Brain

Relationship between Glioblastoma Heterogeneity and Survival Time: An MR Imaging Texture Analysis

Editor’s Choice

A group of 133 patients with primary glioblastoma who underwent postcontrast T1-weighted imaging (acquired before treatment) and whose data were filed with the survival times were selected from the Cancer Genome Atlas. On the basis of overall survival, the patients were divided into 2 groups: long-term (≥12 months, n = 67) and short-term (<12 months, n = 66) survival. To measure heterogeneity, the authors extracted 3 types of textures, co-occurrence matrix, run-length matrix, and histogram, reflecting local, regional, and global spatial variations, respectively. Then the support vector machine classification was used to determine how different texture types perform in differentiating the 2 groups. The results suggest that local and regional heterogeneity may play an important role in the survival stratification of patients with glioblastoma.

Temporal and Spatial Variances in Arterial Spin-Labeling Are Inversely Related to Large-Artery Blood Velocity

Editor’s Choice

The authors performed consecutive pseudocontinuous arterial spin-labeling and phase-contrast MR imaging on 82 individuals (healthy young adults, healthy older adults, and older adults with cerebral small vessel disease or chronic stroke infarcts) and examined associations between extracranial phase-contrast hemodynamics and intracranial arterial spin-labeling characteristics, which were defined by labeling efficiency, temporal signal-to-noise ratio, and spatial coefficient of variation. Large-artery blood velocity was inversely associated with labeling efficiency, temporal SNR, and spatial coefficient of variation of arterial spin-labeling. They conclude that choosing arterial spin-labeling timing parameters with on-line knowledge of blood velocity may improve CBF quantification.

Volumetric Analysis from a Harmonized Multisite Brain MRI Study of a Single Subject with Multiple Sclerosis

Fellows’ Journal Club

The North American Imaging in Multiple Sclerosis Cooperative steering committee developed a uniform high-resolution 3T MR imaging protocol relevant to the quantification of cerebral lesions and atrophy and implemented it at 7 sites across the United States. They assessed intersite variability in scan data, by imaging a volunteer with relapsing-remitting MS with a scan-rescan at each site. In multicenter studies with consistent scanner field strength and manufacturer after protocol harmonization, systematic differences can lead to severe biases in volumetric analyses.

Differentiation between Treatment-Induced Necrosis and Recurrent Tumors in Patients with Metastatic Brain Tumors: Comparison among 11C-Methionine-PET, FDG-PET, MR Permeability Imaging, and MRI-ADC—Preliminary Results

Editor’s Choice

The authors evaluated the feasibility of MR permeability imaging by comparison with 11C-methionine-PET, FDG-PET, and DWI for differentiating radiation necrosis from recurrent tumors in 15 patients with 18 lesions following gamma knife radiosurgery. The area under the ROC curve for differentiating radiation necrosis from recurrent tumors was the best for the 11C-methionine ratio (0.90) followed by the contrast-enhancement ratio (0.81), maximum slope of increase (millimole/second) (0.80), and the initial area under the signal intensity–time curve (0.78). They conclude that PET using 11C-methionine may be superior to MR permeability imaging, ADC, and FDG-PET for differentiating radiation necrosis from recurrent tumors after gamma knife radiosurgery for metastatic brain tumors.

Prevalence of Traumatic Findings on Routine MRI in a Large Cohort of Professional Fighters

Fellows’ Journal Club

Conventional 3T MR imaging was used to assess 499 fighters (boxers, mixed martial artists, and martial artists) and 62 controls for nonspecific WM changes, cerebral microhemorrhage, cavum septum pellucidum, and cavum vergae. Fighters had an increased prevalence of cerebral microhemorrhage (4.2% versus 0% for controls), cavum septum pellucidum (53.1% versus 17.7% for controls), and cavum vergae (14.4% versus 0% for controls). This study assessed MR imaging findings in a large cohort demonstrating a significantly increased prevalence of cavum septum pellucidum among fighters. Although cerebral microhemorrhages were higher in fighters than in controls, this finding was not statistically significant.

Diffusional Kurtosis Imaging and Motor Outcome in Acute Ischemic Stroke

Editor’s Choice

The authors evaluated 17 patients with stroke who underwent brain diffusional kurtosis imaging within 4 days after the onset of symptoms. Neurologic evaluation included the Fugl-Meyer Upper Extremity Motor scale in the acute phase and 3 months poststroke. The largest percentage signal changes of the lesioned hemisphere corticospinal tract were observed with axial kurtosis, with an average 12% increase compared with the contralateral corticospinal tract. The strongest associations between the 3-month Fugl-Meyer Upper Extremity Motor scale score and diffusion metrics were found for the lesioned/contralateral hemisphere corticospinal tract mean kurtosis and axial kurtosis ratios. They conclude that diffusion metrics related to kurtosis were found to be more sensitive than conventional diffusivity metrics to early poststroke corticospinal tract microstructural changes.

The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis

Editor’s Choice

The authors evaluated 37 journal articles that included 985 patients with MS who had MR imaging in which T1-weighted postcontrast sequences were compared with noncontrast sequences obtained during the same MR imaging examination by using ROI analysis of individual MS lesions. DTI-based fractional anisotropy values were significantly different between enhancing and nonenhancing lesions, with enhancing lesions showing decreased FA. None of the other most frequently studied MR imaging biomarkers (mean diffusivity, magnetization transfer ratio, or ADC) were significantly different between enhancing and nonenhancing lesions. They conclude that noncontrast MR imaging techniques, such as DTI-based FA, can assess MS lesion acuity without gadolinium.

Synthetic MRI for Clinical Neuroimaging: Results of the Magnetic Resonance Image Compilation (MAGiC) Prospective, Multicenter, Multireader Trial

Editor’s Choice

The authors performed a prospective multireader, multicase noninferiority trial of 1526 images read by 7 blinded neuroradiologists with prospectively acquired synthetic and conventional brain MR imaging case-control pairs from 109 subjects with neuroimaging indications. Each case included conventional T1- and T2-weighted, T1 and T2 FLAIR, and STIR and/or proton density and synthetic reconstructions from multiple-dynamic multiple-echo imaging. Images were randomized and independently assessed. Overall synthetic MR imaging quality was similar to that of conventional proton-density, STIR, and T1- and T2-weighted contrast views across neurologic conditions. Artifacts were more common in synthetic T2 FLAIR, but were readily recognizable and did not mimic pathology.

Differentiation of Enhancing Glioma and Primary Central Nervous System Lymphoma by Texture-Based Machine Learning

Fellows’ Journal Club

The authors evaluated the diagnostic performance of a machine-learning algorithm by using texture analysis of contrast-enhanced T1-weighted images for differentiation of primary central nervous system lymphoma (n=35) and enhancing glioma (n=71). The mean areas under the receiver operating characteristic curve were 0.877 for the support vector machine classifier; 0.878 for reader 1; 0.899 for reader 2; and 0.845 for reader 3. They conclude that support vector machine classification based on textural features of contrast-enhanced T1WI is noninferior to expert human evaluation in the differentiation of primary central nervous system lymphoma and enhancing glioma.

Heterogeneity of Cortical Lesion Susceptibility Mapping in Multiple Sclerosis

Editor’s Choice

The authors characterized the susceptibility mapping of cortical lesions in patients with MS (n=36) and compared it with neuropathologic observations (n=16). Neuropathologic analysis revealed the presence of an intense band of microglia activation close to the pial membrane in subpial cortical lesions or to the WM border of leukocortical cortical lesions. The quantitative susceptibility mapping analysis revealed 131 cortical lesions classified as hyperintense; 33, as isointense; and 84, as hypointense. They conclude that cortical lesion susceptibility maps are highly heterogeneous, even at individual levels and that the quantitative susceptibility mapping hyperintensity edge found in proximity to the pial surface might be due to the subpial gradient of microglial activation.