MR imaging findings in some rare neurological complications of paediatric cancer

Abstract Neurological complications of paediatric cancers are a substantial problem. Complications can be primary from central nervous system (CNS) spread or secondary from indirect or remote effects of cancer, as well as cancer treatments such as chemotherapy and radiation therapy. In this review, we present the clinical and imaging findings of rare but important neurological complications in paediatric patients with cancer. Neurological complications are classified into three phases: pre-treatment, treatment and post-remission. Paraneoplastic neurological syndromes, hyperviscosity syndrome, haemophagocytic lymphohistiocytosis and infection are found in the pre-treatment phase, while Trousseau’s syndrome, posterior reversible encephalopathy syndrome and methotrexate neurotoxicity are found in the treatment phase; though some complications overlap between the pre-treatment and treatment phases. Hippocampal sclerosis, radiation induced tumour, radiation induced focal haemosiderin deposition and radiation-induced white matter injury are found in the post-remission phase. With increasingly long survival after treatment, CNS complications have become more common. It is critical for radiologists to recognise neurological complications related to paediatric cancer or treatment. Magnetic resonance imaging (MRI) plays a significant role in the recognition and proper management of the neurological complications of paediatric cancer. Teaching Points • Neurological complications of paediatric cancer include various entities. • Neurological complications are classified into three phases: pre-treatment, treatment and post-remission. • Radiologists should be familiar with clinical and imaging findings of neurological complications. • MRI features may be characteristic and lead to early diagnosis and proper treatments

Use of n-butyl cyanoacrylate in abdominal and pelvic embolotherapy: indications and techniques, complications, and their management

The purpose of this article is to describe the indications for use of n-butyl cyanoacrylate (NBCA) in abdominal and pelvic embolotherapy, appropriate techniques for NBCA embolotherapy, and NBCA-related complications and their management. NBCA embolotherapy is a feasible and effective method for treating a variety of abdominal and pelvic vascular lesions or tumors; however, the techniques suitable for each case and knowledge of NBCA-related complications are essential to achieve favorable outcomes

Altered brain metabolite concentration and delayed neurodevelopment in preterm neonates.

A very-low-birth-weight (VLBW) preterm infants is associated with an increased risk of impaired neurodevelopmental outcomes. In this study, we investigated how neonatal brain metabolite concentrations changed with postmenstrual age and examined the relationship between changes in concentration (slopes) and neurodevelopmental level at 3-4 years

Reduced resilience of brain gray matter networks in idiopathic generalized epilepsy: A graph-theoretical analysis.

PurposeThe pathophysiology of idiopathic generalized epilepsy (IGE) is still unclear, but graph theory may help to understand it. Here, we examined the graph-theoretical findings of the gray matter network in IGE using anatomical covariance methods.Materials and methodsWe recruited 33 patients with IGE and 35 age- and sex-matched healthy controls. Gray matter images were obtained by 3.0-T 3D T1-weighted MRI and were normalized using the voxel-based morphometry tools of Statistical Parametric Mapping 12. The normalized images were subjected to graph-theoretical group comparison using the Graph Analysis Toolbox with two different parcellation schemes. Initially, we used the Automated Anatomical Labeling template, whereas the Hammers Adult atlas was used for the second analysis.ResultsThe resilience analyses revealed significantly reduced resilience of the IGE gray matter networks to both random failure and targeted attack. No significant between-group differences were found in global network measures, including the clustering coefficient and characteristic path length. The IGE group showed several changes in regional clustering, including an increase mainly in wide areas of the bilateral frontal lobes. The second analysis with another region of interest (ROI) parcellation generated the same results in resilience and global network measures, but the regional clustering results differed between the two parcellation schemes.ConclusionThese results may reflect the potentially weak network organization in IGE. Our findings contribute to the accumulation of knowledge on IGE

Brain gray matter structural network in myotonic dystrophy type 1.

This study aimed to investigate abnormalities in structural covariance network constructed from gray matter volume in myotonic dystrophy type 1 (DM1) patients by using graph theoretical analysis for further clarification of the underlying mechanisms of central nervous system involvement. Twenty-eight DM1 patients (4 childhood onset, 10 juvenile onset, 14 adult onset), excluding three cases from 31 consecutive patients who underwent magnetic resonance imaging in a certain period, and 28 age- and sex- matched healthy control subjects were included in this study. The normalized gray matter images of both groups were subjected to voxel based morphometry (VBM) and Graph Analysis Toolbox for graph theoretical analysis. VBM revealed extensive gray matter atrophy in DM1 patients, including cortical and subcortical structures. On graph theoretical analysis, there were no significant differences between DM1 and control groups in terms of the global measures of connectivity. Betweenness centrality was increased in several regions including the left fusiform gyrus, whereas it was decreased in the right striatum. The absence of significant differences between the groups in global network measurements on graph theoretical analysis is consistent with the fact that the general cognitive function is preserved in DM1 patients. In DM1 patients, increased connectivity in the left fusiform gyrus and decreased connectivity in the right striatum might be associated with impairment in face perception and theory of mind, and schizotypal-paranoid personality traits, respectively

Results of association matrices (left) and network hub nodes and edges (right).

<p>Lines indicate the edge, and spheres represent nodes. The size of the nodes is proportional to the betweenness centrality (BC). Red denotes hub nodes with BC > 2 standard deviation (SD), and green denotes BC > 1 SD. In DM 1 patients, hub nodes with BC > 2 SD were found only in the left fusiform gyrus, and hub nodes with BC > 1 SD were found in the superior and middle frontal gyrus, and superior temporal gyrus. In controls, hub nodes with BC > 2 SD were found in the right insula, putamen, superior temporal gyrus, and left fusiform gyrus, and hub nodes with BC > 1 SD were found in the middle and inferior gyrus, orbitofrontal gyrus, lingual gyrus, and rolandic operculum.</p

Regional gray matter (GM) atrophy in myotonic dystrophy type 1 (DM1) patients compared with controls.

<p>Clusters of reduced GM volume in DM1 patients compared with controls (clusters significant at <i>p</i> <0.05, FWE corrected, extended threshold = 49 voxels). The colored bar represents the T score. Clusters are diffuse in both hemispheres, particularly in the orbitofrontal, medial frontal, precentral, anterior insula, posterior cingulate, superior temporal, hippocampal, parahippocampal, fusiform, and lingual areas. Clusters are also found bilaterally in subcortical areas, including the thalamus, caudate nucleus, and putamen.</p

Regional comparison of myotonic dystrophy type 1 (DM1) group with healthy control (HC) group for betweenness centrality (BC) and clustering.

<p>Colored areas depict significant differences (at a false discovery rate of <i>p</i> < 0.05). In DM1 patients, an increased BC was found in the left fusiform gyrus, superior temporal gyrus, superior frontal gyrus, and right precuneus, and a decreased BC was found in the right caudate nucleus and putamen. Comparison of clustering showed decreased regions in the right orbitofrontal gyrus, inferior occipital gyrus, precuneus, left pallidum, and increase regions in the left supplementary motor area and superior parietal lobe.</p

Demographic and clinical data of patients with myotonic dystrophy type 1 and healthy subjects.

<p>Demographic and clinical data of patients with myotonic dystrophy type 1 and healthy subjects.</p