H.R. Ferreira Dalla Pria, H. Pokhylevych, A. Hassan, N.H. Tahon, M. Saleh, K. Shah, B.W. Carter, P.R. Bhosale
Despite the efforts spent in clinical trials in neuro-oncology during the last few decades, many challenges remain in the radiologic evaluation of brain tumors and metastases. This article aims to explain the current use of tumor metrics, especially in phase II clinical trials, to evaluate response to systemic therapy in neuro-oncology. We will discuss the imaging findings associated with progression and with partial, minor, or complete response to treatment, as well as the method of measurement, the distinction between disease-related and treatment-related changes, and inclusion of clinical symptoms to define treatment response and progression. The evaluation of response in brain tumors requires metrics that account for differences in response between high- and low-grade gliomas and specific tumor behaviors associated with radiation and immunotherapy, among other pitfalls. Advanced brain imaging techniques, such as perfusion and permeability imaging, should be incorporated into clinical trials to measure response to novel therapeutic agents more accurately.Learning Objectives: To understand the role of tumor metrics analysis and the main challenges and pitfalls of applying neuro-oncology imaging criteria
{"title":"Tumor Response Metrics in Neuro-Oncology: A Review","authors":"H.R. Ferreira Dalla Pria, H. Pokhylevych, A. Hassan, N.H. Tahon, M. Saleh, K. Shah, B.W. Carter, P.R. Bhosale","doi":"10.3174/ng.2100083","DOIUrl":"https://doi.org/10.3174/ng.2100083","url":null,"abstract":"Despite the efforts spent in clinical trials in neuro-oncology during the last few decades, many challenges remain in the radiologic evaluation of brain tumors and metastases. This article aims to explain the current use of tumor metrics, especially in phase II clinical trials, to evaluate response to systemic therapy in neuro-oncology. We will discuss the imaging findings associated with progression and with partial, minor, or complete response to treatment, as well as the method of measurement, the distinction between disease-related and treatment-related changes, and inclusion of clinical symptoms to define treatment response and progression. The evaluation of response in brain tumors requires metrics that account for differences in response between high- and low-grade gliomas and specific tumor behaviors associated with radiation and immunotherapy, among other pitfalls. Advanced brain imaging techniques, such as perfusion and permeability imaging, should be incorporated into clinical trials to measure response to novel therapeutic agents more accurately.Learning Objectives: To understand the role of tumor metrics analysis and the main challenges and pitfalls of applying neuro-oncology imaging criteria","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A.A. Capizzano, J. Kim, J. Starkey, A. Srinivasan, Y. Numaguchi
{"title":"Toshio Moritani, MD, PhD","authors":"A.A. Capizzano, J. Kim, J. Starkey, A. Srinivasan, Y. Numaguchi","doi":"10.3174/ng.2301331","DOIUrl":"https://doi.org/10.3174/ng.2301331","url":null,"abstract":"","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anthony Peret, Kelly W. Capel, Mu-Lan Jen, Warren Chang, Anthony D. Kuner, Jesse M. Manunga, Alexey A. Samsonov, James H. Holmes, Kevin M. Johnson, Laura B. Eisenmenger
The use of brain hemodynamics is important in the assessment of numerous pathophysiologic conditions. The measurement of perfusion or delivery of blood to tissues by MR imaging is essential for neuroradiologists to understand and appropriately apply to clinical practice. Several different approaches are used. DSC and dynamic contrast-enhanced MR imaging study the signal change (according to T2* and T1, respectively) induced by an exogenous contrast agent, allowing the measurement of CBF, CBV, and time-related parameters. Blood oxygen level‐dependent (BOLD) MR imaging measures the T2* signal changes induced by the paramagnetic molecule deoxyhemoglobin. BOLD MR imaging provides complex measurements because the signal varies not only with changes in CBF but also with several other parameters such as tissular oxygen uptake and brain activation. Arterial spin-labeling MR imaging is a technique relying on labeled endogenous water as a tracer. By measuring the signal difference between 2 sets of acquisitions (labeling and control), arterial spin-labeling MR imaging calculates cerebral perfusion in a quantitative manner. This article aims to review the fundamentals of perfusion MR imaging techniques essential to any neuroradiology practice along with their advantages, disadvantages, and applications to research and clinical care.Learning Objective: To review DSC MR imaging and alternative MR imaging perfusion techniques, focusing on methodology, advancements, and applications essential for the neuroradiologist to understand and clinically use these techniques
{"title":"Perfusion MRI Techniques: Beyond DSC","authors":"Anthony Peret, Kelly W. Capel, Mu-Lan Jen, Warren Chang, Anthony D. Kuner, Jesse M. Manunga, Alexey A. Samsonov, James H. Holmes, Kevin M. Johnson, Laura B. Eisenmenger","doi":"10.3174/ng.2100041","DOIUrl":"https://doi.org/10.3174/ng.2100041","url":null,"abstract":"The use of brain hemodynamics is important in the assessment of numerous pathophysiologic conditions. The measurement of perfusion or delivery of blood to tissues by MR imaging is essential for neuroradiologists to understand and appropriately apply to clinical practice. Several different approaches are used. DSC and dynamic contrast-enhanced MR imaging study the signal change (according to T2* and T1, respectively) induced by an exogenous contrast agent, allowing the measurement of CBF, CBV, and time-related parameters. Blood oxygen level‐dependent (BOLD) MR imaging measures the T2* signal changes induced by the paramagnetic molecule deoxyhemoglobin. BOLD MR imaging provides complex measurements because the signal varies not only with changes in CBF but also with several other parameters such as tissular oxygen uptake and brain activation. Arterial spin-labeling MR imaging is a technique relying on labeled endogenous water as a tracer. By measuring the signal difference between 2 sets of acquisitions (labeling and control), arterial spin-labeling MR imaging calculates cerebral perfusion in a quantitative manner. This article aims to review the fundamentals of perfusion MR imaging techniques essential to any neuroradiology practice along with their advantages, disadvantages, and applications to research and clinical care.Learning Objective: To review DSC MR imaging and alternative MR imaging perfusion techniques, focusing on methodology, advancements, and applications essential for the neuroradiologist to understand and clinically use these techniques","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Invasive fungal infection is a major cause of morbidity and mortality after intensive chemotherapy in patients with leukemia who present with febrile neutropenia. The most common sites of involvement are the lungs, sinonasal region, and disseminated blood stream infection. Visceral organ involvement is usually seen in the form of fungal abscesses, with parenchymal infarcts being less common. We report an unusual case of invasive fungal infection presenting with extensive liver infarction, global renal infarction, and multiple brain lesions in a 4-year-old boy with acute lymphoblastic leukemia on induction chemotherapy.
{"title":"Invasive Fungal Infection Mimicking Infarctions in a Child with Acute Lymphoblastic Leukemia","authors":"H. Manek, F. Gala, S. Mudaliar","doi":"10.3174/ng.2200007","DOIUrl":"https://doi.org/10.3174/ng.2200007","url":null,"abstract":"Invasive fungal infection is a major cause of morbidity and mortality after intensive chemotherapy in patients with leukemia who present with febrile neutropenia. The most common sites of involvement are the lungs, sinonasal region, and disseminated blood stream infection. Visceral organ involvement is usually seen in the form of fungal abscesses, with parenchymal infarcts being less common. We report an unusual case of invasive fungal infection presenting with extensive liver infarction, global renal infarction, and multiple brain lesions in a 4-year-old boy with acute lymphoblastic leukemia on induction chemotherapy.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thymur Ali Chaudhry, Muhamad Serhal, Pascale Aouad
The spectrum of ocular diseases encountered in the pediatric population is different from that in adults. Recognition of the normal embryologic development and anatomy is crucial to understand various ocular pathologies. Cross-sectional imaging supplements the clinical evaluation in establishing an accurate diagnosis, guiding management and monitoring diseases of the ocular globe. CT is mostly reserved for evaluation of acute processes in the setting of trauma or infection. MR imaging is the technique of choice for most other ocular conditions, given its high soft-tissue resolution. This article highlights the relevant embryologic developmental stages and normal anatomy and provides a review of various pediatric orbital pathologies and their key imaging features.Learning Objective: To recognize the normal embryologic development, anatomy, and key imaging features of common ocular pathologies in the pediatric population to aid the neuroradiologist in promptly detecting and confidently establishing the diagnosis of pediatric ocular disease
{"title":"Imaging of Pediatric Ocular Globe Pathologies","authors":"Thymur Ali Chaudhry, Muhamad Serhal, Pascale Aouad","doi":"10.3174/ng.2200020","DOIUrl":"https://doi.org/10.3174/ng.2200020","url":null,"abstract":"The spectrum of ocular diseases encountered in the pediatric population is different from that in adults. Recognition of the normal embryologic development and anatomy is crucial to understand various ocular pathologies. Cross-sectional imaging supplements the clinical evaluation in establishing an accurate diagnosis, guiding management and monitoring diseases of the ocular globe. CT is mostly reserved for evaluation of acute processes in the setting of trauma or infection. MR imaging is the technique of choice for most other ocular conditions, given its high soft-tissue resolution. This article highlights the relevant embryologic developmental stages and normal anatomy and provides a review of various pediatric orbital pathologies and their key imaging features.Learning Objective: To recognize the normal embryologic development, anatomy, and key imaging features of common ocular pathologies in the pediatric population to aid the neuroradiologist in promptly detecting and confidently establishing the diagnosis of pediatric ocular disease","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coma is a state of unresponsiveness to external stimuli, which can be secondary to a variety of CNS alterations affecting essential neuronal pathways, particularly the ascending reticular activating system. A comprehensive clinical evaluation is necessary for assessment of motor function and brainstem reflexes but is often insufficient for determination of the underlying etiology and extent of injury. Diagnostic brain imaging is typically needed for management and decision-making, particularly in acute settings where prompt diagnosis of reversible/treatable conditions is essential, as well as for prognostication. Understanding the pathophysiologic mechanisms leading to coma and comalike states and their imaging manifestations will enable selection of appropriate modalities and facilitate a clinically relevant interpretation. For evaluation of brain death, diagnostic imaging has a supportive role, and when indicated, selection of an ancillary diagnostic test is based on multiple factors, including susceptibility to confounding factors and specificity, in addition to safety, convenience, and availability.Learning objective: To describe the pathophysiology of alterations of consciousness and discuss the role of neuroimaging modalities in the evaluation of coma, brain death, and associated conditions
{"title":"Neuroimaging in Coma, Brain Death, and Related Conditions","authors":"Edgar Zamora, Kwang J. Chun, Carlos Zamora","doi":"10.3174/ng.2200001","DOIUrl":"https://doi.org/10.3174/ng.2200001","url":null,"abstract":"Coma is a state of unresponsiveness to external stimuli, which can be secondary to a variety of CNS alterations affecting essential neuronal pathways, particularly the ascending reticular activating system. A comprehensive clinical evaluation is necessary for assessment of motor function and brainstem reflexes but is often insufficient for determination of the underlying etiology and extent of injury. Diagnostic brain imaging is typically needed for management and decision-making, particularly in acute settings where prompt diagnosis of reversible/treatable conditions is essential, as well as for prognostication. Understanding the pathophysiologic mechanisms leading to coma and comalike states and their imaging manifestations will enable selection of appropriate modalities and facilitate a clinically relevant interpretation. For evaluation of brain death, diagnostic imaging has a supportive role, and when indicated, selection of an ancillary diagnostic test is based on multiple factors, including susceptibility to confounding factors and specificity, in addition to safety, convenience, and availability.Learning objective: To describe the pathophysiology of alterations of consciousness and discuss the role of neuroimaging modalities in the evaluation of coma, brain death, and associated conditions","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dorsal arachnoid web is a challenging condition to diagnose on MR imaging. MR imaging flow studies have shown altered CSF flow dynamics near the web. We describe the findings of an arachnoid web with dynamic fluoroscopic myelography in a 77-year-old man. Dynamic myelography revealed functional CSF flow obstruction and focal dorsal thecal sac enlargement with a dynamic change in size at the T6 level.
{"title":"Dynamic Fluoroscopic Myelography in the Evaluation of Spinal Dorsal Arachnoid Web","authors":"S. Majid, H. Park, K. Thamburaj","doi":"10.3174/ng.2100013","DOIUrl":"https://doi.org/10.3174/ng.2100013","url":null,"abstract":"Dorsal arachnoid web is a challenging condition to diagnose on MR imaging. MR imaging flow studies have shown altered CSF flow dynamics near the web. We describe the findings of an arachnoid web with dynamic fluoroscopic myelography in a 77-year-old man. Dynamic myelography revealed functional CSF flow obstruction and focal dorsal thecal sac enlargement with a dynamic change in size at the T6 level.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruth L. Gilliver, James Meacock, Christopher Derham, Stuart Currie
The intent of this article is to provide a comprehensive, educational overview of cervical spinal trauma, bringing together the mechanism of injury, imaging assessment, common injury patterns and classification systems, and acute management. Accompanying illustrations will act as powerful tools for comprehension. These concepts will be underpinned by frequent reference to neuroradiology and a grounding of cervical spinal anatomy. Although primarily aimed at the reporting radiologist, this article will serve as an important scholastic adjunct to other clinical specialties, including emergency physicians, trauma and orthopedic surgeons, and neurosurgeons.Learning Objective: To understand cervical spinal anatomy, describe the common mechanisms and patterns of cervical spinal injury, and identify injuries for which further imaging assessment is recommended
{"title":"Acute Cervical Spine Trauma: Imaging Assessment and Management","authors":"Ruth L. Gilliver, James Meacock, Christopher Derham, Stuart Currie","doi":"10.3174/ng.2200014","DOIUrl":"https://doi.org/10.3174/ng.2200014","url":null,"abstract":"The intent of this article is to provide a comprehensive, educational overview of cervical spinal trauma, bringing together the mechanism of injury, imaging assessment, common injury patterns and classification systems, and acute management. Accompanying illustrations will act as powerful tools for comprehension. These concepts will be underpinned by frequent reference to neuroradiology and a grounding of cervical spinal anatomy. Although primarily aimed at the reporting radiologist, this article will serve as an important scholastic adjunct to other clinical specialties, including emergency physicians, trauma and orthopedic surgeons, and neurosurgeons.Learning Objective: To understand cervical spinal anatomy, describe the common mechanisms and patterns of cervical spinal injury, and identify injuries for which further imaging assessment is recommended","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135852117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The complex anatomy and broad array of potential congenital abnormalities can make developmental anomalies of the midface an intimidating subject. However, a basic understanding of facial development and a location-based approach to evaluation can substantially improve diagnostic confidence. This article briefly reviews relevant embryologic steps in the development of the midface, specifically focusing on the nasal region, frontonasal region, and palate. Then, following a brief discussion of imaging techniques, relevant congenital anomalies in each of these anatomic regions are addressed. Finally, a few of the more common craniofacial syndromes are reviewed.Learning Objective: To understand the key features of midface development and use a location-based approach to generate a relevant differential diagnosis for congenital midface anomalies
{"title":"Developmental Anomalies of the Midface","authors":"A. Foust, J. Estroff, C. Robson","doi":"10.3174/ng.2100027","DOIUrl":"https://doi.org/10.3174/ng.2100027","url":null,"abstract":"The complex anatomy and broad array of potential congenital abnormalities can make developmental anomalies of the midface an intimidating subject. However, a basic understanding of facial development and a location-based approach to evaluation can substantially improve diagnostic confidence.\u0000 This article briefly reviews relevant embryologic steps in the development of the midface, specifically focusing on the nasal region, frontonasal region, and palate. Then, following a brief discussion of imaging techniques, relevant congenital anomalies in each of these anatomic regions are\u0000 addressed. Finally, a few of the more common craniofacial syndromes are reviewed.Learning Objective: To understand the key features of midface development and use a location-based approach to generate a relevant differential diagnosis for congenital midface anomalies","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48055998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case documents the rapid development of a spontaneous spinal epidural hematoma captured during an MR imaging examination.
该病例记录了在核磁共振成像检查中捕获的自发性脊髓硬膜外血肿的快速发展。
{"title":"Expansion of a Spinal Epidural Hematoma During Imaging","authors":"V. Fuchs, E. Sribnick, A. McAllister","doi":"10.3174/ng.2100030","DOIUrl":"https://doi.org/10.3174/ng.2100030","url":null,"abstract":"This case documents the rapid development of a spontaneous spinal epidural hematoma captured during an MR imaging examination.","PeriodicalId":36193,"journal":{"name":"Neurographics","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43155359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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