MR imaging biomarkers in neuro-oncology

The central role of magnetic resonance imaging (MRI) in neuro-oncology is undisputed, to diagnose and monitor disease activity, provide treatment decision support and guide focused treatments, and to determine response to treatment both in clinical practice and in clinical trials. Despite recent substantial advances in imaging technology and image analysis techniques, clinical MRI is still primarily applied on the basis of qualitative, subjective interpretation of macrostructural features rather than quantitatively and with taking pathophysiological features into account. The field of quantitative imaging and imaging biomarker development is however maturing. The European Imaging Biomarker ALLiance (EIBALL) and Quantitative Imaging Biomarker Alliance (QIBA) are important drivers setting standards for development, validation and implementation, and promoting the use of quantitative imaging and imaging biomarkers by demonstrating their clinical value. In parallel advanced imaging techniques are reaching the clinical arena, providing quantitative, commonly physiological parameters that further drive the discovery, validation, and implementation of quantitative imaging and imaging biomarkers in the clinical routine. Additionally, computational analysis techniques convert medical images into objective high-dimensional data to define radiomic signatures of disease states. This review addresses the definition and current state of MRI biomarkers, as well as quantitative image analysis techniques with clinical potential for neuro-oncology

Imaging in Minor Head Injury: Early complications and late consequences

Head injury is traditionally divided into minor, moderate or severe head injury, depending on the patient’s presenting level of consciousness as expressed in the Glasgow Coma Scale (GCS) score. Th e vast majority of patients (>90%) present with a normal or nearnormal level of consciousness (GSC score of 13–15) and are thus classifi ed as minor head injury patients (1, 2). With an estimated 60 000 patients annually in the Netherlands, minor head injury forms a major health care and societal burden. Despite being classifi ed as ‘minor’, the injury is not inconsequential. Consequences of minor head injury can be divided into early, potentially lifethreatening complications, and long-term functional disability as well as a wide range of postconcussive complaints

Delayed life-threatening subdural hematoma after minor head injury in a patient with severe coagulopathy: a case report

Minor head injury is a frequent cause for neurologic consultation and imaging. Most patients with minor head injury will make an uneventful recovery, but in a very small proportion of these patients life threatening intracranial complications occur. We describe a patient on oral anticoagulation therapy, and severely impaired coagulation, with normal head computed tomography on admission, who developed a subdural hematoma requiring surgery 12 hours later. Current guidelines and literature for the management of minor head injury are discussed

Association Between Supratotal Glioblastoma Resection and Patient Survival: A Systematic Review and Meta-Analysis

- BACKGROUND: Gross total resection (GTR) of the contrast enhancing (CE) area will improve the survival of patients with glioblastoma (GBM). However, GBM can infiltrate into the brain parenchyma, beyond the CE margins. It remains unclear whether resection beyond the CE area (supratotal resection [SPTR]) can improve survival without causing additional neurological deficits. The aim of the present meta-analysis was to study the association between SPTR and overall survival of patients of GBM. - METHODS: Embase, PubMed, and other literature databases were searched for eligible studies until August 2018. Studies involving patients with GBM that had compared SPTR with GTR were included in the present study. The main outcome was overall survival, presented as hazard ratios (HRs) with 95% confidence intervals (CIs) and median overall survival differences with the 95% CIs. - RESULTS: The meta-analysis, which included 6 studies and 1168 unique patients with GBM, showed that compared with GTR, SPTR of GBM resulted in a 53% lower risk of mortality at any time during follow-up (HR, 0.47; 95% CI, 0.31e 0.72; P [ 0.0005). The median overall survival of the SPTR group was 6.4 months (95% CI, 3.2e9.7) longer than the GTR group (P [ 0.0001). Reports on postoperative deficits were limited, and the quality of evidence was moderate to very low. - CONCLUSIONS: Compared with GTR, SPTR of GBM resulted in a lower risk of mortality and longer median overall survival. However, the quality of evidence of the available studies was poor. Therefore, it remains unclear whether SPTR is safe and actually improves the survival of patients with GBM. Future prospective trials and a standardized definition of SPTR are needed

Radiomics in neuro-oncological clinical trials

The development of clinical trials has led to substantial improvements in the prevention and treatment of many diseases, including brain cancer. Advances in medicine, such as improved surgical techniques, the development of new drugs and devices, the use of statistical methods in research, and the development of codes of ethics, have considerably influenced the way clinical trials are conducted today. In addition, methods from the broad field of artificial intelligence, such as radiomics, have the potential to considerably affect clinical trials and clinical practice in the future. Radiomics is a method to extract undiscovered features from routinely acquired imaging data that can neither be captured by means of human perception nor conventional image analysis. In patients with brain cancer, radiomics has shown its potential for the non-invasive identification of prognostic biomarkers, automated response assessment, and differentiation between treatment-related changes from tumour progression. Despite promising results, radiomics is not yet established in routine clinical practice nor in clinical trials. In this Viewpoint, the European Organization for Research and Treatment of Cancer Brain Tumour Group summarises the current status of radiomics, discusses its potential and limitations, envisions its future role in clinical trials in neuro-oncology, and provides guidance on how to address the challenges in radiomics