Preoperative Brain Magnetic Resonance Imaging Research Articles

Prognostic Factors in Idiopathic Normal Pressure Hydrocephalus Patients After Ventriculo-Peritoneal Shunt: Results from a Single-Institution Observational Cohort Study with Long Term Follow-Up

The aim of this study is to investigate long-term prognostic factors and clinical outcomes in patients with idiopathic normal pressure hydrocephalus (iNPH) treated with ventriculo-peritoneal shunt (VPS). This single-center retrospective observational study of prospectively collected data included patients with probable iNPH treated with VPS surgery. All patients underwent complete preoperative assessment, including past medical history and neurological examination, dynamic cerebrospinal fluid (CSF) flow brain magnetic resonance imaging (MRI), and preoperative CSF samplings. NPH-consistent brain MRI findings and favorable responses to CSF subtraction tests were the main factors considered for VPS surgery eligibility. All patients were subsequently followed up every six to twelve months (mean follow-up time 40 months, minimum to maximum interval 6-150 months). A total of 238 patients with a diagnosis of probable iNPH treated with VPS were enrolled. Age, comorbidities, and response to CSF samplings were not significantly associated with a better long-term outcome after VPS surgery. The results of our retrospective analysis demonstrated a statistically significant association between the presence of preoperative aqueductal CSF flow acceleration on dynamic brain MRI and neurological outcomes at 12 and 18 months after VPS surgery. Long-term outcomes of iNPH patients treated with VPS surgery do not appear to be directly influenced by preoperative comorbidities, age, or responses to CSF samplings. Alterations in preoperative brain MRI CSF dynamics were found to be related to long-term outcomes following VPS surgery, highlighting the role of radiological assessment as a prognostic factor in patients deemed suitable candidates for VPS surgery.

Comparison of MRI findings of hypothalamic-optic chiasmatic gliomas and craniopharyngiomas.

Differential diagnosis of hypothalamic-optic chiasmatic gliomas (HOCGs) and craniopharyngiomas on magnetic resonance imaging (MRI) can be quite challenging. To compare the MRI features of HOCGs and cranipharyngiomas. Patients diagnosed with HOCG or craniopharyngioma in histopathological evaluation between 2012 and 2022 and who underwent preoperative contrast-enhanced brain MRI were included. Various MRI features were retrospectively evaluated for each lesion: T2-weighted imaging and fluid attenuation inversion recovery hyperintensity, calcification, cystic change, T1-weighted (T1W) imaging hyperintensity of the cystic component, hemorrhage, involvement of sellar, suprasellar or other adjacent structures, lobulated appearance, presence of hydrocephalus, and contrast enhancement pattern. Apparent diffusion coefficient (ADC) values were also evaluated and compared. Among 38 patients included, 13 (34%) had HOCG and 25 (66%) had craniopharyngioma. Craniopharyngiomas had a significantly higher rate of cystic changes, calcification, and T1W imaging hyperintensity of the cystic component than HOCGs (P <0.05). Of HOCGs, 92% had chiasm involvement, 23% had optic nerve involvement, and 31% had brain stem involvement. On the other hand, chiasm involvement was observed in 8% of craniopharyngiomas, but none had optic nerve and/or brain stem involvement (P <0.05). While 62% (8/13) of HOCGs had diffuse homogeneous enhancement, 80% (20/25) of craniopharyngiomas had a diffuse heterogeneous enhancement pattern. Mean ADC values were significantly higher in craniopharyngiomas compared to HOCGs (2.1 vs. 1.6 ×10-3mm2/s, P <0.05). Although some neuroimaging findings may overlap, features such as presence of cyst and calcification, brain stem and optic pathway involvement, different enhancement patterns, and ADC values may be helpful in the differential diagnosis of HOCGs and craniopharyngiomas.

Amygdala enlargement in temporal lobe epilepsy: Histopathology and surgical outcomes.

Amygdala enlargement is detected on magnetic resonance imaging (MRI) in some patients with drug-resistant temporal lobe epilepsy (TLE), but its clinical significance remains uncertain We aimed to assess if the presence of amygdala enlargement (1) predicted seizure outcome following anterior temporal lobectomy with amygdalohippocampectomy (ATL-AH) and (2) was associated with specific histopathological changes. This was a case-control study. We included patients with drug-resistant TLE who underwent ATL-AH with and without amygdala enlargement detected on pre-operative MRI. Amygdala volumetry was done using FreeSurfer for patients who had high-resolution T1-weighted images. Mann-Whitney U test was used to compare pre-operative clinical characteristics between the two groups. The amygdala volume on the epileptogenic side was compared to the amygdala volume on the contralateral side among cases and controls. Then, we used a two-sample, independent t test to compare the means of amygdala volume differences between cases and controls. The chi-square test was used to assess the correlation of amygdala enlargement with (1) post-surgical seizure outcomes and (2) histopathological changes. Nineteen patients with and 19 patients without amygdala enlargement were studied. Their median age at surgery was 38 years for cases and 39 years for controls, and 52.6% were male. There were no statistically significant differences between the two groups in their pre-operative clinical characteristics. There were significant differences in the means of volume difference between cases and controls (Diff = 457.2 mm3, 95% confidence interval [CI] 289.6-624.8; p < .001) and in the means of percentage difference (p < .001). However, there was no significant association between amygdala enlargement and surgical outcome (p = .72) or histopathological changes (p = .63). The presence of amygdala enlargement on the pre-operative brain MRI in patients with TLE does not affect the surgical outcome following ATL-AH, and it does not necessarily suggest abnormal histopathology. These findings suggest that amygdala enlargement might reflect a secondary reactive process to seizures in the epileptogenic temporal lobe.

Brain injury and neurodevelopmental outcomes in children undergoing surgery for congenital heart disease

ObjectivesBrain injury is commonly seen on magnetic resonance imaging in infants with complex congenital heart disease. The impact of perioperative brain injury on neurodevelopmental outcomes is not well understood. We evaluate the association of brain injury and other markers on neurodevelopmental outcomes in patients undergoing surgery for congenital heart surgery during infancy. MethodsTerm newborns with infant cardiac surgery performed between 2008 and 2019 at a single tertiary center, and both preoperative and postoperative brain magnetic resonance imaging were included. Those with underlying genetic conditions were excluded. Brain injury was characterized using an magnetic resonance imaging scoring system. Neurodevelopmental outcomes were assigned using the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended. Independent risk factors for poor neurodevelopmental outcomes were determined by multivariable Cox regression. ResultsA total of 122 patients were included. New or progressive postoperative brain injury was noted in 69 patients (57%). A total of 101 patients (83%) had at least 1 neurodevelopmental assessment (median age 36 months) with an early assessment (5-24 months) performed in 95 children. Multivariable Cox regression analysis of early neurodevelopmental outcomes identified new stroke on postoperative magnetic resonance imaging to be an independent predictor of poor neurodevelopmental outcome. Postoperative peak lactate was an independent predictor of poor outcome assessed by the Pediatric Stroke Outcome Measure and Glasgow Outcome Scale Extended. ConclusionsOur study reveals that evidence of new stroke on magnetic resonance imaging after infant congenital heart surgery is a predictor of poor neurodevelopmental outcomes in early childhood. Postoperative lactic acidosis is associated with poor neurodevelopmental outcome and may be a surrogate biomarker for ischemic brain injury.

Efficient organisation of the contralateral hemisphere connectome is associated with improvement in intelligence quotient after paediatric epilepsy surgery

ObjectiveAims of epilepsy surgery in childhood include optimising seizure control and facilitating cognitive development. Predicting which children will improve cognitively is challenging. We investigated the association of the pre-operative structural connectome of the contralateral non-operated hemisphere with improvement in intelligence quotient (IQ) post-operatively. MethodsConsecutive children who had undergone unilateral resective procedures for epilepsy at a single centre were retrospectively identified. We included those with pre-operative volume T1-weighted non-contrast brain magnetic resonance imaging (MRI), no visible contralateral MRI abnormalities, and both pre-operative and two years post-operative IQ assessment. The MRI of the hemisphere contralateral to the side of resection was anatomically parcellated into 34 cortical regions and the covariance of cortical thickness between regions was used to create binary and weighted group connectomes. ResultsEleven patients with a post-operative IQ increase of at least 10 points at two years were compared with twenty-four patients with no change in IQ score. Children who gained at least 10 IQ points post-operatively had a more efficiently structured contralateral hemisphere connectome with higher global efficiency (0.74) compared to those whose IQ did not change at two years (0.58, p = 0.014). This was consistent across thresholds and both binary and weighted networks. There were no statistically significant group differences in age, sex, age at onset of epilepsy, pre-operative IQ, mean cortical thickness, side or site of procedure, two year post-operative Engel scores or use of anti-seizure medications between the two groups. ConclusionsSurgical procedures to reduce or stop seizures may allow children with an efficiently structured contralateral hemisphere to achieve their cognitive potential.

Adam bald eagle optimization-based Shepard CNN for classification and pixel change detection of brain tumour using post and pre-operative brain MRI images

ABSTRACT Brain tumour is a dangerous disease and it harms health. This research develops a productive model to categorize brain tumours exploiting an Adam Bald Eagle optimization-based Shepard Convolutional Neural Network (ABEO-ShCNN). Initially, the preprocessing is done in pre- and post-operative Magnetic resonance imaging (MRI). Then, U-Net++ is exploited to segment, which is tuned by the Bald Border Collie Firefly Optimization Algorithm (BBCFO). The BBCFO is the incorporation of Border Collie Optimization (BCO), the Firefly optimization Algorithm (FA) and Bald Eagle Search (BES). Thereafter, feature extraction is done and then categorization is conducted using ShCNN in which the training is conducted by ABEO. The ABEO is the integration of Adam and BES. The ABEO-ShCNN model has acquired better accuracy, Positive Predictive Value (PPV), True Negative Rate (TNR), True Positive Rate (TPR) and Negative Predictive Value (NPV) for pre-operative MRI, with values of 92.70%, 92.90%, 91.30%, 89.60% and 89.50%, respectively.

Individual Assessment of Perioperative Brain Growth Trajectories in Infants With Congenital Heart Disease: Correlation With Clinical and Surgical Risk Factors.

Background Infants with congenital heart disease (CHD) are at risk of neurodevelopmental impairments, which may be associated with impaired brain growth. We characterized how perioperative brain growth in infants with CHD deviates from typical trajectories and assessed the relationship between individualized perioperative brain growth and clinical risk factors. Methods and Results A total of 36 infants with CHD underwent preoperative and postoperative brain magnetic resonance imaging. Regional brain volumes were extracted. Normative volumetric development curves were generated using data from 219 healthy infants. Z-scores, representing the degree of positive or negative deviation from the normative mean for age and sex, were calculated for regional brain volumes from each infant with CHD before and after surgery. The degree of Z-score change was correlated with clinical risk factors. Perioperative growth was impaired across the brain, and it was associated with longer postoperative intensive care stay (false discovery rate P<0.05). Higher preoperative creatinine levels were associated with impaired brainstem, caudate nuclei, and right thalamus growth (all false discovery rate P=0.033). Older postnatal age at surgery was associated with impaired brainstem and right lentiform growth (both false discovery rate P=0.042). Longer cardiopulmonary bypass duration was associated with impaired brainstem and right caudate growth (false discovery rate P<0.027). Conclusions Infants with CHD can have impaired brain growth in the immediate postoperative period, the degree of which associates with postoperative intensive care duration. Brainstem growth appears particularly vulnerable to perioperative clinical course, whereas impaired deep gray matter growth was associated with multiple clinical risk factors, possibly reflecting vulnerability of these regions to short- and long-term hypoxic injury.

Carotid massive intraplaque hemorrhage, lipid-rich necrotic core, and heavy circumferential calcification were associated with new ipsilateral ischemic cerebral lesions after carotid artery stenting: high-resolution magnetic resonance vessel wall imaging study.

Following carotid artery stenting (CAS), new ipsilateral ischemic lesions (NIILs) in the brain are frequently seen using diffusion-weighted imaging (DWI). This study's goal was to identify the imaging characteristics associated with NIILs after CAS by high-resolution magnetic resonance vessel wall imaging (HR-VWI). This was a case-control study. 109 patients who received CAS for atherosclerotic carotid stenosis were retrospectively collected and categorized into NIILs positive and NIILs negative groups. Based on the existence or absence of stroke symptoms after CAS, the NIILs positive group was split into two subgroups: the NIILs symptomatic group and the NIILs asymptomatic group. Patients underwent preoperative HR-VWI and brain magnetic resonance imaging (MRI) within 7 days preoperatively and within 3 days postoperatively. Quantitatively assess carotid plaque burden and components using HR-VWI. The baseline and HR-VWI imaging characteristics of all patients were retrospectively analyzed. To ascertain the imaging characteristics connected with NIILs after CAS, logistic regression analysis was carried out. Among 109 patients, 38 patients (34.9%) developed NIILs after CAS. Six patients (5.5%) developed symptomatic stroke with NIILs. The logistic regression analysis revealed that maximum wall thickness (Max WT) [odds ratio (OR), 1.53; 95% confidence interval (CI): 1.20-1.96; P=0.001], the maximum area percentage of lipid-rich necrotic core (LRNC) (OR, 1.05; 95% CI: 1.03-1.07; P<0.001), the volume of LRNC (OR, 1.004; 95% CI: 1.002-1.005; P<0.001), the maximum area percentage of intraplaque hemorrhage (IPH) (OR, 1.17; 95% CI: 1.11-1.24; P<0.001), the volume of IPH (OR, 1.06; 95% CI: 1.03-1.08; P<0.001), and maximum circumference score of calcification in a single slice (OR, 1.66; 95% CI: 1.04-2.63; P=0.03) were linked with NIILs following CAS. The massive IPH, LRNC, and heavy circumferential calcification were associated with NIILs after CAS. Preoperative quantitative assessment of carotid plaque using HR-VWI may be useful for predicting NIILs following CAS.

Impaired Maternal-Fetal Environment and Risk for Preoperative Focal White Matter Injury in Neonates With Complex Congenital Heart Disease.

Background Infants with congenital heart disease (CHD) are at risk for white matter injury (WMI) before neonatal heart surgery. Better knowledge of the causes of preoperative WMI may provide insights into interventions that improve neurodevelopmental outcomes in these patients. Methods and Results A prospective single-center study of preoperative WMI in neonates with CHD recorded data on primary cardiac diagnosis, maternal-fetal environment (MFE), delivery type, subject anthropometrics, and preoperative care. Total maturation score and WMI were assessed, and stepwise logistic regression modeling selected risk factors for WMI. Among subjects with severe CHD (n=183) who received a preoperative brain magnetic resonance imaging, WMI occurred in 40 (21.9%) patients. WMI prevalence (21.4%-22.1%) and mean volumes (119.7-160.4 mm3) were similar across CHD diagnoses. Stepwise logistic regression selected impaired MFE (odds ratio [OR], 2.85 [95% CI, 1.29-6.30]), male sex (OR, 2.27 [95% CI, 1.03-5.36]), and older age at surgery/magnetic resonance imaging (OR, 1.20 per day [95% CI, 1.03-1.41]) as risk factors for preoperative WMI and higher total maturation score values (OR, 0.65 per unit increase [95% CI, 0.43-0.95]) as protective. A quarter (24.6%; n=45) of subjects had ≥1 components of impaired MFE (gestational diabetes [n=12; 6.6%], gestational hypertension [n=11; 6.0%], preeclampsia [n=2; 1.1%], tobacco use [n=9; 4.9%], hypothyroidism [n=6; 3.3%], and other [n=16; 8.7%]). In a subset of 138 subjects, an exploratory analysis of additional MFE-related factors disclosed other potential risk factors for WMI. Conclusions This study is the first to identify impaired MFE as an important risk factor for preoperative WMI. Vulnerability to preoperative WMI was shared across CHD diagnoses.

Deep Learning Radiomics for the Assessment of Telomerase Reverse Transcriptase Promoter Mutation Status in Patients With Glioblastoma Using Multiparametric MRI.

Studies have shown that magnetic resonance imaging (MRI)-based deep learning radiomics (DLR) has the potential to assess glioma grade; however, its role in predicting telomerase reverse transcriptase (TERT) promoter mutation status in patients with glioblastoma (GBM) remains unclear. To evaluate the value of deep learning (DL) in multiparametric MRI-based radiomics in identifying TERT promoter mutations in patients with GBM preoperatively. Retrospective. A total of 274 patients with isocitrate dehydrogenase-wildtype GBM were included in the study. The training and external validation cohorts included 156 (54.3± 12.7 years; 96 males) and 118 (54 .2± 13.4 years; 73 males) patients, respectively. Axial contrast-enhanced T1-weighted spin-echo inversion recovery sequence (T1CE), T1-weighted spin-echo inversion recovery sequence (T1WI), and T2-weighted spin-echo inversion recovery sequence (T2WI) on 1.5-T and 3.0-T scanners were used in this study. Overall tumor area regions (the tumor core and edema) were segmented, and the radiomics and DL features were extracted from preprocessed multiparameter preoperative brain MRI images-T1WI, T1CE, and T2WI. A model based on the DLR signature, clinical signature, and clinical DLR (CDLR) nomogram was developed and validated to identify TERT promoter mutation status. The Mann-Whitney U test, Pearson test, least absolute shrinkage and selection operator, and logistic regression analysis were applied for feature selection and construction of radiomics and DL signatures. Results were considered statistically significant at P-value <0.05. The DLR signature showed the best discriminative power for predicting TERT promoter mutations, yielding an AUC of 0.990 and 0.890 in the training and external validation cohorts, respectively. Furthermore, the DLR signature outperformed CDLR nomogram (P= 0.670) and significantly outperformed clinical models in the validation cohort. The multiparameter MRI-based DLR signature exhibited a promising performance for the assessment of TERT promoter mutations in patients with GBM, which could provide information for individualized treatment. 3 TECHNICAL EFFICACY: Stage 2.

The diagnostic value of ADC histogram and direct ADC measurements for coexisting isocitrate dehydrogenase mutation and O6-methylguanine-DNA methyltransferase promoter methylation in glioma.

To non-invasively predict the coexistence of isocitrate dehydrogenase (IDH) mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation in adult-type diffuse gliomas using apparent diffusion coefficient (ADC) histogram and direct ADC measurements and compare the diagnostic performances of the two methods. A total of 118 patients with adult-type diffuse glioma who underwent preoperative brain magnetic resonance imaging (MRI) and diffusion weighted imaging (DWI) were included in this retrospective study. The patient group included 40 patients with coexisting IDH mutation and MGMT promoter methylation (IDHmut/MGMTmet) and 78 patients with other molecular status, including 32 patients with IDH wildtype and MGMT promoter methylation (IDHwt/MGMTmet), one patient with IDH mutation and unmethylated MGMT promoter (IDHmut/MGMTunmet), and 45 patients with IDH wildtype and unmethylated MGMT promoter (IDHwt/MGMTunmet). ADC histogram parameters of gliomas were extracted by delineating the region of interest (ROI) in solid components of tumors. The minimum and mean ADC of direct ADC measurements were calculated by placing three rounded or elliptic ROIs in solid components of gliomas. Receiver operating characteristic (ROC) curve analysis and the area under the curve (AUC) were used to evaluate the diagnostic performances of the two methods. The 10th percentile, median, mean, root mean squared, 90th percentile, skewness, kurtosis, and minimum of ADC histogram analysis and minimum and mean ADC of direct measurements were significantly different between IDHmut/MGMTmet and the other glioma group (P < 0.001 to P = 0.003). In terms of single factors, 10th percentile of ADC histogram analysis had the best diagnostic efficiency (AUC = 0.860), followed by mean ADC obtained by direct measurements (AUC = 0.844). The logistic regression model combining ADC histogram parameters and direct measurements had the best diagnostic efficiency (AUC = 0.938), followed by the logistic regression model combining the ADC histogram parameters with statistically significant difference (AUC = 0.916) and the logistic regression model combining minimum ADC and mean ADC (AUC = 0.851). Both ADC histogram analysis and direct measurements have potential value in predicting the coexistence of IDHmut and MGMTmet in adult-type diffuse glioma. The diagnostic performance of ADC histogram analysis was better than that of direct ADC measurements. The combination of the two methods showed the best diagnostic performance.

Declining Incidence of Postoperative Neonatal Brain Injury in Congenital Heart Disease

BackgroundBrain injury is common in neonates with complex neonatal congenital heart disease (CHD) and affects neurodevelopmental outcomes. ObjectivesGiven advancements in perioperative care, we sought to determine if the rate of preoperative and postoperative brain injury detected by using brain magnetic resonance imaging (MRI) and associated clinical risk factors have changed over time in complex CHD. MethodsA total of 270 term newborns with complex CHD were prospectively enrolled for preoperative and postoperative brain MRIs between 2001 and 2021 with a total of 466 MRI scans. Brain injuries in the form of white matter injury (WMI) or focal stroke and clinical factors were compared across 4 epochs of 5-year intervals with logistic regression. ResultsRates of preoperative WMI and stroke did not change over time. After adjusting for timing of the postoperative MRI, site, and cardiac group, the odds of newly acquired postoperative WMI were significantly lower in Epoch 4 compared with Epoch 1 (OR: 0.29; 95% CI: 0.09-1.00; P = 0.05). The adjusted probability of postoperative WMI declined significantly by 18.7% from Epoch 1 (24%) to Epoch 4 (6%). Among clinical risk factors, lowest systolic, mean, and diastolic blood pressures in the first 24 hours after surgery were significantly higher in the most recent epoch. ConclusionsThe prevalence of postoperative WMI has declined, whereas preoperative WMI rates remain constant. More robust postoperative blood pressures may explain these findings by minimizing periods of ischemia and supporting cerebral perfusion. These results suggest potential modifiable clinical targets in the postoperative time period to minimize the burden of WMI.

Radiomics for differentiation of the posterior fossa pilocytic astrocytoma versus hemangioblastomas in adults. A pilot study

PurposeBoth pilocytic astrocytoma (PA) and hemangioblastoma (HB) are common primary neoplasms of the posterior fossa with similar radiological manifestations. This study was conducted to evaluate the role of Radiomics in differentiating these two conditions in adults. Materials and methodsAfter a retrospective search of our institutional imaging archive, adult patients with a known diagnosis of PA or HB were included. We reviewed each patient's most recent preoperative brain magnetic resonance imaging (MRI). The solid enhancing nodule of each lesion on post-contrast T1 sequence was manually segmented. Multiple Radiomics features were then extracted from each nodule using the Pyradiomics library. Subsequently, the most predictive features were identified by feature selection models. Following this, different machine learning (ML) models were constructed based on these selected features to classify lesions as PA or HB. Finally, we evaluated the performance of each model by leave-one-out cross-validation. ResultsWith inclusion and exclusion criteria, 34 enhancing PA nodules and 39 HB nodules were selected. A total of 115 features were extracted from each enhancing nodule. Twelve characteristics were detected as most predictive of histopathological diagnosis. Among various ML models, the neural network had the best performance in differentiating these two conditions with an AUC of 0.9 and an accuracy of 82%. ConclusionsIn this retrospective study, Radiomics MRI techniques demonstrated high performance in distinguishing adult posterior fossa PA from HB. Future development of Radiomics models may advance presurgical diagnosis of these two conditions when added to routine clinical practice and thus improve patient management.

Practice variations for fetal and neonatal congenital heart disease within the Children's Hospitals Neonatal Consortium.

Many aspects of care for fetuses and neonates with congenital heart disease (CHD) fall outside standard practice guidelines, leading to the potential for significant variation in clinical care for this vulnerable population. We conducted a cross-sectional survey of site sponsors of the Children's Hospitals Neonatal Consortium, a multicenter collaborative of 41 Level IV neonatal intensive care units to assess key areas of clinical practice variability for patients with fetal and neonatal CHD. We received responses from 31 centers. Fetal consult services are shared by neonatology and pediatric cardiology at 70% of centers. Three centers (10%) routinely perform fetal magnetic resonance imaging (MRI) for women with pregnancies complicated by fetal CHD. Genetic testing for CHD patients is routine at 76% of centers. Preoperative brain MRI is standard practice at 5 centers (17%), while cerebral NIRS monitoring is regularly used at 14 centers (48%). Use of electroencephalogram (EEG) after major cardiac surgery is routine in 5 centers (17%). Neurodevelopmental follow-up programs are offered at 30 centers (97%). Many aspects of fetal and neonatal CHD care are highly variable with evolving shared multidisciplinary models. Many aspects of fetal and neonatal CHD care are highly variable. Genetic testing, placental examination, preoperative neuroimaging, and postoperative EEG monitoring carry a high yield of finding abnormalities in patients with CHD and these tests may contribute to more precise prognostication and improve care. Evidence-based standards for prenatal and postnatal CHD care may decrease inter-center variability.

Imaging, Clinical, and Demographic Differences in Patients With Type III Spinal Cerebrospinal Fluid Leak (Cerebrospinal Venous Fistulas) Compared With Patients With Types I and II Spinal Cerebrospinal Fluid Leak.

Spinal cerebrospinal fluid (CSF) leaks are an underdiagnosed cause of neurologic symptoms. The most common types of spinal CSF leaks are from dural tears (type I) and meningeal diverticula (type II). Cerebrospinal fluid-venous fistulas (type III) are less common and underrecognized. The purpose of this study was to evaluate the intracranial and spinal imaging findings in patients with types I/II versus type III leaks. This was a retrospective, institutional review board-approved study performed on adult patients between January 2020 to September 2021 with surgically confirmed type I/II/III spinal CSF leak. Patients had preoperative brain magnetic resonance imaging (MRI) with contrast and medical records detailing symptoms and clinical diagnoses. Patients were excluded for nondiagnostic brain MRIs. Demographic and clinical information were recorded. The presence of extra-axial collections, pachymeningeal thickening, brain sagging, and decreased pontomamillary distance were evaluated on MRI. Seven patients had type III leaks, and 16 had type I/II leaks. Patients with type III leaks were older ( P = 0.0003) and had higher rates of initial misdiagnosis (100% vs 31%) and longer times to correct diagnosis ( P = 0.03) compared with type I/II leaks. Intracranial extra-axial collections were never seen with type III leaks but were seen in 50% of type I/II leaks. Pachymeningeal thickening and brainstem sagging occurred in nearly equal frequency between groups. Smaller pontomamillary distances were seen in type III leaks versus type I/II leaks ( P = 0.047). When evaluating patients with suspected spinal CSF leak, findings of older age, absence of intracranial extra-axial collections, and small pontomamillary distances may raise suspicion for type III versus type I/II leak.

Intraoperative mobile computed tomography in deep brain stimulation: Comparison between Airo CT and O-arm CT.

Background: A new intraoperative mobile device, called Airo computed tomography (CT), is becoming increasingly used in surgery adding to the current most widespread intraoperative imaging in form of the O-arm CT device. Intraoperative CT imaging has the advantage to reduce the discomfort derived from the patient’s transfer from the operative room to the radiological unit and also the time of control or time of reposition in cases of lead misplacement. This is the first rapport on Airo CT device application in DBS surgery.Methods: In our retrospective study, we have evaluated 52 patients who had DBS from October 2020 to November 2021. All patients underwent a preoperative brain magnetic resonance imaging (MRI) and a stereotactic brain CT scan. We performed an intraoperative CT scan with the Airo device. Images were subsequently transferred to the neuronavigation system (BrainLab cranial software) and merged with preoperative planning images to confirm correct position of leads. Five aspects were compared: patient and surgeon comfort, surgical planning, parenchymal visualization, radioscopic lead visualization, and costs.Results: Both imaging devices are easy-to-use, precise, and safe and have their pros and cons.Conclusion: This is the first study reporting on CT-Airo application in DBS. We advise that if only DBS is considered, the O-arm application might be more suitable. If in addition to DBS cranial surgery is performed, the Airo device is more suitable.

State-of-the-art techniques using pre-operative brain MRI scans for survival prediction of glioblastoma multiforme patients and future research directions.

ObjectiveGlioblastoma multiforme (GBM) is a grade IV brain tumour with very low life expectancy. Physicians and oncologists urgently require automated techniques in clinics for brain tumour segmentation (BTS) and survival prediction (SP) of GBM patients to perform precise surgery followed by chemotherapy treatment.MethodsThis study aims at examining the recent methodologies developed using automated learning and radiomics to automate the process of SP. Automated techniques use pre-operative raw magnetic resonance imaging (MRI) scans and clinical data related to GBM patients. All SP methods submitted for the multimodal brain tumour segmentation (BraTS) challenge are examined to extract the generic workflow for SP.ResultsThe maximum accuracies achieved by 21 state-of-the-art different SP techniques reviewed in this study are 65.5 and 61.7% using the validation and testing subsets of the BraTS dataset, respectively. The comparisons based on segmentation architectures, SP models, training parameters and hardware configurations have been made.ConclusionThe limited accuracies achieved in the literature led us to review the various automated methodologies and evaluation metrics to find out the research gaps and other findings related to the survival prognosis of GBM patients so that these accuracies can be improved in future. Finally, the paper provides the most promising future research directions to improve the performance of automated SP techniques and increase their clinical relevance.

Neurological Screening in Elderly Liver Transplantation Candidates: A Single Center Experience.

Background: Cerebral small vessels disease (cSVD) is an age-related disorder and risk factor for stroke and cognitive/motor impairments. Neurological complications (NCs) are among the causes of adverse outcomes in older liver transplant recipients. This study sought to determine whether cSVD predicts acute NCs in over 65-year-old liver transplant patients. Methods: Data were collected, from a retrospective medical chart review, of 22 deceased donor liver transplant recipients aged 65 years or older with a pre-operative brain magnetic resonance imaging (MRI). We used the Fazekas score (0–3) as a quantitative measurement of the vascular lesion load seen in the MRI. We analyzed all post-operative acute NCs occurring during the hospital stay and any other non-NC. Results: cSVD was recognized in all patients. Neurological complications (NCs) occurred in 18.1% of patients with toxic-metabolic encephalopathy the most frequent diagnosis (13.64%). More severe cSVD was associated with seizures (p = 0.0362), longer hospital stay (p 0.0299), and disability (p 0.0134). In our elderly cohort, hepatic encephalopathy (HE) (p 0.0287) and ascites (p 0.0270) were predictors of NCs after liver transplantation. Ascites and/or variceal bleeding and severity of liver disease were associated with adverse post-operative outcomes. The small sample size limited the statistical analysis power. Conclusions: We present the preliminary data of a single-center retrospective study aimed at understanding the cSVD role on NCs and non-NCs after a liver transplantation in elderly patients. This would encourage a more appropriate multicenter prospective study that will definitely confirm if a neurological screening in old age liver transplant candidates is appropriate.

In infants with congenital heart disease autonomic dysfunction is associated with pre-operative brain injury.

Background:Brain injury is a serious and common complication of critical congenital heart disease (CHD). Impaired autonomic development (assessed by heart rate variability; HRV) is associated with brain injury in other high-risk neonatal populations.Objective:To determine whether impaired early neonatal HRV is associated with pre-operative brain injury in CHD.Methods:In infants with critical CHD, we evaluated HRV during the first 24 hours of cardiac ICU (CICU) admission using time-domain (RMS1, RMS2, and alpha 1) and frequency-domain metrics (LF, nLF, HF, nHF). Pre-operative brain MRI was scored for injury using an established system. Spearman’s correlation coefficient was used to determine the association between HRV and pre-operative brain injury.Results:We enrolled 34 infants with median birth gestational age (GA) of 38.8 weeks (IQR 38.1-39.1). Median postnatal age (PNA) at pre-operative brain MRI was 2 days (IQR 1-3 days). Thirteen infants had MRI evidence of brain injury. RMS 1 and RMS 2 were inversely correlated with pre-operative brain injury.Conclusions:Time-domain metrics of autonomic function measured within the first 24 hours of admission to the CICU are associated with pre-operative brain injury, and may perform better than frequency domain metrics under non-stationary conditions such as critical illness.

Preoperative Magnetic Resonance Imaging Radiomics for Predicting Early Recurrence of Glioblastoma.

PurposeEarly recurrence of glioblastoma after standard treatment makes patient care challenging. This study aimed to assess preoperative magnetic resonance imaging (MRI) radiomics for predicting early recurrence of glioblastoma.Patients and MethodsA total of 122 patients (training cohort: n = 86; validation cohort: n = 36) with pathologically confirmed glioblastoma were included in this retrospective study. Preoperative brain MRI images were analyzed for both radiomics and the Visually Accessible Rembrandt Image (VASARI) features of glioblastoma. Models incorporating MRI radiomics, the VASARI parameters, and clinical variables were developed and presented in a nomogram. Performance was assessed based on calibration, discrimination, and clinical usefulness.ResultsThe nomogram consisting of the radiomic signatures, the VASARI parameters, and blood urea nitrogen (BUN) values showed good discrimination between the patients with early recurrence and those with later recurrence, with an area under the curve of 0.85 (95% CI, 0.77-0.94) in the training cohort and 0.84 [95% CI, 0.71-0.97] in the validation cohort. Decision curve analysis demonstrated favorable clinical application of the nomogram.ConclusionThis study showed the potential usefulness of preoperative brain MRI radiomics in predicting the early recurrence of glioblastoma, which should be helpful in personalized management of glioblastoma.