Publications by authors named "Robert Forbrig"

Introduction: This study evaluates the clinical value of a deep learning-based artificial intelligence (AI) system that performs rapid brain volumetry with automatic lobe segmentation and age- and sex-adjusted percentile comparisons.

Methods: Fifty-five patients-17 with Alzheimer's disease (AD), 18 with frontotemporal dementia (FTD), and 20 healthy controls-underwent cranial magnetic resonance imaging scans. Two board-certified neuroradiologists (BCNR), two board-certified radiologists (BCR), and three radiology residents (RR) assessed the scans twice: first without AI support and then with AI assistance.

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Venous hemangiomas within the central nervous system (CNS) represent a rare pathological entity described by sporadic case reports so far. Comprehensive insights into their histological and imaging features, pathogenesis, natural course, and therapeutic modalities are lacking. This review article presents two patients with contrast-enhancing cerebellar lesions near the tentorium cerebelli lacking edema or diffusion restriction.

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Article Synopsis
  • - The Contour Neurovascular System (CNS) is a new device used to treat intracranial aneurysms, and this study evaluates its effectiveness and safety based on experiences from 76 patients over a midterm follow-up period.
  • - Most treated aneurysms were located at the basilar tip and anterior communicating artery, with a high success rate of implantation and minimal complications, including a few thromboembolic events and no fatalities.
  • - The findings indicate that while the CNS shows promise in achieving complete occlusion of aneurysms, successful outcomes may depend on careful selection of aneurysms and the experience of the medical team, suggesting that longer follow-up might improve the occlusion rates.
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  • Stereotactic radiosurgery/radiotherapy (SRS/SRT) and systemic treatments like tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) are effective for managing brain metastases in non-small cell lung cancer (NSCLC), but the best treatment sequence is unclear.
  • A retrospective analysis of 54 NSCLC patients compared outcomes between those receiving upfront SRS/SRT and those initially treated with TKI/ICI, examining overall survival (OS), intracranial progression-free survival (iPFS), and treatment-related toxicity.
  • The study found no significant differences in OS and iPFS between the two treatment sequences, indicating that both approaches could be similarly effective in managing NSCLC brain metast
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  • The Contour Neurovascular System (CNS) is a new device designed to treat intracranial aneurysms by disrupting blood flow within the aneurysm sac, focusing on cases where previous treatments have failed.
  • In a study involving ten patients with recurring aneurysms, various factors such as technical success, complications, and angiographic outcomes were evaluated, revealing no serious complications during the procedure.
  • Results showed a 50% complete occlusion rate of aneurysms at follow-up, indicating that the CNS could be effective, especially for certain aneurysm shapes; however, more research is needed to determine which types of aneurysms benefit most from this treatment.
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Purpose: Re-irradiation (reRT) is an effective treatment modality for patients with recurrent glioma. Data on dose escalation, the use of simulated integrated boost and concomitant therapy to reRT are still scarce. In this monocentric cohort of n = 223 patients we investigated the influence of reRT dose escalation as well as the concomitant use of bevacizumab (BEV) with regard to post-recurrence survival (PRS) and risk of radionecrosis (RN).

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Background/purpose: Several periprocedural adjuncts for elective surgical aneurysm treatment have been introduced over the last 20 years to increase safety and efficacy. Besides the introduction of IONM in the late-1990s, ICG-videoangiography (ICG-VAG) since the mid-2000s and intraoperative CT-angiography/-perfusion (iCT-A/-P) since the mid-2010s are available. We aimed to clarify whether the introduction of ICG-VAG and iCT-A/-P resulted in our department in a stepwise improvement in the rate of radiologically detected postoperative ischemia, complete aneurysm occlusion and postoperative new deficits.

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Background: Patients with intracranial meningiomas frequently suffer from tumor-related seizures prior to resection, impacting patients' quality of life. We aimed to elaborate on incidence and predictors for seizures in a patient cohort with meningiomas WHO grade 2 and 3.

Methods: We retrospectively searched for patients with meningioma WHO grade 2 and 3 according to the 2021 WHO classification undergoing tumor resection.

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Background: Longitudinal assessments of apparent diffusion coefficients (ADCs) derived from diffusion-weighted imaging (DWI) during intracranial radiotherapy at magnetic resonance imaging-guided linear accelerators (MR-linacs) could enable early response assessment by tracking tumor diffusivity changes. However, DWI pulse sequences are currently unavailable in clinical practice at low-field MR-linacs. Quantifying the in vivo repeatability of ADC measurements is a crucial step towards clinical implementation of DWI sequences but has not yet been reported on for low-field MR-linacs.

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  • The study aimed to evaluate how effective CT-guided drainage (CTD) is for managing fluid collections after liver transplants, looking at technical success, clinical outcomes, and complications.
  • Over a period from 2005 to 2020, 91 drain placements were conducted with a technical success rate of 93.4%, while clinical success rates varied, showing a notable recovery in inflammatory markers within days.
  • The findings suggest that CTD is highly effective, requiring no surgical revisions in most cases, and highlighted a reduction in radiation exposure during procedures in the later years of the study.
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Purpose: To assess accuracy, the frequency of hemorrhagic complications and computed tomography (CT) radiation dose parameters in pediatric patients undergoing landmark-guided external ventricular drain (EVD) placement in an emergency setting.

Methods: Retrospective analysis comprised 36 EVD placements with subsequent CT control scans in 29 patients (aged 0 to 17 years) in our university hospital from 2008 to 2022. The position of the EVD as well as the presence and extension of bleeding were classified according to previously established grading schemes.

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Purpose: Tumor resection represents the first-line treatment for symptomatic meningiomas, and the extent of resection has been shown to be of prognostic importance. Assessment of tumor remnants with somatostatin receptor PET proves to be superior to intraoperative estimation with Simpson grading or MRI. In this preliminary study, we evaluate the prognostic relevance of postoperative PET for progression-free survival in meningiomas.

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Background And Purpose: There is no randomized evidence comparing whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) in the treatment of multiple brain metastases. This prospective nonrandomized controlled single arm trial attempts to reduce the gap until prospective randomized controlled trial results are available.

Material And Methods: We included patients with 4-10 brain metastases and ECOG performance status ≤ 2 from all histologies except small-cell lung cancer, germ cell tumors, and lymphoma.

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Background: The treatment of glioblastomas, the most common primary malignant brain tumors, with a devastating survival perspective, remains a major challenge in medicine. Among the recently explored therapeutic approaches, 5-aminolevulinic acid (5-ALA)-mediated interstitial photodynamic therapy (iPDT) has shown promising results.

Methods: A total of 16 patients suffering from de novo glioblastomas and undergoing iPDT as their primary treatment were retrospectively analyzed regarding survival and the characteristic tissue regions discernible in the MRI data before treatment and during follow-up.

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Background: Encephalitis and myelitis have been linked to both COVID-19 vaccination and infection, causing symptoms such as reduced consciousness, mental state alterations and seizures. Remarkably, most cases do not show significant structural alterations on MRI scans, which poses a diagnostic challenge.

Methods: We present the diagnostic workup and clinical course of a patient who developed a progressive brainstem syndrome two weeks after COVID-19 vaccination and subsequent infection.

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Article Synopsis
  • * Results showed that 33% had new contrast-enhancing tumors due to either tumor remnants or other factors, and 28% had new non-contrast lesions, often related to ischemia rather than actual regrowth.
  • * The findings suggest the need for immediate postoperative MRI to better assess remaining tumor volume for prognostic purposes, while also highlighting the potential for tumor regrowth in some patients, indicating the importance of follow-up imaging before radiotherapy.
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Purpose: Innovative, efficient treatments are desperately needed for people with glioblastoma (GBM).

Methods: Sixteen patients (median age 65.8 years) with newly diagnosed, small-sized, not safely resectable supratentorial GBM underwent interstitial photodynamic therapy (iPDT) as upfront eradicating local therapy followed by standard chemoradiation.

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Purpose: To assess the technical (TS) and clinical success (CS) of CT fluoroscopy-guided drainage (CTD) in patients with symptomatic deep pelvic fluid collections following colorectal surgery.

Methods: A retrospective analysis (years 2005 to 2020) comprised 43 drain placements in 40 patients undergoing low-dose (10-20 mA tube current) quick-check CTD using a percutaneous transgluteal ( = 39) or transperineal ( = 1) access. TS was defined as sufficient drainage of the fluid collection by ≥50% and the absence of complications according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

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Purpose And Objective: Adding stereotactic radiosurgery (SRS) to combined immune checkpoint therapy with ipilimumab and nivolumab (IPI + NIVO) has led to promising results for patients with melanoma brain metastases (MBM). This study retrospectively analyzes the toxicity profile depending on the timing of SRS with regard to IPI + NIVO.

Materials And Methods: For this study, the clinical database was searched for all patients with MBM who were treated with SRS and IPI + NIVO.

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  • Lyme disease is caused by a type of bacteria carried by ticks and can lead to serious problems in some patients, including brain issues.
  • A 56-year-old man had strange symptoms and doctors found he had inflammation in his brain and blocked blood vessels, which is unusual for Lyme disease.
  • After treatment with antibiotics and other medication, he got better, showing that Lyme disease can sometimes cause these serious brain problems, but they are rare.
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