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  • Ovid Technologies (Wolters Kluwer Health)  (23)
  • 1
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    Increased Delay Between Gadolinium Chelate Administration and T1-Weighted Magnetic Resonance Imaging Acquisition Increases Contrast-Enhancing Tumor Volumes and T1 Intensities in Brain Tumor Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Investigative Radiology Vol. 53, No. 4 ( 2018-4), p. 223-228
    Details
    In: Investigative Radiology, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 4 ( 2018-4), p. 223-228
    Abstract: The aim of this study was to evaluate the impact of delayed T1-weighted (T1-w) MRI acquisition after gadolinium chelate administration on brain tumor volumes and T1-w intensities. Materials and Methods Fifty-five patients with histologically confirmed, contrast-enhancing intra-axial brain tumors were analyzed in this prospective test-retest study. Patients underwent 2 consecutive 3 T MRI scans (separated by a 1-minute break) during routine follow-up with contrast-enhanced T1 (ceT1-w), T2, and FLAIR acquisition. Macrocyclic gadolinium chelate–based contrast agent was only administered before the first ceT1-w acquisition; median latency to ceT1-w acquisition was 6.72 minutes (IQR, 6.53–6.92) in the first and 16.27 minutes (IQR, 15.49–17.26) in the second scan. Changes in tumor volumes and relative ceT1-w intensities between the 2 acquisitions were quantitatively assessed following semiautomated tumor segmentation (separately for contrast-enhancement [CE], necrosis [NEC] , and nonenhancing [NE] tumor). Results Semiautomatically segmented CE tumor volumes were significantly larger in the second acquisition (median +32% [1.2 cm 3 ]; IQR, 16%–62%; P 〈 0.01), which corresponded to a 10% increase in CE tumor diameter (+0.3 cm). Contrarily, NEC and NE tumor volumes were significantly smaller (median −24% [IQR, −36% to −54%], P 〈 0.01 for NEC and −2% [IQR, −1% to −3%], P = 0.02 for NE tumor). Bland-Altman plots confirmed a proportional bias toward higher CE and lower NEC volumes for the second ceT1-w acquisition. Relative ceT1-w intensities for both early- (regions already enhancing in the first scan) and late-enhancing (newly enhancing regions in the second scan) tumor were significantly increased in the second acquisition (by 5.8% and 27.3% [ P 〈 0.01, respectively]). Linear-mixed effects modeling confirmed that the increase in CE volumes and CE intensities is a function of the interval between contrast agent injection and ceT1-w acquisition ( P 〈 0.01 each). Conclusions Our study indicates that the maximum extent of CE tumor volumes and intensities may increase beyond the time frame of 4 to 8 minutes after contrast agent injection and potentially affects the diagnosis of progressive or recurrent disease because late-enhancing recurrent disease might not be unequivocally detected on standard follow-up MRI.
    Type of Medium: Online Resource
    ISSN: 1536-0210 , 0020-9996
    URL: Article
    DOI: 10.1097/RLI.0000000000000432
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2041543-6
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  • 2
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    Association of Blood Pressure With Short- and Long-Term Functional Outcome After Stroke Thrombectomy : Post Hoc Analysis of the SIESTA Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 6 ( 2018-06), p. 1451-1456
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 6 ( 2018-06), p. 1451-1456
    Abstract: Outcome after mechanical thrombectomy for ischemic stroke may be influenced by blood pressure (BP). This study aims to assess the association of BP changes during general anesthesia versus conscious sedation with functional outcome after mechanical thrombectomy. Methods— SIESTA (Sedation vs Intubation for Endovascular Stroke Treatment) was a monocentric randomized trial of general anesthesia versus conscious sedation during mechanical thrombectomy involving BP target protocols. In this post hoc analysis, BP measurements were divided into 4 phases: preintervention, prerecanalization, postrecanalization, and postintervention. We examined the association between BP and functional outcomes (defined by improvement of 24-hour National Institutes of Health Stroke Scale [NIHSS] and 3-month modified Rankin Scale). Results— We found no association between the difference in systolic BP, diastolic BP, and mean arterial pressure from baseline to the different phases of intervention and NIHSS change after 24 hours. Only baseline diastolic BP was associated with a reduced improvement in NIHSS (β=0.17, P 〈 0.01). There was no association of BP drops with a change in modified Rankin Scale at 3 months. About sedation, only baseline mean arterial pressure preintervention revealed significant associations (β=0.16, P 〈 0.01) with less change in 24-hour NIHSS in conscious sedation group. Otherwise, there was no association for differences of any of the BP measurements with a change in 24-hour NIHSS and long-term functional outcome either in general anesthesia or the conscious sedation group when analyzed separately, consistent with our findings in the entire cohort. Doses of propofol (β=0.84, P =0.04) and norepinephrine (β=1.87, P =0.01) administered during intervention before recanalization were associated with reduced improvement of NIHSS at 24 hours. Conclusions— In a setting, where both sedation regimes general anesthesia and conscious sedation were performed according to strict protocols directed at avoiding BP extremes, our findings suggest that peri-interventional BP drops were not associated with either early neurological improvement or long-term functional outcome. Clinical Trial Registration— URL: https://www.clinicaltrials.gov . Unique identifier: NCT02126085.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.019709
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1467823-8
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  • 3
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    High-Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Images : Evaluation of the Macrocyclic Gadolinium-Based Contrast Agent Gadobutrol
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Investigative Radiology Vol. 50, No. 12 ( 2015-12), p. 805-810
    Details
    In: Investigative Radiology, Ovid Technologies (Wolters Kluwer Health), Vol. 50, No. 12 ( 2015-12), p. 805-810
    Type of Medium: Online Resource
    ISSN: 0020-9996
    URL: Article
    DOI: 10.1097/RLI.0000000000000227
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 2041543-6
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  • 4
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    Perspectives of immunotherapy in isocitrate dehydrogenase-mutant gliomas
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Current Opinion in Oncology Vol. 30, No. 6 ( 2018-11), p. 368-374
    Details
    In: Current Opinion in Oncology, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 6 ( 2018-11), p. 368-374
    Abstract: The present review introduces recent progress in eliciting the role of mutant isocitrate dehydrogenase ( IDH ) in gliomas, especially regarding its mode of action as a modulator of antitumor immune response, and provides rationales for targeting mutant IDH in glioma immunotherapy. Both the development of small molecule inhibitors repressing the enzymatic activity of mutant IDH and novel, mechanism-led combination immunotherapies are discussed. Recent findings Since the discovery of highly frequent IDH mutations in low-grade gliomas and nonsolid malignancies, its tumor cell-intrinsic effects have been intensively investigated. Tumor cells expressing mutant IDH display profound alterations of redox control capacity, phospholipid profile, and ATP supply. Recent findings suggest that IDH mutations – via intricate, yet druggable pathways – cause immunological alterations, highlighting the importance of oncogenic drivers as modulators of antitumor immunity and targets for immunotherapy. Summary Mutant IDH is not only a disease-defining biomarker and oncogenic driver in glioma, but is also a neoantigen and a regulator of glioma immune evasion. Effective and specific strategies targeting the immunomodulatory properties of mutant IDH may complement current (immuno-)therapeutic strategies and approved antiglioma treatments to improve outcome.
    Type of Medium: Online Resource
    ISSN: 1040-8746 , 1531-703X
    URL: Article
    DOI: 10.1097/CCO.0000000000000478
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2026986-9
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  • 5
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    Intraindividual Analysis of Signal Intensity Changes in the Dentate Nucleus After Consecutive Serial Applications of Linear and Macrocyclic Gadolinium-Based Contrast Agents
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Investigative Radiology Vol. 51, No. 11 ( 2016-11), p. 683-690
    Details
    In: Investigative Radiology, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 11 ( 2016-11), p. 683-690
    Abstract: Recent studies reported an increase in the dentate nucleus (DN)-to-pons signal intensity (SI) ratio (DN-pons SI ratio) on unenhanced T1-weighted images in patients who received consecutive serial injections of linear gadolinium-based contrast agents (GBCAs). In contrast, most studies found no increase in the DN-pons SI ratio when patients were treated with consecutive serial injections of macrocyclic GBCAs. However, the potential difference between macrocyclic and linear GBCAs has never been assessed in individuals who received subsequent applications of both contrast agents. In this retrospective study, we assessed the evolution of the DN-pons SI ratio change in patients that were treated with a comparable number of serial consecutive injections of the linear GBCA gadopentetate dimeglumine and subsequent serial injections of the macrocyclic GBCAs gadobutrol and gadoterate meglumine. Materials and Methods Data of 36 patients was analyzed. All patients underwent at least 5 consecutive administrations of the linear GBCA gadopentetate dimeglumine followed by an equal number of consecutive administrations of the macrocyclic GBCA gadobutrol. In 12 of the 36 patients, 5 or more final consecutive injections of the macrocyclic GBCA gadoterate meglumine were analyzed additionally. The difference of DN-pons SI ratios on unenhanced T1-weighted images was calculated by subtracting the ratio at the first examination from the ratio at the last examination in each of the 3 periods. Results The mean DN-pons SI ratio difference in the gadopentetate dimeglumine period was significantly greater than 0 (mean ± SD, 0.0448 ± 0.0345; P 〈 0.001), whereas the mean DN-pons SI ratio difference in the subsequent gadobutrol and gadoterate meglumine period was significantly smaller than 0 (gadobutrol: −0.0178 ± 0.0459, P = 0.026; gadoterate meglumine: −0.0250 ± 0.0284, P = 0.011). Conclusions In this observational study, the application of the linear GBCA gadopentetate dimeglumine was associated with a DN-pons SI ratio increase, whereas subsequent applications of the macrocyclic GBCAs gadobutrol or gadoterate meglumine in the same patients were not. Rather, the current data tentatively suggest a decrease in preexisting hyperintensities over time when linear GBCAs are changed to macrocyclic GBCAs, potentially indicating a washout effect or precipitation of gadolinium. Future patient studies need to include control groups to replicate the present results, and additional animal studies should be conducted to clarify the underlying mechanism of the proposed SI decrease.
    Type of Medium: Online Resource
    ISSN: 1536-0210 , 0020-9996
    URL: Article
    DOI: 10.1097/RLI.0000000000000308
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2041543-6
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  • 6
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    Peripheral Nerve Involvement at First Diagnosis of Multiple Sclerosis : A Prospective MR Neurography Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Investigative Radiology Vol. 58, No. 2 ( 2023-2), p. 173-179
    Details
    In: Investigative Radiology, Ovid Technologies (Wolters Kluwer Health), Vol. 58, No. 2 ( 2023-2), p. 173-179
    Abstract: The aim of this study was to assess peripheral nerve involvement in patients with multiple sclerosis (MS) at first clinical presentation using quantitative magnetic resonance (MR) neurography in correlation with clinical, laboratory, electrophysiological, and central nervous MR imaging data. Materials and Methods In this prospective monocentric study, 30 patients first diagnosed with MS according to the McDonald criteria (19 women; mean age, 32.4 ± 8.8 years) and 30 age- and sex-matched healthy volunteers were examined with high-resolution 3 T MR neurography using a dual-echo T2-relaxometry sequence covering the tibial and peroneal nerves from proximal thigh to distal calf. Magnetic resonance biomarkers of T2 relaxation time (T2 app ), proton spin density (PSD), and nerve cross-sectional area (CSA) were correlated with clinical symptoms, intrathecal immunoglobulin (Ig) synthesis, nerve conduction study, and lesion load on brain and spine MR imaging. The diagnostic accuracy of MR biomarkers was assessed using receiver-operating characteristic curves. Results Diffuse nerve changes were detected along the tibial and peroneal nerves in MS patients, who showed decreased PSD ( P 〈 0.001), increased T2 app ( P 〈 0.001), and smaller tibial nerve CSA ( P 〈 0.001) compared with healthy subjects. Tibial PSD was identified as best parameter separating patients from controls (area under the curve = 0.876). Intrathecal IgG and IgM synthesis correlated with PSD values ( r = −0.44, P = 0.016, and r = −0.42, P = 0.022). Contrast-enhancement of brain or spine lesions was related to larger tibial and peroneal CSA ( P 〈 0.001, P = 0.033). Abnormal electrophysiology correlated with higher tibial and peroneal T2 app ( P 〈 0.001 and P = 0.033), lower tibial and peroneal PSD ( P = 0.018 and P = 0.002), and smaller peroneal CSA ( P 〈 0.001). Conclusions Quantitative MR neurography reveals peripheral nerve changes in patients with initial diagnosis of MS. Correlation of imaging findings with intrathecal immunoglobulin synthesis may indicate a primary coaffection of the peripheral nervous system in MS.
    Type of Medium: Online Resource
    ISSN: 1536-0210 , 0020-9996
    URL: Article
    DOI: 10.1097/RLI.0000000000000915
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 2041543-6
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  • 7
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    Geriatric neuro-oncology : from mythology to biology
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Current Opinion in Neurology Vol. 24, No. 6 ( 2011-12), p. 599-604
    Details
    In: Current Opinion in Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 24, No. 6 ( 2011-12), p. 599-604
    Type of Medium: Online Resource
    ISSN: 1350-7540
    URL: Article
    DOI: 10.1097/WCO.0b013e32834c4967
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 2026967-5
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  • 8
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    Classification and management of anaplastic gliomas
    Ovid Technologies (Wolters Kluwer Health) ; 2009
    In:  Current Opinion in Neurology Vol. 22, No. 6 ( 2009-12), p. 650-656
    Details
    In: Current Opinion in Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 22, No. 6 ( 2009-12), p. 650-656
    Type of Medium: Online Resource
    ISSN: 1350-7540
    URL: Article
    DOI: 10.1097/WCO.0b013e3283329ce7
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2009
    detail.hit.zdb_id: 2026967-5
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  • 9
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    Quantitative MR neurography biomarkers in 5q-linked spinal muscular atrophy
    Ovid Technologies (Wolters Kluwer Health) ; 2019
    In:  Neurology Vol. 93, No. 7 ( 2019-08-13), p. e653-e664
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 93, No. 7 ( 2019-08-13), p. e653-e664
    Abstract: To characterize and quantify peripheral nerve lesions and muscle degeneration in clinically, genetically, and electrophysiologically well-classified, nonpediatric patients with 5q-linked spinal muscular atrophy (SMA) by high-resolution magnetic resonance neurography (MRN). Methods Thirty-one adult patients with genetically confirmed 5q-linked SMA types II, IIIa, and IIIb and 31 age- and sex-matched healthy volunteers were prospectively investigated. All patients received neurologic, physiotherapeutic, and electrophysiologic assessments. MRN at 3.0T with anatomic coverage from the lumbosacral plexus and proximal thigh down to the tibiotalar joint was performed with dual-echo 2D relaxometry sequences with spectral fat saturation and a 3D T2-weighted inversion recovery sequence. Detailed quantification of nerve injury by morphometric and microstructural MRN markers and qualitative classification of fatty muscle degeneration were conducted. Results Established clinical scores and compound muscle action potentials discriminated well between the 3 SMA types. MRN revealed that peroneal and tibial nerve cross-sectional area (CSA) at the thigh and lower leg level as well as spinal nerve CSA were markedly decreased throughout all 3 groups, indicating severe generalized peripheral nerve atrophy. While peroneal and tibial nerve T2 relaxation time was distinctly increased at all analyzed anatomic regions, the proton spin density was clearly decreased. Marked differences in fatty muscle degeneration were found between the 3 groups and for all analyzed compartments. Conclusions MRN detects and quantifies peripheral nerve involvement in SMA types II, IIIa, and IIIb with high sensitivity in vivo. Quantitative MRN parameters (T2 relaxation time , proton spin density, CSA) might serve as novel imaging biomarkers in SMA to indicate early microstructural nerve tissue changes in response to treatment.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000007945
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2019
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  • 10
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    Limited role for extended maintenance temozolomide for newly diagnosed glioblastoma
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Neurology Vol. 88, No. 15 ( 2017-04-11), p. 1422-1430
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 15 ( 2017-04-11), p. 1422-1430
    Abstract: To explore an association with survival of modifying the current standard of care for patients with newly diagnosed glioblastoma of surgery followed by radiotherapy plus concurrent and 6 cycles of maintenance temozolomide chemotherapy (TMZ/RT → TMZ) by extending TMZ beyond 6 cycles. Methods: The German Glioma Network cohort was screened for patients with newly diagnosed glioblastoma who received TMZ/RT → TMZ and completed ≥6 cycles of maintenance chemotherapy without progression. Associations of clinical patient characteristics, molecular markers, and residual tumor determined by magnetic resonance imaging after 6 cycles of TMZ with progression-free survival (PFS) and overall survival (OS) were analyzed with the log-rank test. Multivariate analyses using the Cox proportional hazards model were performed to assess associations of prolonged TMZ use with outcome. Results: Sixty-one of 142 identified patients received at least 7 maintenance TMZ cycles (median 11, range 7–20). Patients with extended maintenance TMZ treatment had better PFS (20.5 months, 95% confidence interval [CI] 17.7–23.3, vs 17.2 months, 95% CI 10.2–24.2, p = 0.035) but not OS (32.6 months, 95% CI 28.9–36.4, vs 33.2 months, 95% CI 25.3–41.0, p = 0.126). However, there was no significant association of prolonged TMZ chemotherapy with PFS (hazard ratio [HR] = 0.8, 95% CI 0.4–1.6, p = 0.559) or OS (HR = 1.6, 95% CI 0.8–3.3, p = 0.218) adjusted for age, extent of resection, Karnofsky performance score, presence of residual tumor, O 6 -methylguanine DNA methyltransferase (MGMT) promoter methylation status, or isocitrate dehydrogenase ( IDH ) mutation status. Conclusion: These data may not support the practice of prolonging maintenance TMZ chemotherapy beyond 6 cycles. Classification of evidence: This study provides Class III evidence that in patients with newly diagnosed glioblastoma, prolonged TMZ chemotherapy does not significantly increase PFS or OS.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000003809
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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