Radiation-induced brain injury in patients with meningioma treated with proton or photon therapy.

Introduction: Radiation therapy is often used to treat meningioma with adverse features or when unresectable. Proton therapy has advantages over photon therapy in reducing integral dose to the brain. This study compared the incidence of radiological and clinical adverse events after photon versus proton therapy in the treatment of meningioma.

Spontaneous bilateral orbital subperiosteal hemorrhage resulting from thoracoabdominal crush injury.

Orbital subperiosteal hemorrhage in the absence of facial fractures is uncommon. We report an unusual case of spontaneous bilateral orbital subperiosteal hemorrhage from a thoracoabdominal crush injury. To our knowledge, this is the second case report of this entity occurring in the setting of thoracic compression.

Assessment of the Prognostic Value of Radiomic Features in F-FMISO PET Imaging of Hypoxia in Postsurgery Brain Cancer Patients: Secondary Analysis of Imaging Data from a Single-Center Study and the Multicenter ACRIN 6684 Trial.

Hypoxia is associated with resistance to radiotherapy and chemotherapy in malignant gliomas, and it can be imaged by positron emission tomography with F-fluoromisonidazole (F-FMISO). Previous results for patients with brain cancer imaged with F-FMISO at a single center before conventional chemoradiotherapy showed that tumor uptake via T/Bmax (tissue SUVmax/blood SUV) and hypoxic volume (HV) was associated with poor survival. However, in a multicenter clinical trial (ACRIN 6684), traditional uptake parameters were not found to be prognostically significant, but tumor SUVpeak did predict survival at 1 year.

ACRIN 6684: Assessment of Tumor Hypoxia in Newly Diagnosed Glioblastoma Using 18F-FMISO PET and MRI.

Purpose: Structural and functional alterations in tumor vasculature are thought to contribute to tumor hypoxia which is a primary driver of malignancy through its negative impact on the efficacy of radiation, immune surveillance, apoptosis, genomic stability, and accelerated angiogenesis. We performed a prospective, multicenter study to test the hypothesis that abnormal tumor vasculature and hypoxia, as measured with MRI and PET, will negatively impact survival in patients with newly diagnosed glioblastoma.

Experimental Design: Prior to the start of chemoradiation, patients with glioblastoma underwent MRI scans that included dynamic contrast enhanced and dynamic susceptibility contrast perfusion sequences to quantitate tumor cerebral blood volume/flow (CBV/CBF) and vascular permeability (k) as well as F-Fluoromisonidazole (F-FMISO) PET to quantitate tumor hypoxia.

Multimodality Brain Tumor Imaging: MR Imaging, PET, and PET/MR Imaging.

Standard MR imaging and CT are routinely used for anatomic diagnosis in brain tumors. Pretherapy planning and posttreatment response assessments rely heavily on gadolinium-enhanced MR imaging. Advanced MR imaging techniques and PET imaging offer physiologic, metabolic, or functional information about tumor biology that goes beyond the diagnostic yield of standard anatomic imaging.

18F-Fluoromisonidazole Quantification of Hypoxia in Human Cancer Patients Using Image-Derived Blood Surrogate Tissue Reference Regions.

Unlabelled: (18)F-fluoromisonidazole ((18)F-FMISO) is the most widely used PET agent for imaging hypoxia, a condition associated with resistance to tumor therapy. (18)F-FMISO equilibrates in normoxic tissues but is retained under hypoxic conditions because of reduction and binding to macromolecules. A simple tissue-to-blood (TB) ratio is suitable for quantifying hypoxia.

Subarachnoid hemorrhage: beyond aneurysms.

Objective: Spontaneous subarachnoid hemorrhage (SAH) typically prompts a search for an underlying ruptured saccular aneurysm, which is the most common nontraumatic cause. Depending on the clinical presentation and pattern of SAH, the differential diagnosis may include a diverse group of causes other than aneurysm rupture.

Conclusion: For the purposes of this review, we classify SAH into three main patterns, defined by the distribution of blood on unenhanced CT: diffuse, perimesencephalic, and convexal.

Imaging of brain metastases.

Imaging plays a key role in the diagnosis of central nervous system (CNS) metastasis. Imaging is used to detect metastases in patients with known malignancies and new neurological signs or symptoms, as well as to screen for CNS involvement in patients with known cancer. Computed tomography (CT) and magnetic resonance imaging (MRI) are the key imaging modalities used in the diagnosis of brain metastases.

Carboplatin and bevacizumab for recurrent malignant glioma.

Over 65,000 primary brain tumors are diagnosed annually in the US alone. Malignant gliomas represent more than one-third of such cases. Despite advances in neuroimaging, surgical techniques, radiotherapy and chemotherapy, the survival rate of this disease remains poor.

Comparison of 3 Tesla proton MR spectroscopy, MR perfusion and MR diffusion for distinguishing glioma recurrence from posttreatment effects.

Purpose: To compare 3 Tesla (3T) multi-voxel and single-voxel proton MR spectroscopy (MRS), dynamic susceptibility contrast perfusion MRI (DSC), and diffusion-weighted MRI (DWI) for distinguishing recurrent glioma from postradiation injury.

Materials And Methods: We reviewed all 3T MRS, DSC and DWI studies performed for suspicion of malignant glioma recurrence between October 2006 and December 2008. Maximum Cho/NAA and Cho/Cr peak-area and peak-height ratios were recorded for both multi-voxel and single-voxel MRS.

Cervical collaterals may protect against stroke after blunt vertebral artery injury.

The incidence of ischemic stroke reported after blunt vertebral artery injury is lower than that reported after blunt carotid artery injury. Unlike the carotid arteries, the vertebral arteries receive collateral blood flow through ascending cervical branches in addition to a convergent arterial supply with the contralateral vertebral artery. We hypothesize that the incidence of stroke after vertebral artery injury is less than after carotid artery injury in part because of reconstitution of vertebral arteries by cervical collaterals.

Detection of ventricular shunt malfunction in the ED: relative utility of radiography, CT, and nuclear imaging.

The study objective was to determine the relative diagnostic utility of the radiographic shunt series (SS), head computed tomography (CT), and nuclear imaging performed in our Emergency Department (ED) for evaluating ventricular shunt malfunction. We retrospectively reviewed medical records, head CT (if performed), and nuclear imaging (if performed) for all ED patients with suspected shunt malfunction from 2002 to 2007 who underwent plain film shunt evaluation (296 cases/186 individuals) to determine if surgical shunt revision was performed. Logistic regression analysis was applied.

Imaging of cerebellopontine angle masses: self-assessment module.

The educational objectives for this self-assessment module are for the participant to exercise, self-assess, and improve his or her understanding of the imaging features of cerebellopontine angle (CPA) masses and the role of advanced MRI in the differential diagnosis of CPA masses.

Asymmetric sensorineural hearing loss caused by vestibular schwannoma: Characteristic imaging features before and after treatment with stereotactic radiosurgery.

We report the case of a 71-year-old man who presented with a 2-year history of progressive left-sided hearing loss caused by a cerebellopontine angle mass lesion with classic imaging characteristics of a vestibular schwannoma. Vestibular schwannomas are typically diagnosed on dedicated MRI of the internal auditory canals obtained for asymmetric sensorineural hearing loss, as in this case. We review the characteristic imaging features of vestibular schwannomas that enable their differentiation from other mass lesions of the cerebellopontine angle cistern, allowing for treatment with stereotactic radiosurgery in this case.

Acute sensorineural hearing loss resulting from cerebellopontine angle arachnoid cyst.

We present the case of a 49-year-old woman who presented with acute, nonprogressive left sensorineural hearing loss and benign positional vertigo that was associated with an arachnoid cyst of the cerebellopontine angle. The presence of the lesion was documented by MRI examinations that were obtained 7 years apart. Arachnoid cysts at the cerebellopontine angle are usually found incidentally on MRI performed for unrelated reasons.

Cerebellopontine angle meningioma presenting with hearing loss.

We present the case of a 48-year-old woman with a cerebellopontine angle meningioma who presented with sensorineural hearing loss. The lesion was nearly 4 cm in maximum dimension and extended into the internal auditory canal. Hearing loss resulting from cerebellopontine angle tumor is most commonly caused by vestibular schwannomas, which arise directly from the sheath of the vestibular nerve (VIII) in the internal auditory canal.

Distinction between glioma progression and post-radiation change by combined physiologic MR imaging.

Introduction: Magnetic resonance (MR) diffusion-weighted imaging (DWI), dynamic susceptibility contrast-enhanced perfusion imaging (DSC), and MR spectroscopy (MRS) techniques provide specific physiologic information that may distinguish malignant glioma progression from post-radiation change, yet no single technique is completely reliable. We propose a simple, multiparametric scoring system to improve diagnostic accuracy beyond that of each technique alone.

Methods: Fifteen subjects with lesions suspicious for glioma progression following radiation therapy who had also undergone 3-tesla DWI, DSC, and MRS studies of the lesion were retrospectively reviewed.

Intradural intramedullary spinal cord metastasis due to mesothelioma.

Unlabelled: To report the occurrence of intramedullary spinal cord metastases in a patient with a mesothelioma. A case report.

Setting: University medical center.

Sonographic NASCET index: a new doppler parameter for assessment of internal carotid artery stenosis.

Background And Purpose: Established Doppler parameters for carotid stenosis assessment do not reflect North American Symptomatic Carotid Endarterectomy Trial (NASCET)-style methodology. We derived a Doppler parameter, termed sonographic NASCET index (SNI), and hypothesized that the SNI would provide greater angiographic correlation and better accuracy in predicting stenosis of 70% or greater than that of currently used peak systolic velocity (PSV) measurements.

Methods: Inclusion criteria of angiographically proved carotid stenoses of 40-95% and measured proximal and distal internal carotid artery Doppler PSV values were established.