55 research outputs found
Recommended from our members
Restriction Spectrum Imaging Differentiates True Tumor Progression From Immune-Mediated Pseudoprogression: Case Report of a Patient With Glioblastoma.
Immunotherapy is increasingly used in the treatment of glioblastoma (GBM), with immune checkpoint therapy gaining in popularity given favorable outcomes achieved for other tumors. However, immune-mediated (IM)-pseudoprogression is common, remains poorly characterized, and renders conventional imaging of little utility when evaluating for treatment response. We present the case of a 64-year-old man with GBM who developed pathologically proven IM-pseudoprogression after initiation of a checkpoint inhibitor, and who subsequently developed true tumor progression at a distant location. Based on both qualitative and quantitative analysis, we demonstrate that an advanced diffusion-weighted imaging (DWI) technique called restriction spectrum imaging (RSI) can differentiate IM-pseudoprogression from true progression even when conventional imaging, including standard DWI/apparent diffusion coefficient (ADC), is not informative. These data complement existing literature supporting the ability of RSI to estimate tumor cellularity, which may help to resolve complex diagnostic challenges such as the identification of IM-pseudoprogression
Recommended from our members
Dose-dependent atrophy of the amygdala after radiotherapy.
Background and purposeThe amygdalae are deep brain nuclei critical to emotional processing and the creation and storage of memory. It is not known whether the amygdalae are affected by brain radiotherapy (RT). We sought to quantify dose-dependent amygdala change one year after brain RT.Materials and methods52 patients with primary brain tumors were retrospectively identified. Study patients underwent high-resolution, volumetric magnetic resonance imaging before RT and 1 year afterward. Images were processed using FDA-cleared software for automated segmentation of amygdala volume. Tumor, surgical changes, and segmentation errors were manually censored. Mean amygdala RT dose was tested for correlation with amygdala volume change 1 year after RT via the Pearson correlation coefficient. A linear mixed-effects model was constructed to evaluate potential predictors of amygdala volume change, including age, tumor hemisphere, sex, seizure history, and bevacizumab treatment during the study period. As 51 of 52 patients received chemotherapy, possible chemotherapy effects could not be studied. A two-tailed p-value <0.05 was considered statistically significant.ResultsMean amygdala RT dose (r = -0.28, p = 0.01) was significantly correlated with volume loss. On multivariable analysis, the only significant predictor of amygdala atrophy was radiation dose. The final linear mixed-effects model estimated amygdala volume loss of 0.17% for every 1 Gy increase in mean amygdala RT dose (p = 0.008).ConclusionsThe amygdala demonstrates dose-dependent atrophy one year after radiotherapy for brain tumors. Amygdala atrophy may mediate neuropsychological effects seen after brain RT
Altered Network Topology in Patients with Primary Brain Tumors After Fractionated Radiotherapy
Radiation therapy (RT) is a critical treatment modality for patients with brain tumors, although it can cause adverse effects. Recent data suggest that brain RT is associated with dose-dependent cortical atrophy, which could disrupt neocortical networks. This study examines whether brain RT affects structural network properties in brain tumor patients. We applied graph theory to MRI-derived cortical thickness estimates of 54 brain tumor patients before and after RT. Cortical surfaces were parcellated into 68 regions and correlation matrices were created for patients pre- and post-RT. Significant changes in graph network properties were tested using nonparametric permutation tests. Linear regressions were conducted to measure the association between dose and changes in nodal network connectivity. Increases in transitivity, modularity, and global efficiency (n = 54, p < 0.0001) were all observed in patients post-RT. Decreases in local efficiency (n = 54, p = 0.007) and clustering coefficient (n = 54, p = 0.005) were seen in regions receiving higher RT doses, including the inferior parietal lobule and rostral anterior cingulate. These findings demonstrate alterations in global and local network topology following RT, characterized by increased segregation of brain regions critical to cognition. These pathological network changes may contribute to the late delayed cognitive impairments observed in many patients following brain RT
Recommended from our members
Altered Network Topology in Patients with Primary Brain Tumors After Fractionated Radiotherapy
Radiation therapy (RT) is a critical treatment modality for patients with brain tumors, although it can cause adverse effects. Recent data suggest that brain RT is associated with dose-dependent cortical atrophy, which could disrupt neocortical networks. This study examines whether brain RT affects structural network properties in brain tumor patients. We applied graph theory to MRI-derived cortical thickness estimates of 54 brain tumor patients before and after RT. Cortical surfaces were parcellated into 68 regions and correlation matrices were created for patients pre- and post-RT. Significant changes in graph network properties were tested using nonparametric permutation tests. Linear regressions were conducted to measure the association between dose and changes in nodal network connectivity. Increases in transitivity, modularity, and global efficiency (n = 54, p < 0.0001) were all observed in patients post-RT. Decreases in local efficiency (n = 54, p = 0.007) and clustering coefficient (n = 54, p = 0.005) were seen in regions receiving higher RT doses, including the inferior parietal lobule and rostral anterior cingulate. These findings demonstrate alterations in global and local network topology following RT, characterized by increased segregation of brain regions critical to cognition. These pathological network changes may contribute to the late delayed cognitive impairments observed in many patients following brain RT
- …