial Cell Carcinoma by Urine Cytology in a Patient with Valvular Heart Disease: A Case Report

A 58-year-old male was admitted to the hospital with severe gross hematuria and many comorbidities such as rheumatic heart disease and severe mitral valve stenosis. Because of atrial fibrillation, the patient took anticoagulant drug for stroke prevention. The patient was requested to stop anticoagulant agents and received blood replacement therapy for blood loss after hospitalization. Ureterorenoscopy was unable to visualize or biopsy the mass due to a massive blood clot. Urine cytology of left and right ureter showed high-grade urothelial carcinoma (HGUC) and few suspicious cells, respectively. Computed tomography angiography (CTA) of the whole abdomen revealed blood clot in the upper pole calyx and renal pelvis of the left kidney as well as the urinary bladder, but no abnormal enhancing lesion. The patient underwent the standard treatment for upper tract urothelial carcinoma (UTUC) with laparoscopic radical nephroureterectomy (RNU) with bladder cuff excision because the consulted cardiologist suggested to start anticoagulant agents as soon as possible. Surgical pathology analysis revealed high-risk tumors with multiple low grade papillary urothelial carcinoma. The patient required long term follow-up. Here, the authors reported a case of UTUC with valvular heart disease, earlier diagnosed by using only positive urinary cytology, rather than by radiological examinations and/or related symptoms before definite treatment. Keywords: Urine Cytology; Upper tract; Ureter; Ureteroscopy; Urothelial carcinoma; False positive; Nephroureterectomy

Contrast-Enhanced 3D Spin Echo T1-Weighted Sequence Outperforms 3D Gradient Echo T1-Weighted Sequence for the Detection of Multiple Sclerosis Lesions on 3.0 T Brain MRI.

Using reliable contrast-enhanced T1 sequences is crucial to detect enhancing brain lesions for multiple sclerosis (MS) at the time of diagnosis and over follow-up. Contrast-enhanced 3D gradient-recalled echo (GRE) T1-weighted imaging (WI) and 3D turbo spin echo (TSE) T1-WI are both available for clinical practice and have never been compared within the context of this diagnosis. The aim of this study was to compare contrast-enhanced 3D GRE T1-WI and 3D TSE T1-WI for the detection of enhancing lesions in the brains of MS patients. This single-center prospective study enrolled patients with MS who underwent a 3.0 T brain MRI from August 2017 to April 2021 for follow-up. Contrast-enhanced 3D GRE T1-WI and 3D TSE T1-WI were acquired in randomized order. Two independent radiologists blinded to all data reported all contrast-enhanced lesions in each sequence. Their readings were compared with a reference standard established by a third expert neuroradiologist. Interobserver agreement, contrast ratio, and contrast-to-noise ratio were calculated for both sequences. A total of 158 MS patients were included (mean age, 40 ± 11 years; 95 women). Significantly more patients had at least 1 contrast-enhanced lesion on 3D TSE T1-WI than on 3D GRE T1-WI for both readers (61/158 [38.6%] vs 48/158 [30.4%] and 60/158 [38.6%] vs 47/158 [29.7%], P < 0.001). Significantly more contrast-enhanced lesions per patient were detected on 3D TSE T1-WI (mean 2.47 vs 1.56 and 2.56 vs 1.39, respectively, P < 0.001). Interobserver agreement was excellent for both sequences, κ = 0.96 (confidence interval [CI], 0.91-1.00) for 3D TSE T1-WI and 0.92 (CI, 0.86-0.99) for 3D GRE T1-WI. Contrast ratio and contrast-to-noise ratio were significantly higher on 3D TSE T1-WI (0.84 vs 0.53, P < 0.001, and 87.9 vs 57.8, P = 0.03, respectively). At 3.0 T, contrast-enhanced 3D TSE-T1-WI supports the detection of significantly more enhancing lesions than 3D GRE T1-WI and should therefore be used for MS patients requiring contrast-enhanced examination.

New Contrast Enhancement Method for Multiple Sclerosis Lesion Detection.

Multiple sclerosis (MS) is oneof the most serious neurological diseases. It is the most frequent reason of non-traumatic disability among young adults. MS is an autoimmune disease wherein the central nervous system wrongly destructs the myelin sheath surrounding and protecting axons of nerve cells of the brain and the spinal cord which results in presence of lesions called plaques. The damage of myelin sheath alters the normal transmission of nerve flow at the plaqueslevel, consequently, a loss of communication between the brain and other organs. The consequence of this poor transmission of nerve impulses is the occurrence of various neurological symptoms. MS lesions cause mobility, vision, cognitive, and memory disorders. Indeed, early detection of lesions provides an accurate MS diagnosis. Consequently, and with the adequate treatment, clinicians will be able to deal effectively with the disease and reduce the number of relapses. Therefore, the use of magnetic resonance imaging (MRI) is primordial which is proven as the relevant imaging tool for early diagnosis of MS patients. But, low contrast MRI images can hide important objects in the image such lesions. In this paper, we propose a new automated contrast enhancement (CE) method to ameliorate the low contrast of MRI images for a better enhancement of MS lesions. This step is very important as it helps radiologists in confirming their diagnosis. The developed algorithm called BDS is based on Brightness Preserving Dynamic Fuzzy Histogram Equalization (BPDFHE) and Singular Value Decomposition with Discrete Wavelet Transform (SVD-DWT) techniques. BDS is dedicated to improve the low quality of MRI images with preservation of the brightness level and the edge details from degradation and without added artifacts or noise. These features are essential in CE approaches for a better lesion recognition. A modified version of BDS called MBDS is also implemented in the second part of this paper wherein we have proposed a new method for computing the correction factor. Indeed, with the use of the new correction factor, the entropy has been increased and the contrast is greatly enhanced. MBDS is specially dedicated for very low contrast MRI images.The experimental results proved the effectiveness of developed methods in improving low contrast of MRI images with preservation of brightness level and edge information. Moreover, performances of both proposed BDS and MBDS algorithms exceeded conventional CE methods.

Development of New or Enlarging MRI Lesions Outside of Clinical Attacks in MOG-Antibody-Associated Disease

Objective To determine the frequency of new/enlarging T2 or enhancing asymptomatic lesions in myelin-oligodendrocyte-glycoprotein-antibody-associated-disease (MOGAD) and compare to multiple sclerosis (MS) and aquaporin-4 antibody-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD). Background Data on new asymptomatic lesions in MOGAD is limited. Design/Methods We retrospectively identified Mayo Clinic MOGAD patients with inclusion criteria of: 1)MOG-IgG positivity by live-cell-based-assay; 2)Fulfilling current MOGAD diagnostic criteria; 3) Baseline and follow-up paired MRIs without interval attacks. Paired MRIs (baseline and follow-up) were categorized as either attack-to-remission or remission-to-remission scans. A neurologist and neuroradiologist reviewed MRIs (T2-FLAIR brain, T2 spine, and T1-post-gadolinium brain and spine) to identify new/enlarging lesions. A subset of MOGAD patients matched for follow-up interval were compared to MS and AQP4+NMOSD patients. Results We included 105 MOGAD patients (median age, 31 years[range, 3-80]; 60% female) with 373 paired MRIs (brain, 213, spine 160). In total, 13/373 (3%) scans (10/105 patients) had one or more new/enlarging T2-lesions (brain, 12/213[5.6%]; spine, 1/160[0.6%]) and 8/367 (2%) had enhancing lesions. New spinal lesions were rare across all groups (0-4%). T2 lesions occurred more commonly in attack-remission scans (8/171[4.7%]) then remission-remission scans (5/202[2.4%]). Clinical characteristics did not differ between patients who developed new/enlarging lesions and those who did not. Maintenance immunosuppressants were used in 44/105 (42%) patients. New/enlarging lesions did not predict future clinical relapse. New brain lesions were less in MOGAD (1/25[4%]) than MS (14/26[54%], p &lt; 0.0001) but did not differ from AQP4+NMOSD (1/13[8%], p = 1.0) in subgroup analysis. Conclusions New brain MRI lesions rarely develop outside of attacks in MOGAD which differs from MS. Surveillance MRI in MOGAD may have limited utility as a surrogate biomarker of disease activity in clinical practice and for clinical trials.

Headache as Initial Presentation of Human Chronic Necrotizing Granulomatous Meningoencephalitis

Objective Chronic necrotizing and granulomatous meningoencephalitis is an idiopathic inflammatory disease with possible autoimmune mediated delayed type hypersensitivity response. It commonly affects the central nervous system of dogs and cats. However, this inflammatory disease has rarely been described in humans. Background A 69-year-old right-handed woman presented with worsening subacute headaches that were intermittent, sharp and holocephalic in nature which worsened with coughing and/or laughing. Her initial neurological examination was unremarkable. MRI of the brain revealed multifocal enhancing lesions and edema as well as multifocal signal abnormality throughout the supratentorial and infratentorial parenchyma. Her cerebrospinal fluid showed elevated opening pressure, elevated nucleated cells, elevated protein and normal glucose. CSF cytology, gram stains and cultures were unremarkable. Possibility of sarcoidosis, mycobacterium and fungal etiologies were ruled out. Other work up included but not limited to MRA head, MRV head, diagnostic cerebral angiogram, extensive serum and CSF autoimmune labs were also unremarkable. She underwent a brain biopsy which showed necrotizing granulomatous inflammation with associated dystrophic calcification. Patient was started on high dose methylprednisolone followed by a 6-week prednisone taper. There was a complete resolution of her symptoms, as well as improvement in her follow up MRI brain over a six month period. Design/Methods N/A. Results N/A. Conclusions We describe what we believe would be the third reported case of necrotizing granulomatous meningitis of an unknown cause in humans. This case demonstrates the response of necrotizing granulomatous meningoencephalitis in humans to steroid therapy. Yet, further studies are necessary to determine symptomatology and pathogenesis, as well as the treatment in humans.

The Eye as a Window to the Brain: Prominent Retinal Vasculopathy Points to Neuro-Behcet Diagnosis for an Undifferentiated Solitary Brain Lesion

Objective To report a perplexing case of Behcet disease (BD) presenting as a focal parenchymal lesion that reached a diagnosis after noting a prominent retinal vasculopathy, highlighting the importance of ophthalmologic evaluation in undifferentiated CNS disease. Background BD can have variable systemic manifestations driven by a vasculitis, including oral or genital ulcers, pulmonary aneurysms, and uveitis. Neurologic involvement is present in less than 10% of patients, most commonly as a meningoencephalitis. Design/Methods We present the case of a woman who developed asymmetric sub-acute sensorineural hearing loss at age 31 followed by transient right facial weakness at age 40, and most recently presented with right facial numbness and arm weakness at age 47. Brain MRI revealed a left frontal enhancing lesion with associated T2/FLAIR hyperintensity extending from the periventricular to the juxtacortical area with a thin rim of a reduced diffusion. CSF and serum studies were negative for inflammation, infection and malignancy except for elevated ESR and CRP. Brain biopsy revealed non-specific gliosis. Persistent enhancement on MRI was noted over 3 months, with spontaneous clinical improvement. Patient endorsed insidious vision changes over recent years, and visual testing was performed. Results Dilated ophthalmic examination demonstrated striking peripheral attenuation and sclerosis of retinal vasculature, with evidence of nonperfusion and skip lesions on retinal fluorescein angiography (FA). Findings of occlusive retinal peripheral vasculopathy suggested an underlying vasculitis as the etiology of the brain lesion and prior deficits, raising the likelihood of BD. Patient was homozygous for HLA-B*51, further supporting this diagnosis even with lack of mucosal ulcers and negative history of pathergy. Conclusions Neurologic manifestations of BD can be diverse including retinal occlusive vasculopathy; ulcers are not universally present. Ophthalmologic examination, even when minimally symptomatic, can inform the diagnosis of CNS lesions. Patient was started on Prednisone, Infliximab and Methotrexate, achieving disease remission.

Unmasking of a Relapsing Encephalomyelitis After SARS-CoV-2 Infection and COVID-19 Vaccination

Objective NA. Background Prior case studies suggest that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its vaccines may unmask neuroinflammatory conditions. We present a case of relapsing steroid-responsive encephalomyelitis after SARS-CoV-2 infection and subsequent COVID-19 vaccination. Design/Methods NA. Results A 47-year-old man with a history COVID-19 presented with subacute lower extremity weakness, erectile dysfunction, and gait instability with falls. His symptoms started several weeks after COVID-19 vaccination which he underwent 3 months after COVID-19 infection. His initial exam demonstrated weakness at the knees and ankles and extensor plantar responses. MRI demonstrated innumerable enhancing lesions involving the subcortical white matter, basal ganglia, thalami, brainstem, cerebellum, and the entire spinal cord parenchyma. CSF testing revealed a lymphocytic pleocytosis (10 WBC, 88% lymphocytes), and transient matched serum and CSF oligoclonal bands. Testing was unremarkable for infections, malignancies, primary demyelinating conditions, etc. He responded dramatically to five days of high dose methylprednisolone but had recurrence of symptoms with weaning of oral prednisone, requiring another pulse of IV steroids. After 2 months, his steroids were weaned again, with clinical and radiographic recurrence, requiring another course of IV steroids. He was subsequently transitioned to mycophenolate as a steroid-sparing agent. Literature review identified 20 additional cases of CNS neuroinflammatory disease after either SARS-CoV-2 infection or vaccination (11 transverse myelitis, 6 optic neuritis, 3 encephalomyelitis). Conclusions Our patient's steroid-dependency and relapsing course suggests unmasking of an underlying CNS neuroinflammatory condition. Temporal associations of neurological conditions with vaccinations or infections do not prove causality despite previous reports of such sequelae. Vaccines containing SARS-CoV-2 antigens may enhance autoimmunity by mechanisms including polyclonal activation, epitope spreading, or molecular mimicry. This case highlights that the resulting inflammation may be insidious and extensive, though treatable. As COVID-19 constitutes a life-threatening infection in some patients, the benefits of vaccination outweigh the smaller risk of unmasking an immune-related condition.

Validation of a highly accelerated post-contrast wave-controlled aliasing in parallel imaging (CAIPI) 3D-T1 MPRAGE compared to standard 3D-T1 MPRAGE for detection of intracranial enhancing lesions on 3-T MRI.

High-resolution post-contrast T1-weighted imaging is a workhorse sequence in the evaluation of neurological disorders. The T1-MPRAGE sequence has been widely adopted for the visualization of enhancing pathology in the brain. However, this three-dimensional (3D) acquisition is lengthy and prone to motion artifact, which often compromises diagnostic quality. The goal of this study was to compare a highly accelerated wave-controlled aliasing in parallel imaging (CAIPI) post-contrast 3D T1-MPRAGE sequence (Wave-T1-MPRAGE) with the standard 3D T1-MPRAGE sequence for visualizing enhancing lesions in brain imaging at 3 T. This study included 80 patients undergoing contrast-enhanced brain MRI. The participants were scanned with a standard post-contrast T1-MPRAGE sequence (acceleration factor [R] = 2 using GRAPPA parallel imaging technique, acquisition time [TA] = 5 min 18 s) and a prototype post-contrast Wave-T1-MPRAGE sequence (R = 4, TA = 2 min 32 s). Two neuroradiologists performed a head-to-head evaluation of both sequences and rated the visualization of enhancement, sharpness, noise, motion artifacts, and overall diagnostic quality. A 15% noninferiority margin was used to test whether post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE. Inter-rater and intra-rater agreement were calculated. Quantitative assessment of CNR/SNR was performed. Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE for delineating enhancing lesions with unanimous agreement in all cases between raters. Wave-T1-MPRAGE was noninferior in the perception of noise (p < 0.001), motion artifact (p < 0.001), and overall diagnostic quality (p < 0.001). High-accelerated post-contrast Wave-T1-MPRAGE enabled a two-fold reduction in acquisition time compared to the standard sequence with comparable performance for visualization of enhancing pathology and equivalent perception ofnoise, motion artifacts and overall diagnostic quality without loss of clinically important information. • Post-contrast wave-controlled aliasing in parallel imaging (CAIPI) T1-MPRAGE accelerated the acquisition of three-dimensional (3D) high-resolution post-contrast images by more than two-fold. • Post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE with unanimous agreement between reviewers (100% in 80 cases) for the visualization of intracranial enhancing lesions. • Wave-T1-MPRAGE was equivalent to the standard sequence in the perception of noise in 94% (75 of 80) of cases and was preferred in 16% (13 of 80) of cases for decreased motion artifact.

Chitosan nanocomposite as an effective carrier of potential herbicidal metabolites for noteworthy phytotoxic effect against major aquatic invasive weed water hyacinth (Eichhornia crassipes)

In this current work, the herbicidal activity of fungal metabolites stacked chitosan nanocomposite against significant aquatic invasive weed Eichhornia crassipes (water hyacinth) was examined. Herbicidal metabolites from the fungal strain Allophoma oligotrophica were extracted and purified under standard condition. Altered ionic gelation technique was received for the amalgamation of chitosan nanocomposite fabricated with herbicidal metabolites. Synthesized nanocomposite incited checked herbicidal impact on the leaflets of water hyacinth. Synthesized nanocomposite induced marked herbicidal effect on the tested leaflets of water hyacinth. Necrotic development on the tested leaflets at earlier incubation period followed by progressive enhancement of necrotic lesion reveals the noteworthy herbicidal activity of the synthesized nanocomposite. Parenchymal, mesenchymal tissue disintegration, reduction of total chlorophyll content, elevated anti oxidative enzymes and changes in qualitative protein profiling of tested leaflets reveals the nanocomposite induced noteworthy morphometric and functional effects. Effect of solvents on the release profile demonstrates that ethyl acetate treatment brought about controlled or sustained release of metabolites. No sign of toxic effect on the zebra fish embryonic developmental stages revealed biocompatibility of the nanocomposite.

Silk sericin alleviates aberrant photoperiod-induced alterations in testicular and adrenal steroidogenesis in adult mice

BackgroundSteroidogenesis is a complex process of sequential enzymatic reactions affected by climate change. Animals respond to altered day length, the so-called photoperiod, with changes in physiology. The study aimed to an evaluation of sericin effect in alleviating steroidogenesis disorders induced by disturbed photoperiod in mice.MethodsThe animals were randomly divided into three groups according to the lighting cycle: a control group with a standard 12Light:12Dark cycle, a short-term photoperiod group with a 6Light:18Dark cycle, and a long-term photoperiod group with an 18Light:6Dark cycle. Both short and long-term groups were subdivided into two equal subgroups: The placebo and the sericin-treated subgroups received, for five weeks from prepubertal throughout adulthood, one intraperitoneal injection per week of the solvent and 1 g sericin/kg body weight, respectively.ResultsSelected oxidative stress parameters and testicular and adrenal steroidogenic capacities of adult mice were measured. After five weeks, the placebo group with impaired photoperiod showed a decrease in the quality and quantity of sperm and a reduction in testosterone, corticosterone, aldosterone, total antioxidant capacity, xanthine oxidase, and melatonin. At the same time, in these groups, there was an increase in the level of aromatase, malondialdehyde, cholesterol, and steroidogenic factor-1 (SF-1) expression in the adrenal cortex and an enhancement in histological lesions. Mice receiving sericin had parameters similar to the control group.ConclusionOur findings reveal that silk sericin can reduce the stress caused by photoperiod disorders regarding testicular function, sex hormone levels, and sperm quantity and quality. Thus, sericin is a biocompatible protein with a promising potential for its use in the case of organisms living under an abnormal photoperiod.

Comparison of Apparent Diffusion Coefficient Value Measurement and Contrast-Enhanced T1-Weighted Imaging in Detecting Active Demyelinating Lesions in Multiple Sclerosis

Objective: To find a difference in apparent diffusion coefficient (ADC) values of non-enhancing and enhancing lesions in patients with multiple sclerosis (MS) and to find a cutoff ADC value to predict the enhancement of the MS lesion. Materials and Methods: A retrospective review of magnetic resonance imaging (MRI) of the brain in MS patients between January 2015 and December 2019 was done. The MS plaques in the images were mapped in fluid attenuation inversion recovery (FLAIR) and post-contrast T1- weighted imaging sequences (T1WI). The lesions were categorized into enhancing and non-enhancing lesions based on the presence of enhancement on post-contrast T1WI. The ADC value of each lesion was measured using circular regions of interest (ROI) placed in the enhancing portion. The difference in mean ADC values between the two groups was assessed. Results: There were 22 patients with 194 MS lesions. The mean ADC values of the enhancing lesions at 0.891±0.164×10⁻³ mm²/s were significantly lower than those of the non-enhancing lesions at 1.303±0.280×10⁻³ mm²/s (p&lt;0.001). A cutoff ADC value of 1.117×10⁻³ mm²/s was used to distinguish between the enhancing and the non-enhancing lesions. The best results were obtained with a sensitivity of 93.9%, specificity of 71.4%, positive predictive value (PPV) of 40.3%, negative predictive value (NPV) of 98.3%, and accuracy of 75.3%. Conclusion: ADC value measurement can be used to predict the enhancement of the MS plaque, which may be helpful as a screening tool for active demyelinating plaque in MS patients. Keywords: Multiple sclerosis; Active demyelinating lesion; Active MS; Contrast-enhanced T1-weighted imaging; ADC value

NCMP-17. PLASMA EXCHANGE FOR IMMUNE CHECKPOINT INHIBITOR INDUCED ACUTE DEMYELINATING POLYNEUROPATHY REFRACTORY TO IVIG

Abstract The use of immune checkpoint inhibitors in the treatment of cancer has gained prominence due to their effectiveness. Unfortunately, neurological immune-related adverse events represent a growing problem in neuro-oncology practice. Many of these cases are rare and their diagnoses and management can be challenging. We present a case of a 69-year-old male with urothelial carcinoma status post left nephrectomy who developed bilateral lower extremity weakness that began following his first dose of Atezolizumab. After three doses, his lower extremity weakness worsened to the point where he could not walk. A NCV study was performed and was consistent with acute demyelinating polyneuropathy. A cervical MRI (Magnetic Resonance Imaging) showed an enhancing lesion at C6-C8. He was treated with three days of intravenous methylprednisolone every six hours for three days followed by three days of 0.4gm/kg IVIG. He regained his ability to walk after IVIG treatment. The enhancing lesion noted on MRI remained. Three weeks after the first IVIG treatment, he declined significantly, redeveloping symptoms where he could not ambulate and required assistance to use the toilet. He had no lower extremity reflexes and had loss of proprioception of his hands. He was scheduled for another IVIG infusion at .4gm/kg followed by a dose of IVIG .6gm/kg the next day, and then four more days of IVIG .25gm/kg. His lower extremity weakness and difficulty walking remained so he was arranged for plasmapheresis x five cycles. His weakness improved, reflexes returned, and he no longer had proprioceptive loss of his hands. A cervical MRI obtained one month after plasma exchange showed resolution of the C6-C8 enhancing lesion. He is now ambulating with a cane. This case highlights the effectiveness of plasma exchange in a case that was refractory to IVIG

PATH-43. HISTOLOGY OF RADIATION-INDUCED PSEUDOPROGRESSION WITH MULTIPLE FOCI IN TREATED GLIOBLASTOMA

Abstract Radiation induced pseudoprogression (PsP) of brain tumors is defined radiologically as new or enlarging areas of non-tumor magnetic resonance imaging (MRI) contrast enhancement developing within the initial 3-6 months after completing radiation. Distinguishing PsP from genuine tumor progression is of the utmost importance in deciding the clinical course of a patient. Although it is typically diagnosed radiologically, obtaining tissue histopathology can clarify diagnostic uncertainty. However, there is no consensus on defining PsP pathologically. We present the case of a 38-year-old man with a glioblastoma, IDH-wild type, CNS WHO Grade 4 (MGMT promoter methylated) with steroid-refractory PsP, and correlate both radiologic and pathologic features. After initial treatment with a gross total resection and radiation with concurrent temozolomide, he developed a new contrast-enhancing, mass-neutral enhancing lesion consistent with PsP, which did not resolve despite 4 cycles of temozolomide and prolonged steroid treatment. The enhancing lesion was resected, and the pathological examination demonstrated areas of non-pseudopallisading necrosis, numerous macrophages, astrocytosis, hyalinization of blood vessels, and low mitotic activity in the brain parenchyma with residual infiltrative glioma. These features were consistent with radiation-treatment effect and supported a diagnosis of PsP. Over time, varying definitions for PsP include a percentage threshold of treatment effect or necrosis per sample. However, the authors recognize potential sampling bias. Therefore, we recommend including treatment-related effects coupled with the absence of tumor proliferation in the results. These features include fibrinoid necrosis, hyalinization of blood vessels, and eosinophilic coagulation necrosis. From a therapeutic standpoint, it is important to comment on the presence or absence of residual glioma cell proliferation. This case highlights a unique paring of focal histopathology with correlative sections on MRI for pseudoprogression which has not been previously presented.

PATH-23. HIGHLY INFILTRATING OLIGODENDROGLIOMAS SHOW DIFFERENT MORPHOLOGY FROM TYPICAL OLIGODENDROGLIOMAS WHILE MAINTAINING GOOD RESPONSE TO CHEMO-RADIATION THERAPY

Abstract Oligodendrogliomas are diffuse gliomas located in the cerebral hemisphere, and the MRI typically show swollen cortex and subcortical white matter by the tumor cells. IDH mutation and 1p/19q co-deletion define oligodendrogliomas in WHO classification, and these genetic alterations are associated with good response to chemo-radiation therapy and better prognosis compared to the IDH-mutant astrocytomas. We reviewed MRI findings of 60 oligodendrogliomas with 1p/19q co-deleted tumors which were diagnosed at Dokkyo Medical University since 1999. Of those, 3 cases showed highly infiltrating pattern in which tumors were more predominant in the white matter than the cortex and the infiltration involved multiple lobes. We retrospectively investigated those 3 cases for histological features, treatment, and clinical outcome. There were 2 males and 1 female. MRI showed faint-brushed Gd enhancement around the center of the tumor-infiltrated area in 1 case, while there was no enhancing lesion in other 2 cases. All three underwent stereotactic biopsy. Histologically, all 3 cases lacked typical oligodendroglioma morphology: the tumor cells have irregular round, oval to elongated nuclei without perinuclear halo and had dense, closed chromatin similar to astrocytoma. Two cases underwent chemotherapy (TMZ and PAV accordingly), without radiation and 1 case underwent chemotherapy with radiation as the primary treatment. Interestingly, all three tumors responded well not only to the primary treatments but also to the radiation therapy administered after recurrence, although all eventually succumbed to the tumor. PFS were 16, 37, 67 months and OS were 104, 70, 115 months for each, which were at the worse end as oligodendrogliomas but are apparently better than astrocytomas. Highly infiltrating oligodendrogliomas appeared to show significantly different MRI and histological features from typical oligodendrogliomas that primarily involve cerebral cortex. The underlying mechanism of such differences might involve specific genetic alterations and/or gene expression alterations that may not affect treatment response.

PATH-16. THRESHOLDS OF MITOTIC ACTIVITY AND POST-SURGERY RESIDUAL VOLUME ARE INDEPENDENT PROGNOSTIC FACTORS IN ASTROCYTOMA IDH-MUTANT

Abstract BACKGROUND The distinction between grade 2 and 3 is instrumental to choose between observational follow-up and adjuvant treatment in resected astrocytoma IDH-mutant. However, criteria for discriminating grade 2 and 3 tumors have not been updated since the WHO 2007 classification. There is no consensus on the method of evaluation of the mitotic activity or a mitosis cut-off for grading. The objectives were to evaluate the maximal mitotic activity on a series of resected astrocytoma IDH-mutant and assess its prognostic impact on survival. METHODS Maximal mitotic activity on consecutive high-power fields corresponding to 3 mm2 was examined in 118 lower-grade astrocytomas IDH-mutant. The prognostic value for time-to-treatment (TTT) and overall survival (OS) of mitotic activity as well as other prognostic factors (including age, performance status, presurgical tumor volume, plurilobar involvement, postsurgical residual tumor volume, midline involvement) was assessed in tumors with (i) ATRX loss, and (ii) without CDKN2A homozygous deletion, lesional enhancement, histological necrosis nor microvascular proliferation. RESULTS Among the 75 (64%) tumors which had gone through observational follow-up after resection, maximal mitotic activity, post-surgical residual volume and plurilobar involvement were independent prognostic factors of TTT (p &amp;lt; 0.0001). A threshold of mitotic activity for grade 2 was fitted using TTT and OS parameters. Using this threshold, patients with “grade 2 tumors” had a median TTT of 55 months versus 19 months for “grade 3” (p= 0.0057) and a median OS of 102 months versus 73 months respectively (p= 0.001). Residual volume &amp;lt; 1 cm3 was associated with longer OS (113 months versus 88 months, p= 0.0021). CONCLUSIONS The combination of mitotic activity and postsurgical residual volume improves prognostication in resected astrocytoma IDH-mutant. This novel risk assessment method could identify the best candidates for observational follow-up.