Incidence and Clinical Features of Pseudoprogression in Brain Metastases After Immune-Checkpoint Inhibitor Therapy: A Retrospective Study.

Pseudoprogression is known to occur after immune-checkpoint inhibitor (ICI) therapy in brain metastasis and can complicate clinical decision-making. Still, its incidence, timing, and clinical presentation remain unclear. A retrospective cohort study in melanoma and non-small cell lung cancer brain metastasis patients was conducted to address this.

Relationship between DTI-MRI derived metrics and radiotherapy dose range in the contralateral cerebrum in lower grade glioma.

Background And Purpose: To evaluate the value of diffusion tensor imaging (DTI) MRI derived fractional anisotropy (FA) and apparent diffusion coefficient (ADC) for both white matter (WM) and grey matter (GM) of the contralateral cerebrum following radiotherapy (RT) for supratentorial lower grade glioma (LGG) as markers for radiotherapy-induced brain damage (RIBD).

Materials And Methods: 14 patients were analysed. WM and GM were segmented using automated software (cNeuro) and the mean FA and ADC were extracted per RT dose bin (0-10, 10-20, 20-30, 30-40, 40-50, >50 Gy) of WM and GM.

The Use of Minor Response, Volumetric Assessment and Growth Rate Kinetics as Endpoints in Grade 1-3 Glioma Clinical Trials: a RANO perspective.

The RANO criteria for response to treatment in glioma make a distinction between enhancing and unenhancing tumors, which reflects assessment of a different biological process underlying the MRI findings in enhancing and non-enhancing tumors. The recent regulatory approval of tovorafenib has also considered the patients with minor responses (25% - 50% decrease) based on the 2D measurement on T2/FLAIR MR imaging, while incorporating other measures of patient benefit. The INDIGO placebo controlled trial led to the regulatory approval of vorasidenib based on the increase in PFS in the active treatment arm, as measured by blinded independent radiology review using the 2D RANO criteria.

DSC Perfusion MRI Artefact Reduction Strategies: A Short Overview for Clinicians and Scientific Applications.

MRI perfusion is used to diagnose and monitor neurological conditions such as brain tumors, stroke, dementia, and traumatic brain injury. Dynamic Susceptibility Contrast (DSC) is the most widely available quantitative MRI technique for perfusion imaging. Even in its most basic implementation, DSC MRI provides critical hemodynamic metrics like cerebral blood flow (CBF), blood volume (CBV), mean transit time (MTT), and time between the peak of arterial input and residue function (Tmax), through the dynamic tracking of a gadolinium-based contrast agent.

The Future of PET Imaging in Multiple Sclerosis: Characterisation of Individual White Matter Lesions.

Multiple sclerosis (MS) is a multifaceted inflammatory, demyelinating, and neurodegenerative disease typified by lesions with distinct hallmarks in the central nervous system. Dysregulation of micro-environmental factors, including extracellular matrix (ECM) remodelling and glial cell activation, has a decisive effect on lesion development and disease progression. Understanding the biological and pathological features of lesions would aid in prognosis and personalised treatment decision making.

Current Developments on [F]FDG PET/CT in Inflammatory Disorders of the Central Nervous System.

2-Deoxy-2-[F]fluoro-D-glucose positron emission tomography (FDG-PET) is widely used to study cerebral glucose metabolism and may be useful in several inflammatory disorders of the central nervous system. Emerging literature suggests that [F]FDG may be more sensitive to detect abnormalities in auto-immune encephalitis (AIE) in comparison to MRI, especially in NDMA receptor encephalitis. Distinct patterns of regional abnormalities in AIE have been reported, depending on the auto-antibody involved.

Recommendations on the use of gadolinium-based contrast agents in the diagnosis and monitoring of common adult intracranial tumours.

Gadolinium-based contrast agents (GBCAs) have been indispensable in intracranial tumour imaging, particularly for detecting and characterising malignant lesions, as well as assessing treatment response and disease progression. However, growing concerns about gadolinium deposition in the central nervous system and its environmental impact have prompted a re-evaluation of its use, particularly in the management of benign or stable lesions. This review examines the role of GBCAs in imaging the most common types of intracranial tumours, including gliomas, meningiomas, pituitary adenomas, cranial nerve tumours, and metastases.

Arterial collateral status and treatment effect of intravenous alteplase thrombolysis prior to endovascular treatment in patients with anterior circulation large vessel occlusion: prespecified analysis of the MR CLEAN-NO IV trial.

Background And Purpose: Collateral blood flow to the affected cerebral territory in acute ischemic stroke may modify the effect of intravenous alteplase treatment (IVT) prior to endovascular treatment (EVT). We assessed whether an interaction effect between arterial collateral status, assessed by both a visual and quantitative collateral score (CS), and administration of IVT plus EVT was present in the MR CLEAN-NO IV trial.

Methods: Baseline CT or MR angiography (CTA and MRA) from patients included in MR CLEAN-NO IV was assessed using both a visual and automated quantitative score for arterial collateral status.

CT Perfusion Imaging After Selection for Late-Window Endovascular Stroke Treatment: Secondary Analysis of the MR CLEAN-LATE Randomized Trial.

Importance: MR CLEAN-LATE (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands for Late Arrivals) showed efficacy of endovascular treatment (EVT) in the late window (6-24 hours after stroke symptom onset or time last seen well) among patients with ischemic stroke selected based on collateral flow. Therefore, the future role of computed tomography perfusion (CTP) imaging in patient selection for late-window EVT may change.

Objective: To investigate the interaction among CTP parameters (core volumes, penumbra volumes, and mismatch ratio) and the association of EVT with functional outcomes among patients in the late window after ischemic stroke selected based on collateral flow.

National trends in patient characteristics, interventional techniques and outcomes of endovascular treatment for acute ischaemic stroke: Final results of the MR CLEAN Registry (2014-2018).

Introduction: Endovascular thrombectomy (EVT) procedures and workflow have evolved over the years. We examined trends in patient characteristics, EVT techniques and outcomes over 5 years in the Netherlands.

Patients And Methods: Data from the MR CLEAN Registry (2014-2018) were analysed, including patients treated with EVT for anterior circulation acute ischaemic stroke (AIS).

Endovascular treatment in comatose patients with anterior circulation ischemic stroke.

Background: Coma in the first hours after anterior circulation ischemic stroke is rare. We aimed to assess the causes of coma and outcomes after endovascular thrombectomy (EVT) in this relatively unexplored subgroup of patients.

Materials And Methods: We used data from the MR CLEAN Registry, a prospective, multicenter, observational cohort study of patients treated with EVT in the Netherlands between March 2014, and December 2018.

Neurocognitive function in lower grade glioma patients selected for proton radiotherapy: real-world data from a prospective cohort study.

Purpose: To determine neurocognitive function (NCF) profiles of patients with lower grade glioma (LGG) eligible to undergo proton radiotherapy (PRT), and how these relate to clinical and radiological characteristics. PRT is offered to those patients for whom sparing of NCF is considered important given their favorable prognosis. To date it is unknown to which extent their NCF profiles are favorable as well.

Unveiling the relation between swallowing muscle mass and skeletal muscle mass in head and neck cancer patients.

Purpose: Sarcopenia, characterized by loss of skeletal muscle mass (SMM) and strength, often leads to dysphagia in the elderly. This condition can also worsen treatment outcomes in head and neck cancer (HNC) patients, who are susceptible to swallowing difficulties. This study aimed to establish the correlation between swallowing muscle mass (SwMM) and SMM in HNC patients.

Assessing the Validity of Diffusion Weighted Imaging Models: A Study in Patients with Post-Surgical Lower-Grade Glioma.

Diffusion weighted imaging (DWI) is used for monitoring purposes for lower-grade glioma (LGG). While the apparent diffusion coefficient (ADC) is clinically used, various DWI models have been developed to better understand the micro-environment. However, the validity of these models and how they relate to each other is currently unknown.

Myelin Imaging of the Spinal Cord in Animal Models and Patients with Multiple Sclerosis Using [C]MeDAS PET: A Translational Study.

Multiple sclerosis (MS) is a neurodegenerative disease characterized by demyelinated lesions in the brain and spinal cord. A few clinical studies using PET to image myelin in the brain have been performed, but none investigated the spinal cord. Because clinically relevant motor symptoms are primarily due to spinal cord damage, this translational study evaluated [C]-methyl-4,4'-diaminostilbene (MeDAS) as a PET tracer for myelin imaging in the rat and human spinal cord.

White matter abnormalities in aneurysmal and angiographically negative subarachnoid hemorrhage: A diffusion kurtosis imaging study.

Objective: Aneurysmal subarachnoid hemorrhage (aSAH) and angiographically negative subarachnoid hemorrhage (anSAH) cause an abrupt rise in intracranial pressure, resulting in shearing forces, causing damage to the white matter tracts. This study aims to investigate whole-brain white matter abnormalities with diffusion kurtosis imaging (DKI) after both aSAH and anSAH and explores whether these abnormalities are associated with impaired cognitive functioning.

Methods: Five months post-ictus, 34 patients with aSAH, 24 patients with anSAH and 17 healthy controls (HC) underwent DKI MRI scanning and neuropsychological assessment (measuring verbal memory, psychomotor speed, executive control, and social cognition).

Spatial distribution of cerebral microbleeds and FLAIR hyperintensities on follow-up MRI after radiotherapy for lower grade glioma.

Background And Purpose: Cerebral microbleeds (CMBs) and fluid-attenuated-inversion recovery (FLAIR) hyperintensities on brain MRI scans after radiotherapy (RT) are considered markers for microvascular damage and related cognitive changes. However, the spatial distribution using existing scoring systems as well as colocation of these imaging biomarkers remain unclear, hampering clinical interpretation. This study aims to elucidate the distribution and colocation of these markers in patients with lower grade glioma (LGG).

A new computed tomography-based approach to quantify swallowing muscle volume by measuring tongue muscle area in a single slice.

Background: Measuring the swallowing muscle mass with volume measurements is complex and time intensive; therefore, it is not used in clinical practice. However, it can be clinically relevant, for instance, in the case of sarcopenic dysphagia. The aim of the study was to develop a feasible and clinically applicable method to measure swallowing muscle mass.

Clusters of resilience and vulnerability: executive functioning, coping and mental distress in patients with diffuse low-grade glioma.

Purpose: Diffuse low-grade gliomas (dLGG) often have a frontal location, which may negatively affect patients' executive functions (EF). Being diagnosed with dLGG and having to undergo intensive treatment can be emotionally stressful. The ability to cope with this stress in an adaptive, active and flexible way may be hampered by impaired EF.

C-Methionine uptake in meningiomas after stereotactic radiotherapy.

Objective: C-Methionine positron emission tomography (MET-PET) is used for stereotactic radiotherapy planning in meningioma patients. The role of MET-PET during subsequent follow-up (FU) is unclear. We analyzed the uptake of C-Methionine before and after stereotactic radiotherapy (SRT) in patients with a complex meningioma and investigated if there was a difference between patients with progressive disease (PD) and stable disease (SD) during FU.

Re-evaluating patient communication and care in angiographically negative subarachnoid hemorrhage: Balancing realism and optimism.

Angiographically negative subarachnoid hemorrhage (anSAH) has traditionally been considered a benign condition, mainly because of favorable outcomes in the acute stage in comparison to the often negative acute outcomes of aneurysmal subarachnoid hemorrhage. However, a growing body of research in recent years shows that anSAH often leads to cognitive impairments, emotional distress, and difficulties in resuming work or other daily life activities. Therefore, in this position paper, we call for a change in neurological care and a shift in patient communication, emphasizing the importance of addressing patient needs and fostering realistic expectations rather than solely focusing on the benign nature of the condition.

Automated magnetic resonance imaging quantification of cerebral parenchymal and ventricular volume following subarachnoid hemorrhage: associations with cognition.

This study aims to investigate cerebral parenchymal and ventricular volume changes after subarachnoid hemorrhage (SAH) and their potential association with cognitive impairment. 17 patients with aneurysmal SAH (aSAH) and 21 patients with angiographically negative SAH (anSAH) without visually apparent parenchymal loss on conventional magnetic resonance imaging (MRI) were included, along with 76 healthy controls. Volumetric analyses were performed using an automated clinical segmentation and quantification tool.

Head-to-head comparison of [C]methionine PET, [C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism.

Purpose: Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [C]methionine PET/CT, [C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan.

Emotion recognition in relation to tumor characteristics in patients with low-grade glioma.

Background: Patients with low-grade gliomas (LGG) treated with surgery, generally function well and have a favorable prognosis. However, LGG can affect neurocognitive functioning. To date, little is known about social cognition (SC) in these patients, although impaired SC is related to social-behavioral problems and poor societal participation.

Influence of MRI Follow-Up on Treatment Decisions during Standard Concomitant and Adjuvant Chemotherapy in Patients with Glioblastoma: Is Less More?

MRI is the gold standard for treatment response assessments for glioblastoma. However, there is no consensus regarding the optimal interval for MRI follow-up during standard treatment. Moreover, a reliable assessment of treatment response is hindered by the occurrence of pseudoprogression.