Perilesional Edema Research Articles

Clinical profile of meningioma: an experience from South India

Background: Meningiomas are one of the most common primary intracranial tumours. The incidence, varieties of tumour, site, imaging findings, resectability, outcome and prognosis vary from tumour to tumour. The understanding of these characteristics is essential in the management of meningiomas.Methods: An observational study was carried out among 50 patients with imaging proven meningioma and involved recording of age, gender, clinical history, physical examination, imaging findings, intraoperative characteristics, anatomical and pathological diagnosis. The parameters evaluated in the study were gender distribution, age distribution, presenting symptoms, neurological deficits, mri findings, volume of tumour, intraoperative findings, grade of excision, anatomical, pathological diagnosis and recurrence rates.Results: The male to female ratio was 1:2.57, with 50-70 years being the most affected population. The common symptomatology was that of features of raised ICP with motor deficit as the common neurological abnormality. Simpson grade 2 was the common clearance obtained. 3 common sites were parasagittal, sphenoid wing and convexity. Commonest histological type was transitional. Recurrence rate was 6%. This study also pointed out general imaging and intraoperative characteristics of Grade 3 tumours as T2 hyperintensity, heterogeneous, with significant perilesional oedema and intensely contrast enhancing, high vascularity, friable, suckable and ill-defined margins.Conclusions: The study enables us to understand the general trend of presentation, imaging and surgical properties of Meningiomas and to compare with international standards. It also helps us to finger out the possible high-grade lesions even before the pathological diagnosis is obtained.

FDG PET/CT and MRI Features of Pathologically Proven Schwannomas.

The aim of this study was to examine the MRI and FDG PET/CT imaging features of pathologically proven schwannomas. This institutional review board-approved retrospective study examined biopsy-proven schwannomas that underwent FDG PET/CT and/or MRI at our institution between January 1, 2002, and April 1, 2018. PET/CT features analyzed included SUVmax, metabolic ratios, volumetric metabolic measures, presence of calcification, and pattern of FDG activity. MRI features included T1/T2 signal, enhancement pattern, margins, perilesional edema, presence of muscular denervation, and size. Ninety-five biopsy-proven schwannomas were identified (40 with both PET and MRI, 35 with PET only, and 20 with MRI only), 46 females and 49 males, average age of 57.7 ± 15.3 years. The average largest dimension was 4.6 ± 2.7 cm, the average SUVmax was 5.4 ± 2.7, and lesion SUVmax/liver SUVmean was 2.2 ± 1.2. Eleven (15%) of 75 lesions had SUVmax greater than 8.1, 26/75 (35%) had SUVmax greater than 6.1, and 14/75 (19%) had lesion SUVmax/liver SUVmean greater than 3.0. On MRI, 29/53 (55%) demonstrated internal nonenhancing areas. Twenty-eight (70%) of 40 lesions with both MRI and PET demonstrated at least 1 imaging feature concerning for malignant peripheral nerve sheath tumor (irregular margins, internal nonenhancement, perilesional edema, heterogeneous FDG uptake, or SUVmax >8.1). Lesions with heterogeneous FDG activity had higher SUVmax (6.5 ± 0.5 vs 4.7 ± 0.4, P = 0.0031) and more frequent internal nonenhancement on MRI (P = 0.0218). Schwannomas may be large, be intensely FDG avid, and demonstrate significant heterogeneity, features typically associated with malignant peripheral nerve sheath tumors. A significant proportion exhibit FDG activity above cutoff levels previously thought useful in differentiating malignant from benign peripheral nerve sheath tumors.

Computed tomography features of spontaneous acute intracranial hemorrhages in a tertiary hospital in Southern Ghana.

Introductionspontaneous acute intracranial hemorrhage (SICH) accounts for approximately 10-15% of all stroke cases. Early detection by computed tomography (CT) and early treatment are key. Hence this study to examine the CT features of SICH.Methodsthis retrospective cohort study reviewed all 435 patients diagnosed with SICH from 1st March, 2017 to 1st January, 2021 in a tertiary facility in Southern Ghana. Data collected (age, sex, SICH type and the CT scan features) were organized and analyzed using GNU PSPP and Libre Office Calc. Statistical significance level was pegged at p≤0.05.Resultsthe SICH types were acute intracerebral hemorrhage (97.93%), acute subarachnoid/intraventricular hemorrhage (1.15%), acute epidural hemorrhage (0.46%) and acute subdural hemorrhage (0.46%). Acute intracerebral hemorrhage was more common in those >60 years (57.75%, p<0.001). The commonest CT feature for acute intracerebral hemorrhage was hyperdense lesion with perilesional edema (40.98%), with smoking (OR=2.24, 95% CI: 1.14-4.41, p=0.019) and anticoagulants intake (OR=2.56, 95% CI: 1.15-5.72, p=0.022) as the predictive factors; followed by hyperdense lesion extending to the edge of the brain (25.03%), also predictable by smoking (OR=0.23, 95% CI: 0.11-0.47, p<0.001); and hyperdense lesion with mass effects (22.70%) was not predictive with any risk factor. Type 2 diabetes mellitus (60.00%, p<0.001) and smoking (97.83%, p<0.001) were more common in males.Conclusionhyperdense lesion with perilesional edema was the most frequent CT feature for acute intracerebral hemorrhage and was predictable by smoking and anticoagulants intake. Smoking was a predictive factor to the development of most of the features of acute intracerebral hemorrhage.

Tumefactive demyelinating lesions in multiple sclerosis mimicking brain tumors: a major diagnostic challenge

Tumefactive demyelinating lesions (TDL) are large (usually more than 2 cm) demyelinating lesions, that can present with perilesional edema, mass effect, and different en­han­cement patterns mimicking tumor, infection, or acute vascular diseases of the brain. Magnetic resonance ima­ging (MRI) is the most useful diagnostic tool that can help set the proper course of treatment, follow-up and avoid unnecessary invasive procedures. We present a pictorial review of pseudotumoral demyelinating lesions from a series of cases diagnosed in our clinic and we discuss the most important differential diagnostics. We reviewed the magnetic resonance investigations of the patients with known or suspected multiple sclerosis or other inflammatory demyelinating lesions over a period of three years (2018-2020). Out of the 187 reviewed cases, 11 presented TDL, representing 5.88%. The mean age at the time of diagnosis was 38 years old, with a net female predominance. The main common element of TDL was the incomplete ring enhancement pattern, essential for positive and differential diagnosis.

A clinical suspected case of cerebral syphilitic gumma showing spontaneous regression

A 46-years-old man who complained of headache for 4 months was transported our hospital due to vertigo and nausea. Gadolinium-enhanced T1WI showed ring-like enhancements in the right pedunculus cerebellaris medius and left frontal lobe on the brain surface. Additionally, FLAIR images showed high intensity area indicating perilesional edema. We diagnosed the patient as neurosyphilis with his serum and cerebrospinal fluid findings, and considered him as cerebral syphilitic gumma because of brain MRI findings. An HIV test was negative. Follow-up MRI before treatment demonstrated spontaneous regression of these lesions, and after intravenous treatment with penicillin G for 14 days complete regression. Since then, he has had no sign of recurrence. Although there are some characteristic brain MRI findings of cerebral syphilitic gumma, spontaneous regression of these lesions in this case was an unusual finding.

Cerebral Venous Sinus Thrombosis as an Uncommon Presentation of Polycythemia Vera

Cerebral venous sinus thrombosis (CVST) accounts for &lt;1% of all cerebrovascular accidents which were attributed to increased viscosity of blood and activation of platelet in blood vessels. Polycythemia vera (PV) increases the risk of vaso-occlusive events including CVST which may be initial unusual presentation of disease. We present a 28-year-old male patient with headache associated with nausea, vomiting, and blurring of vision. Initial clinical examination was unremarkable, and blood investigations revealed erythrocytosis and neutrophilic leukocytosis with prominent granules. Brain imaging studies were consistent of cerebral venous thrombosis with hemorrhagic transformation and perilesional edema with midline shift. He was managed by decompressive hemicraniectomy, low molecular weight heparin, central nervous system decongestants, antiepileptics, and supportive care with close monitoring. PV is a hypercoagulable state which may precipitate vascular thrombosis. CVST is rare presentation of PV. Early screening for occult prothrombotic entities with prompt management increases the patient outcome and prognosis.

Diagnostic findings and successful management of central diabetes insipidus following a self-inflicted penetrating brain injury in a dog

A 6-year-old 12 kg male neutered mixed breed dog presented in lateral recumbency with dysphoria and vocalization following a self-inflicted fork impalement injury. Computed tomography (CT) was performed which showed a penetrating wound through the right orbit, into the calvarium, and through the brain parenchyma. The dog was hospitalized with supportive care, sedatives, analgesia, antiepileptics, anti-inflammatories, antibiotics, and desmopressin acetate (DDAVP) to control post-traumatic central diabetes insipidus (PTCDI) which developed during recovery. Magnetic resonance imaging (MRI) findings 16 days later revealed resolving ventricular hemorrhage and mild perilesional edema and inflammation. Normal mentation and ambulation slowly returned and 3 months later the dog was clinically normal. To the author’s knowledge, this is the first report of a self-inflicted penetrating brain injury in a dog. This case demonstrates successful medical management of a dog with a traumatic brain injury (TBI) and PTCDI which is an uncommon occurrence in veterinary medicine.

A Bayesian approach for diagnostic accuracy of malignant peripheral nerve sheath tumors: a systematic review and meta-analysis.

BackgroundMalignant peripheral nerve sheath tumors (MPNST) carry a dismal prognosis and require early detection and complete resection. However, MPNSTs are prone to sampling errors and biopsies or resections are cumbersome and possibly damaging in benign peripheral nerve sheath tumor (BPNST). This study aimed to systematically review and quantify the diagnostic accuracy of noninvasive tests for distinguishing MPNST from BPNST.MethodsStudies on accuracy of MRI, FDG-PET (fluorodeoxyglucose positron emission tomography), and liquid biopsies were identified in PubMed and Embase from 2000 to 2019. Pooled accuracies were calculated using Bayesian bivariate meta-analyses. Individual level-patient data were analyzed for ideal maximum standardized uptake value (SUVmax) threshold on FDG-PET.ResultsForty-three studies were selected for qualitative synthesis including data on 1875 patients and 2939 lesions. Thirty-five studies were included for meta-analyses. For MRI, the absence of target sign showed highest sensitivity (0.99, 95% CI: 0.94-1.00); ill-defined margins (0.94, 95% CI: 0.88-0.98); and perilesional edema (0.95, 95% CI: 0.83-1.00) showed highest specificity. For FDG-PET, SUVmax and tumor-to-liver ratio show similar accuracy; sensitivity 0.94, 95% CI: 0.91-0.97 and 0.93, 95% CI: 0.87-0.97, respectively, specificity 0.81, 95% CI: 0.76-0.87 and 0.79, 95% CI: 0.70-0.86, respectively. SUVmax ≥3.5 yielded the best accuracy with a sensitivity of 0.99 (95% CI: 0.93-1.00) and specificity of 0.75 (95% CI: 0.56-0.90).ConclusionsBiopsies may be omitted in the presence of a target sign and the absence of ill-defined margins or perilesional edema. Because of diverse radiological characteristics of MPNST, biopsies may still commonly be required. In neurofibromatosis type 1, FDG-PET scans may further reduce biopsies. Ideal SUVmax threshold is ≥3.5.

Simple Stepwise Approach to Differentiate Cyst-Like Soft-Tissue Masses by Using Time-Resolved Magnetic Resonance Angiography

This retrospective study aimed to differentiate cyst-like musculoskeletal soft-tissue masses by using time-resolved magnetic resonance angiography (MRA). During May 2015 to November 2019, patients with cyst-like soft-tissue masses examined through contrast-enhanced MRI followed by histologic diagnosis were included. The masses were classified into vascular lesions, solid lesions, and true cysts. Size, T1 hyperintensity, T2 composition, perilesional edema, time-resolved MRA, and static internal enhancement were assessed. The time-resolved MRA manifestations were classified into vascular pooling, solid stain, and occult lesion. Imaging predictors for each type of mass were identified through logistic regression and were used to develop a diagnostic flowchart. A total of 80 patients (47 men; median age, 42 years) were included, with 22 vascular lesions, 38 solid lesions, and 20 true cysts. The T2 composition, time-resolved MRA, and static internal enhancement were significantly different among the masses. Vascular pooling on time-resolved MRA was the sole predictor of vascular lesions (odds ratio = 722.0, p < 0.001). Solid stain on time-resolved MRA was the sole predictor of solid lesions (odds ratio = 73.6, p < 0.001). Occult lesion on time-resolved MRA (odds ratio = 7.4, p = 0.001) and absence of static internal enhancement (odds ratio = 80.0, p < 0.001) both predicted true cysts, while the latter was the sole predictor of true cysts after multivariate analysis. A diagnostic flowchart based on time-resolved MRA correctly classified 89% of the masses. In conclusion, time-resolved MRA accurately differentiates cyst-like soft-tissue masses and provides guidance for management.

Intracranial dural AV fistula- An unfolding enigma

An Intracranial dural arteriovenous fistulas (DAVF), is an abnormal direct connection (fistula) between a meningeal artery and a meningeal vein or dural venous sinus &/ cortical vein 1. When there are multiple fistulas they are termed as dural arteriovenous malformations and comprise 10-15% of all intracranial arteriovenous malformations1. Here we present a case of52yr old patient who presented to our casualty with history of sudden onset of headache, giddiness, and vomiting, followed by loss of consciousness. Neurological examination revealed impairment of consciousness, no verbal response, with left hemiparesis (E2V1M5). Bilaterally, pupils were 5mm and sluggishly reacting to light. Vitals were stable with B.P. recording of 140/80 mm of hg, and a pulse rate of 80 /min. Pre contrast CT scan showed an intraparenchymal haemorrhage with perilesional oedema in the right frontal region. CT angiography brainshoweda intracranial dural AVF with varix and adjacent intraparenchymal haemorrhage. D.S.A. revealed a Borden type III & Cognard type IV –midline dural Arteriovenous fistula in the regionofmid superior sagittal sinus and along the cerebral falx, with a large venous ectasia/varix along the anterior cerebral falx. Management: Patient underwent afronto parietal rectangular craniotomy Right posterior frontal, parasagittal engorged bunch of focal cortical veins was cauterized. Underlying haematoma was evacuated and the underlying venous ectasia/ varix identified. It was found to be thrombosed. A large draining vein was found which was clipped and any consequent brain swelling was looked for, before finally excising it in toto. Post –op period was uneventful, with the patient gradually improving in sensorium with residual hemiplegia and aphasia. Although recent developments in catheter interventionhas made it the preferred option in most of the cases, surgery is still preferred in some select cases. Keywords:Intracranial dural AV fistula, Superior sagittal sinus, Cog

Spectrum of Imaging Findings in Oriental Cerebral Schistosomiasis and Their Categorization by MRI

Introduction: To describe the spectrum of imaging findings in oriental cerebral schistosomiasis and characterizing different stages by MRI.Methods: A retrospective review of the clinical and MRI images of twenty nine pathologically proven cases of neuroschistomiasis was performed. Patients with either absence of complete MR examination, previously treated patients were excluded from the study. MRI images were analyzed and lesions were evaluated for the following parameters - distribution, size, clusterity, perilesional edema, mass effect, intralesional hemorrhage, necrosis, cystic degeneration, any abnormal enhancements, any atypical features as abscess,vasculitis, infarctions, or focal atrophy and encephalomalacia.Results: Lesions were only supratentorial in 25 cases, only infratentorial in 3 cases while were both supratentorial and infratentorial in 1 case. Lesions were unilateral in 26 cases. Significant mass effect was noted in 8 cases. All nodular and mass lesions were hyperintense or isointense in T1WI while all but two lesions were hyperintense in T2WI. Lesions were predominantly as clustered nodules (12 cases). All nodules enhanced homogeneously except three that demonstrated ring like enhancement. Masses were demonstrated either homogeneous (2 cases) or heterogeneous in enhancement (2 cases). Central linear enhancement was noted in 12 cases, leptomeningeal enhancement in 10 cases while gyral enhancement was noted in 1 case.Conclusions: Radiological presentation of neuroschistosomiasis varies at different stages of infection as well as among the asymptomatic groups. Recognition of spectrum of presentation has an implied role in the overall management and outcome in cases

Rapidly progressive dementia in the COVID‐19 era

BackgroundRapidly progressive dementias(RPD) are conditions that typically cause dementia over weeks or months.1 Due to the current COVID‐19 pandemic, it has become difficult for dementia caregivers on the one hand, and relevant detailed examination and management in the hospitals worldwide, on the other. Recent studies shows that ApoE e4 genotype is associated with both dementia and delirium2. Hence further research into the possible genetic link between dementia and COVID‐19 is the need of the hour.MethodWe studied two elderly male patients, aged 66 and 68 years, presenting with memory decline of recent events, untimely and non‐sequential Activities of Daily Living and apathetic alongwith way finding difficulty and errors in money transactions. One patient also had forgetfulness of handwashing and face hygiene measures, and of using preventive face masks in public places as advised for public health during COVID‐19 outbreak. On examination, vitals were stable and normal fundus examination with no fever, dry cough or tiredness, and no evidence of Increased Intracranial Pressure(ICP). MMSE score was 16/30 and 17/30 respectively, recent memory and visuospatial skills were impaired and slowness of activities were present. Motor examination was normal, with no focal or non‐focal neurological deficit or sensory impairment. All routine tests were normal. Neuroimaging with contrast in one patient showed well defined hyperdense mass lesion of size 4.0*3.5*3.0 cms. showing heterogenous contrast enhancement in left parieto‐occipital lobes with moderate perilesional edema suggestive of astrocytoma (intermediate type).ResultHigh index of suspicion of Space occupying lesions should be made in the background of RPD even in the absence of focal or non focal neurological deficit or without signs of raised ICP.ConclusionMost of the etiologies causing RPD especially surgical causes, if diagnosed early and promptly are reversible and treatable. The double hit of dementia and COVID‐19 pandemic necessitates further research globally.

Differentiating high-grade glioma recurrence from pseudoprogression: Comparing diffusion kurtosis imaging and diffusion tensor imaging

PurposeTo compare the diagnostic value of DKI and DTI in differentiation of high-grade glioma recurrence and pseudoprogression (PsP). MethodForty patients with high-grade gliomas who exhibited new enhancing lesions (24 high-grade glioma recurrence and 16 PsP) within 6 months after surgery followed by completion of chemoradiation therapy. All patients underwent repeat surgery or biopsy after routine MRI and DKI (including DTI). They were histologically classified into high-grade glioma recurrence and PsP groups. DKI (mean kurtosis [MK], axial kurtosis [Ka], and radial kurtosis [Kr]) and DTI (mean diffusivity [MD] and fractional anisotropy [FA]) parameters in the enhancing lesions and in the perilesional edema were measured. Inter-group differences between high-grade glioma recurrence and PsP were compared using the Mann-Whitney U test The receiver operating characteristic (ROC) curve was used to assess differential diagnostic efficacy of each parameter, and Z-scores were used to compare the value between DKI and DTI. ResultsRelative MK (rMK) was significantly higher and relative MD (rMD) was significantly lower in the enhancing lesions of high-grade glioma recurrence compared to PsP (P < 0.001, P = 0.006, respectively). The AUC was 0.914 for rMK and 0.760 for rMD, and this difference was significant (P = 0.030). In the perilesional edema, rMK values were significantly higher and rMD values were significantly lower in high-grade glioma recurrence compared to PsP (P < 0.001, P = 0.005). ConclusionsDKI had superior performance in differentiating high-grade glioma recurrence from PsP, and rMK appeared to be the best independent predictor.

RADT-12. DISEASE CHARACTERISTICS IN ACUTE SEIZURE FOLLOWING RADIOTHERAPY FOR BRAIN METASTASES

Abstract INTRODUCTION Acute seizure following radiotherapy (RT) for brain metastases is an infrequent but significant adverse event that has not been well-described. Prophylactic antiepileptic drug (AED) or steroid therapy is not recommended for asymptomatic lesions. However, there is minimal data incorporating individualized factors into acute seizure risk-assessment with respect to RT. METHODS We retrospectively examined patients treated for brain metastases with any RT modality from 2013-2020 who experienced acute post-treatment seizure, which we defined as within 4 weeks post-RT. RESULTS Twenty patients experienced acute seizure at median 2 days post-treatment (range 0-27); 15 (75%) within 7 days and 7 (35%) on day 0 (radiosurgery date or during fractionated RT). Seizures occurred after radiosurgery (n=9, 45%), fractionated stereotactic RT (n=3, 15%), whole-brain RT (n=5, 25%), and post-operative RT (n=3, 15%). All RT encompassed at least one supratentorial lesion; 11 (55%) had &amp;gt;1 lesion treated. Median lesion size was 23mm (range 7-51mm). Moderate-to-severe perilesional edema was present in 12 (60%) and hemorrhage in 8 (40%) cases. Seizures occurred despite AED therapy in 8 (40%) overall; 5/8 (63%) were hemorrhagic and 7/8 (88%) had moderate-to-severe edema. Nine (45%) patients receiving steroids developed seizures. Primary pathologies were: melanoma (5), non-small cell lung (5), renal cell carcinoma (4), breast (3), colon (1), Merkel cell (1), and thyroid (1). Patients with melanoma who developed acute seizure had mainly non-hemorrhagic (80%), small lesions (median 9mm), not receiving AED (0%) or steroid (20%) therapy. CONCLUSIONS In acute post-RT seizure, lesions were predominantly supratentorial, &amp;gt;23mm, and had moderate-to-severe edema. Breakthrough seizures were common in edematous and/or hemorrhagic lesions. However, acute seizure also occurred with smaller, non-hemorrhagic melanoma lesions not receiving AED therapy. A larger series is needed to further evaluate these identified characteristics in acute seizure, and whether prophylactic therapy may be appropriate.

Characteristics of Magnetic Resonance Imaging Findings in 32 Dogs Diagnosed with Meningoencephalitis of Unknown Etiology

The purpose of this retrospective study was to describe the characteristics of magnetic resonance imaging (MRI) findings in dogs with meningoencephalitis of unknown etiology (MUE), and to evaluate the usefulness of meningeal enhancement. Thirty-two dogs were included in MUE group on the basis of clinical signs, MRI findings and cerebrospinal fluid (CSF) results, and for comparison of the meningeal enhancement, twenty-three dogs with normal MRI, normal CSF and no clinical sign were included in the control group. The evaluated MRI findings included lesion site, lesion number, signal intensity of each MRI sequence, mass effect, perilesional edema, contrast enhancement, and meningeal enhancement. The MUE was most frequently associated with multiple lesions (50%) with perilesional edema (72%) in forebrain (66%) that were hyperintense (92%) in T2W and FLAIR images. Of the meningeal enhancement, there was no significant difference between the control group and the MUE groups in the pachymeningeal enhancement. However, leptomeningeal (or both) enhancement was found relatively high proportion in the MUE group than in the control group (P ＜ 0.001, Odd ratio = 10.26), and based on this result, leptomeningeal (or both) enhancement is considered to be significant finding for indicating MUE.

Radiosurgery for Multiple Brain Metastases using Volumetric Modulated Arc Therapy: Clinical Outcomes and Toxicity from a Single-Institutional Series

To analyze clinical outcomes and toxicities in patients with multiple brain metastases undergoing SRS using VMAT technique. Retrospective analyzes of SRS for brain metastasis using VMAT in a single institution from 2012 to 2019. GTV was defined on enhanced lesion at Magnetic Resonance Image overlapped to planning CT, expanded for PTV from 1 to 2mm. All the patients used thermoplastic mask for frameless image-guided radiosurgery, using cone beam CT with 6D positioning and surface-guided set-up were applied in some cases. The collected data were demographic and histopathologic features, local control, brain and systemic control from patient charts. Local control (LC) was analyzed from SRS treatment to local progression (any failure inside the brain). Other treatments, and toxicities (acute and late) were also evaluated. There were 75 patients with totalizing 418 lesions. The average number of treated lesions was 5.6 (range 2 – 19). Patients with 2 lesions were the most prevalent (18.6%). The primary sites were lung (45%), breast (29.3%), melanoma (8%), colon (8%), and others (8.7%). Most patients already had received systemic therapy before SRS (chemotherapy in 52, targeted therapy or immunotherapy in 36). Only 3 patients underwent hypofractionated treatments (2 in 3 fractions and 1 in 5 fractions). The median single-shot dose was 18 (12 – 24) Gy. The median follow-up was 7.3 months (1 – 40). The 1-, and 2-year local recurrence free survival were respectively 65% and 47.3%. The mean time to local recurrence was 7.1 months. The 1-year brain recurrence free survival and overall survival were respectively 28% and 36%. There were 11 local recurrences and 30 non-local tumors, having 7 of them leptomeningeal spread. Grade 1 or 2 acute toxicities were present in 7.1% (headache, seizures, perilesional edema), whereas late toxicities including radionecrosis and neurocognitive impairment were seen respectively in 3.38%, and in 3.44%. The use of VMAT – SRS for multiple brain metastases was feasible, effective, and with low treatment-related toxicity rates. We might infer that the simultaneous treatment provided by VMAT is an advantageous way to yield local control without compromise toxicity.

A prospective cohort study to assess the frequency and risk factors for calcification in single lesion parenchymal neurocysticercosis

BackgroundCalcified neurocysticercosis (NCC) predisposes patients to an enduring state of epilepsy. The predictors for calcification in parenchymal neurocysticercosis are not well defined. MethodIn this prospective cohort study, consecutive children with single-lesion parenchymal NCC were enrolled and followed up for one year. All patients were investigated with brain 3 T-MRI and electroimmunotransfer blot (EITB). Clinical follow-ups were performed every 3 months. Radiology was repeated at the 6-month and one-year follow-ups. The proportion of calcified lesions at one year and the predictors of calcification were studied. ResultDuring the study period from June 2013 to December 2015, 93 children with single lesion parenchymal NCC were enrolled. At presentation, 90 % of the lesions were in the colloidal stage, and 71 % of the lesions had moderate to severe perilesional oedema. All children had 6 months of follow-up, and 86 (92.5 %) had one year of follow-up. Seizure recurrence was present in 13 (14 %) children. Follow-up radiology at one year showed lesion resolution in 51 (59 %) lesions and calcification in 28 (32.5 %) lesions. Children with calcified lesions during follow-up had a higher odds of seizure recurrences {OR, 95 % CI 3.6(2.3–5.6)}. The presence at baseline of diffusion restriction {OR, 95% CI 2.9 (1.01–8.8)}, scolex or wall calcification in the T2 Star weighted angiography MRI images {OR, 95% CI 3.7 (1.7–8.2)} and >10 mm size of the lesion {OR, 95 % CI 2.4 (1.2–5.01)} predicted lesion calcification. ConclusionChildren with calcification of the parenchymal NCC lesions have a higher risk for seizure recurrence during follow-up. The presence of diffusion restriction, calcified nidus in the colloidal nodular stage, and >10 mm size of the lesion at baseline predicted calcification of the lesion during follow-up.

Role of diffusion tensor imaging and diffusion metrics in primary, secondary brain tumours and tumour mimics

Background and Aim: Diffusion Tensor Imaging studies provide a valuable information regarding the status of white matter tracts adjacent to the intracranial brain lesions. The quantitative nature of Diffusion Tensor Imaging will play a role in assessing the outcome of clinical trials, as an additional surrogate marker in monitoring the therapeutic response. The aim of our study were to determine the Mean Diffusivity and Fractional Anisotropy coefficients in the affected white matter tracts and thereby to compare the Fractional Anisotropy and Mean Diffusivity of the affected white matter tracts in primary, secondary brain tumours and tumour like lesions.Materials and Methods: From December 2018 to September 2019, 49 patients were included in the study who were referred to the department for conventional Magnetic Resonance Imaging. The histopathological diagnosis was obtained and confirmed in patients who have undergone surgical resection.Results: Diffusion Tensor Imaging studies provide a valuable information regarding the status of white matter tracts adjacent to the intra cranial brain lesions. Fractional Anisotropy depends on the orientation and density of white matter fibres and Mean Diffusivity depends on the degree of perilesional edema. Gliomas present with white matter fibre destruction and less vasogenic edema when compared to tumour like lesions, and a higher perilesional Apparent Diffusion Coefficient favours a non-neoplastic etiology. Thus, the Diffusion Tensor Imaging sequences may help in differentiating the brain lesions of different aetiologies.Conclusion: The quantitative nature of Diffusion Tensor Imaging will play a role in assessing the outcome of clinical trials, as an additional surrogate marker in monitoring the therapeutic response. Careful studies to validate Diffusion Tensor Imaging and its metrics will allow it to become more applicable clinically and can affect therapeutic decision-making, choosing appropriate treatment and eventually patient outcome.

Preoperative Evaluation of Myxofibrosarcoma: Prognostic Value and Reproducibility of Different Features on MRI.

Myxofibrosarcoma (MFS) is characterized by an infiltrative growth pattern. This study aimed to determine the correlation between overall survival (OS) and morphological features of MFS as well as examine the reproducibility of these findings on preoperative magnetic resonance imaging (MRI). Fifty-eight MFS patients underwent preoperative MR imaging with the following features analysed: i) tumour size, ii) localization, iii) margins, iv) morphology, v) signal characteristics, vi) contrast enhancement, vii) presence and extent of perilesional oedema, and viii) presence of the tail sign. Only circumscribed perilesional oedema was associated with a significantly better survival compared to diffuse oedema (p=0.010), which was found in the majority of cases. The tail sign was found in less than 50% of the cases. Cohen's kappa coefficients confirmed a relatively high interrater variability. Perilesional diffuse oedema on MR imaging of MFS is significantly correlated with a poor overall survival. The interrater variability in interpretation of MR examinations varies from slight to substantial agreement. Preoperative MR imaging with detailed planning of the resection seem to be a logical approach to achieve negative resection margins and recurrence-free survival.

Hyperattenuating lesions after mechanical thrombectomy in acute ischaemic stroke: factors predicting symptomatic haemorrhage and clinical outcomes

To evaluate the clinical significance of hyperattenuating lesions on CT after mechanical thrombectomy for acute ischaemic stroke, and to identify imaging factors that predict symptomatic haemorrhage and unfavourable outcomes. Seventy-eight patients with acute ischaemic stroke in the anterior circulation who underwent mechanical thrombectomy were evaluated. All patients underwent post-interventional unenhanced computed tomography (CT) within 24 h and follow-up CT or magnetic resonance imaging (MRI) within 7 days. Baseline characteristics and clinical outcomes were compared between patients with and without hyperattenuating lesions. In patients with hyperattenuating lesions, clinical and imaging factors that predict symptomatic haemorrhage and unfavourable outcomes were determined. Fifty-six of 78 patients (71.8%) demonstrated hyperattenuating lesions on post-interventional CT. Patients with hyperattenuating lesions showed lower Alberta Stroke Program Early CT score (ASPECTS), persistent/symptomatic haemorrhage, and unfavourable outcomes than those without. In patients with hyperattenuating lesions, larger hyperattenuating lesion volume (>21.3 ml; OR, 55.60, p<0.001) and perilesional oedema (OR, 46.04, p=0.015) were independent factors predicting symptomatic haemorrhage. Older age (OR, 1.2, p=0.006) and lower ASPECTS (OR, 0.45, p=0.046) were independent factors predicting unfavourable outcomes in patients with hyperattenuating lesions. Adding the volume of the hyperattenuating lesion to age and ASPECTS increased the predictive performance of unfavourable outcomes (area under the curve 0.874 versus 0.934, p=0.043). Hyperattenuating lesions on post-interventional CT are associated with increased risk of symptomatic haemorrhage and unfavourable outcomes. Larger hyperattenuating lesion volume is an independent factor of symptomatic haemorrhage and it has added predictive value for unfavourable outcomes.