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Objective Investigate radiological findings on temporal bone computed tomography, which are associated with obstructive Eustachian tube dysfunction and determine its diagnostic validity. Methods The present study was conducted as a prospective, cross-sectional case series study in a tertiary referral center. Forty patients with clinically diagnosed unilateral Eustachian tube dysfunction and older than 16 years old underwent pre interventional radiological assessment by temporal bone computed tomography while performing a Valsalva-maneuvre to enhance visualization of Eustachian tube lumen. The Eustachian tubes were assessed for intersite morphological differences, presence of mucus in the lumen or middle ear cleft and secretion retention or mucosal swelling in the adjacent sinuses. Image analyses and radiological statements about the side of pathology were delivered blinded to the clinical diagnoses. Results The radiologic detection of mucus/mucosal edema in Eustachian tube or adjacent middle ear cleft structures was associated with the pathological side (t (1, N = 40) = 3.60, p = 0.001 0.05). The diagnostic value of radiologic assessment in Eustachian tube dysfunction has a sensitivity and specificity of 52,5 and 97,5% respectively. Conclusion The sensitivity of radiologic assessment is rather low, and hence it is inappropriate as a screening tool for Eustachian tube dysfunction in routine clinical practice. In the case of present CT-scans of the temporal bone, the focus should be laid on the detection of mucus in the Eustachian tube or adjacent structures, as a predictor of disease.

Cerebral hypoperfusion and vascular dysfunction are closely related to common risk factors for ischemic stroke such as hypertension, dyslipidemia, diabetes, and smoking. The role of inhibitory G protein-dependent receptor (GiPCR) signaling in regulating cerebrovascular functions remains largely elusive. We examined the importance of GiPCR signaling in cerebral blood flow (CBF) and its stability after sudden interruption using various in vivo high-resolution magnetic resonance imaging techniques. To this end, we induced a functional knockout of GiPCR signaling in the brain vasculature by injection of pertussis toxin (PTX). Our results show that PTX induced global brain hypoperfusion and microvascular collapse. When PTX-pretreated animals underwent transient unilateral occlusion of one common carotid artery, CBF was disrupted in the ipsilateral hemisphere resulting in the collapse of the cortically penetrating microvessels. In addition, pronounced stroke features in the affected brain regions appeared in both MRI and histological examination. Our findings suggest an impact of cerebrovascular GiPCR signaling in the maintenance of CBF, which may be useful for novel pharmacotherapeutic approaches to prevent and treat cerebrovascular dysfunction and stroke.

Introduction Meningiomas are the most common benign intracranial neoplasms. CNS invasion in meningiomas has been integrated into the 2016 WHO classification of CNS tumors as a stand-alone criterion for atypia. Since then, its prognostic impact has been debated based on contradictory results from retrospective analyses. The aim of the study was to elucidate whether histopathological evidence of CNS invasion is associated with increased proliferative potential. Methods We have conducted a quantified measurement of the proliferation marker Ki67 and analyzed its association with CNS invasion determined by histology together with other established prognostic markers of progression. Routine, immunohistochemical staining for Ki67 were digitalized and automatic quantification was done using Image J software. Results Overall, 1718 meningiomas were assessed. Histopathological CNS invasion was seen in 108 cases (6.7%). Uni- and multivariate analysis revealed a significantly higher Ki67 proliferation rate in meningiomas with CNS invasion (p Conclusions Meningiomas with histopathological CNS invasion show a higher proliferative activity.

Es gibt vielfaltige Anwendungsmoglichkeiten der strukturierten Befundung („structured reporting“, SR) und der kunstlichen Intelligenz (KI) in der Radiologie. Die Anzahl der wissenschaftlichen Publikationen steigt seit vielen Jahren kontinuierlich. Es existiert ein umfangreiches Portfolio verfugbarer KI-Algorithmen, die z. B. fur die automatisierte Detektion und Vorselektion von Pathologien oder fur die Erleichterung von Arbeitsablaufen innerhalb des Befundungsworkflows angeboten werden. Auch Gerate nutzen bereits KI-Algorithmen fur die Verbesserung des Bedienungskomforts. Die SR ist insbesondere fur die Erfassung von maschinell auswertbaren, semantischen Daten aus radiologischen Befundberichten erforderlich. Vor dem Hintergrund von Zertifizierungsprozessen ist ihre Verwendung bereits Voraussetzung fur die Akkreditierung der Deutschen Krebsgesellschaft als onkologisches Zentrum oder auserhalb Deutschlands als European Cancer Centre. Die mittels SR erfassten Daten konnen maschinell zu Zwecken der Patientenversorgung, Forschung, Lehre und Qualitatssicherung ausgewertet werden. Die Extraktion valider Informationen aus Befundberichten in Prosaform mittels NLP (neurolinguistisches Programmieren) ist aufgrund der grosen Variabilitat und v. a. fehlender Informationen deutlich erschwert. Vor dem Hintergrund des uberwachten Lernens werden fur das Training von KI-Algorithmen oder KNN („k-nearest neighbours“) grose Mengen validierter Daten benotigt. Auch die semantischen Daten aus strukturierten Befundberichten konnen von KI verarbeitet und zum Training verwendet werden. KI und SR stellen somit Entitaten eines Kontinuums innerhalb der Radiologie dar, die sich zum Teil gegenseitig bedingen und vor allem sinnvoll erganzen. Beide haben in diesem Feld ein groses Potenzial fur tiefgreifende, anstehende Veranderungen und Weiterentwicklungen.

The expression of somatostatin receptors in meningioma is well established. First, suggestions of a prognostic impact of SSTRs in meningioma have been made. However, the knowledge is based on few investigations in small cohorts. We recently analyzed the expression of all five known SSTRs in a large cohort of over 700 meningiomas and demonstrated significant correlations with WHO tumor grade and other clinical characteristics. We therefore expanded our dataset and additionally collected information about radiographic tumor recurrence and progression as well as clinically relevant factors (gender, age, extent of resection, WHO grade, tumor location, adjuvant radiotherapy, neurofibromatosis type 2, primary/recurrent tumor) for a comprehensive prognostic multivariate analysis (n = 666). The immunohistochemical expression scores of SSTR1, 2A, 3, 4, and 5 were scored using an intensity distribution score ranging from 0 to 12. For recurrence-free progression analysis, a cutoff at an intensity distribution score of 6 was used. Univariate analysis demonstrated a higher rate of tumor recurrence for increased expression scores for SSTR2A, SSTR3, and SSTR4 (p = 0.0312, p = 0.0351, and p = 0.0390, respectively), while high expression levels of SSTR1 showed less frequent tumor recurrences (p = 0.0012). In the Kaplan–Meier analysis, a higher intensity distribution score showed a favorable prognosis for SSTR1 (p = 0.0158) and an unfavorable prognosis for SSTR2A (0.0143). The negative prognostic impact of higher SSTR2A expression remained a significant factor in the multivariate analysis (RR 1.69, p = 0.0060). We conclude that the expression of SSTR2A has an independent prognostic value regarding meningioma recurrence.

Background Injury to the artery of Adamkiewicz (AKA) during surgery may lead to spinal cord ischemia and severe neurologic complications. Posterior mediastinal tumors may be adjacent to AKA, but data on preoperative visualization of AKA in children are rare. This study analyzed the importance of identifying the AKA preoperatively by spinal digital subtraction angiography (DSA) in children with posterior mediastinal tumors for therapeutic procedure. Methods Between 2002 and 2021, 36 children with posterior mediastinal tumors were evaluated for surgery at the authors’ clinic. In 10 children with left-sided or bilateral tumor located at vertebral levels T8 to L1, spinal DSA was performed during preoperative workup to assess AKA. The patient and tumor characteristics as well as the diagnostic and therapeutic procedures were analyzed. Results The median age of the 10 children at examination was 69 months (range, 16–217 months). Three of the children were younger than 2 years. The tumor entities were neuroblastoma, ganglioneuroblastoma, ganglioneuroma, local relapse of a hepatocellular carcinoma, and neurofibroma. The AKA was identified in all cases, and proximity to the tumor was detected in four patients, three of whom had their planned surgery changed to irradiation. No complications occurred during spinal DSA or surgery. Conclusions In posterior mediastinal pediatric tumors, spinal DSA is a safe and reliable method for preoperative visualization of the AKA. It can show proximity to the tumor and guide the local therapy, thereby avoiding critical intra- and postoperative situations.

Choroid plexus papillomas (CPPs) are primary neuroectodermal neoplasms that usually arise in the fourth ventricle in adults. In this study, we present 12 patients with CPP arising from the cerebellopontine angle (CPP-CPA) and/or of the cerebellomedullary angle (CPP-CMA) that were treated in our department. Patients who underwent surgery for the treatment for CPP-CPA/CMA from January 2004 to March 2020 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. CPPs were classified according to their location into type 1 (tumor portion only in the CPA,), type 2 (tumor portions only in the CMA), and type 3 (tumor portions both in the CPA and CMA). Patients were evaluated for initial symptoms, previous therapies in other hospitals, extent of tumor resection, recurrence rate, and complications by reviewing patient documents. Of approximately 1500 CPA lesions, which were surgically treated in our department in the last 16 years, 12 patients (mean age 42 ± 19 years) were found to have CPP-CPA/CMA. Five were male, and seven were female patients. Gross total resection was achieved in nine cases, and a subtotal resection was attained in three cases. Tumor recurrence in the same location after the first surgery in our hospital was observed in 2 patients after 15 and 40 months of follow-up, and in another patient, distant metastases (C3/4 and L3 levels) were observed. Surgical removal of CPP is the treatment of choice, but additional therapeutic options may be necessary in case of remnant tumor portions, recurrence, or malignant transformation. Supplementary Information The online version contains supplementary material available at 10.1007/s10143-021-01506-4.

Purpose The updated 2016 CNS World Health Organization classification differentiates three main groups of diffuse glioma according to their molecular characteristics: astrocytic tumors with and without isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deleted oligodendrogliomas. The present study aimed to determine whether dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is an independent prognostic marker within the molecular subgroups of diffuse glioma. Methods Fifty-six patients with treatment-naive gliomas and advanced preoperative MRI examination were assessed retrospectively. The mean and maximal normalized cerebral blood volume values from DSC-MRI within the tumors were measured. Optimal cutoff values for the 1-year progression-free survival (PFS) were defined, and Kaplan-Meier analyses were performed separately for the three glioma subgroups. Results IDH wild-type astrocytic tumors had a higher mean and maximal perfusion than IDH-mutant astrocytic tumors and oligodendrogliomas. Patients with IDH wild-type astrocytic tumors and a low mean or maximal perfusion had a significantly shorter PFS than patients of the same group with high perfusion (p = 0.0159/0.0112). Furthermore, they had a significantly higher risk for early progression (hazard ratio = 5.6/5.1). This finding was independent of the methylation status of O6-methylguanin-DNA-methyltransferase and variations of the therapy. Within the groups of IDH-mutant astrocytic tumors and oligodendrogliomas, the PFS of low and highly perfused tumors did not differ. Conclusion High perfusion upon initial diagnosis is not compellingly associated with worse short-term prognosis within the different molecular subgroups of diffuse glioma. Particularly, the overall highly perfused group of IDH wild-type astrocytic tumors contains tumors with low perfusion but unfavorable prognosis.

Glial tumors in the cerebellopontine angle (CPA) are uncommon and comprise less than 1% of CPA tumors. We present four cases of pilocytic astrocytoma of the CPA (PA-CPA) that were treated in our department. Patients who received surgical treatment for PA-CPA from January 2004 to December 2019 were identified by a computer search of their files from the Department of Neurosurgery, Tübingen. Patients were evaluated for initial symptoms, pre- and postoperative facial nerve function and cochlear function, complications, and recurrence rate by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. We identified four patients with PA-CPA out of about 1500 CPA lesions (~ 0.2%), which were surgically treated in our department in the last 16 years. Of the four patients, three were male, and one was a female patient. Two were adults, and two were children (mean age 35 years). A gross total resection was achieved in three cases, and a subtotal resection was attained in one case. Two patients experienced a moderate facial palsy immediately after surgery (House–Brackmann grade III). In all cases, the facial function was intact or good (House–Brackmann grades I–II) at the long-term follow-up (mean follow-up 4.5 years). No mortality occurred during follow-up. Three of the patients had no recurrence at the latest follow-up (mean latest follow-up 4.5 years), while one patient had a slight recurrence. PA-CPA can be safely removed, and most complications immediately after surgery resolve in the long-term follow-up.

Complicated nonstenosing carotid artery plaques (CAPs) are an under-recognized cause of stroke.The purpose of this study was to determine whether complicated CAP ipsilateral to acute ischemic anterior circulation stroke (icCAP) are associated with recurrent ischemic stroke or transient ischemic attack (TIA).The CAPIAS (Carotid Plaque Imaging in Acute Stroke) multicenter study prospectively recruited patients with ischemic stroke restricted to the territory of a single carotid artery. Complicated (AHA-lesion type VI) CAP were defined by multisequence, contrast-enhanced carotid magnetic resonance imaging obtained within 10 days from stroke onset. Recurrent events were assessed after 3, 12, 24, and 36 months. The primary outcome was recurrent ischemic stroke or TIA.Among 196 patients enrolled, 104 patients had cryptogenic stroke and nonstenosing CAP. During a mean follow-up of 30 months, recurrent ischemic stroke or TIA occurred in 21 patients. Recurrent events were significantly more frequent in patients with icCAP than in patients without icCAP, both in the overall cohort (incidence rate [3-year interval]: 9.50 vs 3.61 per 100 patient-years; P = 0.025, log-rank test) and in patients with cryptogenic stroke (10.92 vs 1.82 per 100 patient-years; P = 0.003). The results were driven by ipsilateral events. A ruptured fibrous cap (HR: 4.91; 95% CI: 1.31-18.45; P = 0.018) and intraplaque hemorrhage (HR: 4.37; 95% CI: 1.20-15.97; P = 0.026) were associated with a significantly increased risk of recurrent events in patients with cryptogenic stroke.Complicated CAP ipsilateral to acute ischemic anterior circulation stroke are associated with an increased risk of recurrent ischemic stroke or TIA. Carotid plaque imaging identifies high-risk patients who might be suited for inclusion into future secondary prevention trials. (Carotid Plaque Imaging in Acute Stroke [CAPIAS]; NCT01284933).

As a result of technical developments and greater availability of imaging equipment, the number of neuroradiological examinations is steadily increasing [1]. Due to improved image quality and sensitivity, more details can be detected making reporting more complex and time-intensive. At the same time, reliable algorithms increasingly allow quantitative image analysis that should be integrated in reports in a standardized manner. Moreover, increasing digitalization is resulting in a decrease in the personal exchange between neuroradiologists and referring disciplines, thereby making communication more difficult. The introduction of structured reporting tailored to the specific disease and medical issue [2, 3] and corresponding to at least the second reporting level as defined by the German Radiological Society (https://www.befundung.drg.de/de-DE/2908/strukturierte-befundung/) is therefore desirable to ensure that the quality standards of neuroradiological reports continue to be met.The advantages of structured reporting include a reduced workload for neuroradiologists and an information gain for referring physicians. A complete and standardized list with relevant details for image reporting is provided to neuroradiologists in accordance with the current state of knowledge, thereby ensuring that important points are not forgotten [4]. A time savings and increase in efficiency during reporting were also seen [5]. Further advantages include report clarity and consistency and better comparability in follow-up examinations regardless of the neuroradiologist's particular reporting style. This results in better communication with the referring disciplines and makes clinical decision significantly easier [6, 7]. Although the advantages are significant, any potential disadvantages like the reduction of autonomy in reporting and inadequate coverage of all relevant details and any incidental findings not associated with the main pathology in complex cases or in rare diseases should be taken into consideration [4]. Therefore, studies examining the advantages of structured reporting, promoting the introduction of this system in the clinical routine, and increasing the acceptance among neuroradiologists are still needed.Numerous specific templates for structured reporting, e. g., regarding diseases in cardiology and oncology, are already available on the website www.befundung.drg.de. Multiple sclerosis (MS) is an idiopathic chronic inflammatory and neurodegenerative disease of the central nervous system and is the most common non-trauma-based inflammatory neurological disease in young adults. Therefore, it has significant individual and socioeconomic relevance [8]. Magnetic resonance imaging (MRI) plays an important role in the diagnosis, prognosis evaluation, and follow-up of this disease. MRI is established as the central diagnostic method in the diagnostic criteria. Therefore, specific changes are seen on MRI in almost all patients with a verified MS diagnosis [9]. Reporting of MRI datasets regarding the brain and spinal cord of patients with MS includes examination of the images with respect to the relevant medical issue in order to determine whether the McDonald criteria, which were revised in 2017 [10] and define dissemination in time and space clinically as well as with respect to MRI based on the recommendations of the MAGNIMS groups [11, 12], are fulfilled. A more precise definition of lesion types and locations according to the recommendations of an international expert group [13] is discussed in the supplementary material. Spinal cord signal abnormalities are seen in up to 92 % of MS patients [14-16] and are primarily located in the cervical spine [15]. The recommendations of the MAGNIMS-CMSC-NAIMS working group published in 2021 [11] explicitly recommend the use of structured reporting for MS patients.Therefore, a reporting template for evaluating MRI examinations of the brain and spinal cord of patients with MS was created as part of the BMBF-funded DIFUTURE consortium in consensus with neuroradiological and neurological experts in concordance with the recommendations mentioned above [11] and was made available for broad use (https://github.com/DRGagit/ak_befundung). The goal is to facilitate efficient and comprehensive evaluation of patients with MS in the primary diagnostic workup and follow-up imaging. These reporting templates are consensus-based recommendations and do not make any claim to general validity or completeness. The information technology working group (@GIT) of the German Radiological Society and the German Society for Neuroradiology strive to keep the reporting templates presented here up-to-date with respect to new research data and recommendations of the MAGNIMS-CMSC-NAIMS group [11]. KEY POINTS:: · consensus-based reporting templates. · template for the structured reporting of MRI examinations of patients with multiple sclerosis. · structured reporting might facilitate communication between neuroradiologists and referring disciplines. CITATION FORMAT: · Riederer I, Mühlau M, Wiestler B et al. Structured Reporting in Multiple Sclerosis - Consensus-Based Reporting Templates for Magnetic Resonance Imaging of the Brain and Spinal Cord. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1867-3942.Aufgrund technischer Entwicklungen und der breiteren Verfügbarkeit von Geräten der Bildgebung nimmt die Zahl an neuroradiologischen Untersuchungen stetig zu [1]. Mit steigender Bildqualität und Sensitivität können zusätzlich mehr Details erkannt werden, sodass auch die Befundung komplexer und zeitaufwendiger wird. Gleichzeitig erlauben zuverlässige Algorithmen auch vermehrt quantitative Bildanalysen, die standardisiert in Befunde integriert werden sollten. Mit zunehmender Digitalisierung nimmt außerdem der persönliche Austausch zwischen den Neuroradiologen und zuweisenden Disziplinen ab, wodurch die Kommunikation erschwert wird. Um weiterhin die gewohnten Qualitätsstandards der neuroradiologischen Befunde gewährleisten zu können, ist daher die Einführung der strukturierten Befundung wünschenswert, die auf die jeweilige spezifische Erkrankung und Fragestellung zugeschnitten sein muss [2, 3] und mindestens der zweiten Stufe entsprechend der Definition der Deutschen Röntgengesellschaft entsprechen sollte (https://www.befundung.drg.de/de-DE/2908/strukturierte-befundung/). Zu den Vorteilen der strukturierten Befundung gehört eine Arbeitserleichterung für die Neuroradiologen sowie ein Informationsgewinn für den Zuweiser. Eine vollständige und standardisierte Liste mit relevanten Details für die Bildbefundung werden den Neuroradiologen auf dem jeweils aktuellen Wissenstand zur Verfügung gestellt, wodurch dem Vergessen wichtiger Punkte vorgebeugt wird [4]. Zusätzlich sind eine Zeitersparnis und Effizienzsteigerung bei der Befundung festgestellt worden [5]. Ein weiterer Vorteil liegt in der Klarheit und Konstanz des Befundes sowie in der besseren Vergleichbarkeit in Verlaufsuntersuchungen, die unabhängig vom jeweiligen Befundstil der Neuroradiologen sind. Dadurch wird die Kommunikation mit den zuweisenden Disziplinen verbessert und die klinische Entscheidungsfindung wesentlich erleichtert [6, 7]. Obwohl diese Vorteile deutlich überwiegen, sollten potenzielle Nachteile, wie die Reduzierung der Autonomie in der Befunderstellung und die inadäquate Abdeckung aller relevanten Einzelheiten und ggf. von nicht mit der Hauptpathologie assoziierten Nebenbefunden in komplexen Fällen oder bei seltenen Erkrankungen, bedacht werden [4]. Daher sind weiterhin Studien erforderlich, die die Vorteile der strukturierten Befundung untersuchen, die Einführung dieses Systems in den klinischen Alltag fördern und die Akzeptanz bei den Neuroradiologen erhöhen. Auf der Website www.befundung.drg.de sind bereits zahlreiche spezifische Vorlagen für die strukturierte Befundung vorhanden, wie z. B. zu Erkrankungen aus dem Bereich der Kardiologie und Onkologie. Die Multiple Sklerose (MS) ist eine idiopathische chronisch-entzündliche und neurodegenerative Erkrankung des zentralen Nervensystems und die häufigste nicht traumatisch bedingte entzündliche neurologische Erkrankung bei jungen Erwachsenen und daher von bedeutender individueller, aber auch sozioökonomischer Relevanz [8]. Die Magnetresonanztomografie (MRT) spielt bei dieser Erkrankung eine bedeutende Rolle bei der Diagnose, Prognoseabschätzung und Verlaufsbeurteilung. Die Diagnosekriterien haben als zentrale Diagnostik die MRT verankert, sodass praktisch alle Patienten mit einer gesicherten MS-Diagnose spezifische Veränderungen im MRT aufweisen [9]. Bei der Befundung von MRT-Datensätzen des Gehirns und des Rückenmarks von Patienten mit einer MS werden die Bilder hinsichtlich der Fragestellung untersucht, ob die Diagnosekriterien der sogenannten im Jahr 2017 revidierten McDonald-Kriterien [10] erfüllt sind, welche die zeitliche und räumliche Dissemination klinisch, aber auch kernspintomografisch nach den Empfehlungen der MAGNIMS-Gruppe [11, 12] definieren. Eine genauere Definition der Läsionstypen und -lokalisationen gemäß den Empfehlungen einer internationalen Expertengruppe [13] wird im Zusatzmaterial erläutert. Signalauffälligkeiten im Myelon zeigen sich in bis zu 92 % der MS-Patienten [14–16] und sind vor allem im zervikalen Myelon lokalisiert [15]. Die 2021 erschienenen Empfehlungen der MAGNIMS–CMSC–NAIMS Arbeitsgruppe [11] empfehlen auch explizit die Verwendung einer strukturierten Befundung für MS-Patienten.Daher wurde in einem Konsensverfahren im Rahmen des BMBF geförderten DIFUTURE-Konsortiums interdisziplinär mit neuroradiologischen und neurologischen Experten in Übereinstimmung mit den oben genannten aktuellen Empfehlungen [11] eine Befundvorlage für die Beurteilung von magnetresonanztomografischen Untersuchungen des Gehirns und Rückenmarks von Patienten mit MS erstellt und zur möglichst breiten Anwendung zur Verfügung gestellt (https://github.com/DRGagit/ak_befundung). Es soll dadurch eine effiziente und vollständige Beurteilung von Patienten mit MS in der Primärdiagnostik und der Verlaufsbildgebung ermöglicht werden. Diese Befundvorlagen sind als konsensbasierte Empfehlung anzusehen und besitzen keinen Anspruch auf Allgemeingültigkeit oder gar Vollständigkeit. Die AG für Informationstechnologie (@GIT) der DRG und die DGNR sind bestrebt, die hier vorgestellten Befundvorlagen bei neuen Forschungserkenntnissen oder Empfehlungen der MAGNIMS-CMSC-NAIMS-Gruppe [11] auf dem jeweils aktuellen Stand zu halten. KERNAUSSAGEN:: · Konsensbasierte Befundvorlage. · Vorschlag einer strukturierten Befundung für die Beurteilung von MRT-Untersuchungen von Patienten mit Multipler Sklerose. · Die strukturierte Befundung kann die Kommunikation zwischen Neuroradiologen und Zuweisern erleichtern. ZITIERWEISE: · Riederer I, Mühlau M, Wiestler B et al. Structured Reporting in Multiple Sclerosis – Consensus-Based Reporting Templates for Magnetic Resonance Imaging of the Brain and Spinal Cord. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1867-3942.

BACKGROUND Validation of the 2016 LANO MRI scorecard for leptomeningeal metastasis failed for multiple reasons. The objective of this joint EORTC Brain Tumor Group and RANO effort was to validate the feasibility of the revised MRI scorecard for assessing response in leptomeningeal metastasis. METHODS Coded paired cerebrospinal MRI of 20 patients with leptomeningeal metastases from solid cancers at baseline and follow-up after treatment and instructions for assessment were provided via the EORTC imaging platform. The kappa coefficient (K) was used to evaluate inter-observer pairwise agreement. Statistical analyses were performed using SAS V9.4 software (Cary, NC). The sponsor of the study was the University Hospital Zurich (2018-00192). RESULTS Thirty-five raters participated, including 9 neuroradiologists, 17 neurologists, 4 radiation oncologists, 3 neurosurgeons and 2 medical oncologists. Among leptomeningeal metastases-related items at baseline, the best median concordance was noted for hydrocephalus (K=0.63), and the worst median for spinal linear enhancing disease (K=0.46). The median concordance for overall response was moderate (K=0.44). Notably, the interobserver agreement for the presence of parenchymal brain metastases at baseline was minimal (K=0.29). Significant differences were observed when considering the specialty of the raters. Only 394 of 700 ratings (56%) were fully completed. Among 394 fully completed ratings, perfect concordance was noted in 293 ratings (74%) when comparing the overall response according to the guidelines provided in the scorecard and the overall response provided by the raters. The main discordances were noted for partial response according to the rater versus stable disease according to the guidelines (n=44), followed by progression according to the raters versus stable disease according to the guidelines (n=23). CONCLUSION Electronic case report forms with "blocking solutions" are probably required to enforce completeness and quality of scoring. These results confirm the necessity of central review and the need for training of MRI assessment in clinical trials.

There are a multitude of application possibilities of artificial intelligence (AI) and structured reporting (SR) in radiology. The number of scientific publications have continuously increased for many years. There is an extensive portfolio of available AI algorithms for, e.g. automatic detection and preselection of pathologic patterns in images or for facilitating the reporting workflows. Even machines already use AI algorithms for improvement of operating comfort.The use of SR is essential especially for the extraction of automatically evaluable semantic data from radiology results reports. Regarding eligibility in certification processes, the use of SR is mandatory for the accreditation of the German Cancer Society as an oncological center or outside Germany, such as the European Cancer Center.The data from SR can be automatically evaluated for the purpose of patient care, research and educational purposes and quality assurance. Lack of information and a high degree of variability often hamper the extraction of valid information from free-text reports using neurolinguistic programming (NLP). Against the background of supervised training, AI algorithms or k‑nearest neighbors (KNN) require a considerable amount of validated data. The semantic data from SR can also be processed by AI and used for training.The AI and SR are separate entities within the field of radiology with mutual dependencies and significant added value. Both have a high potential for profound upcoming changes and further developments in radiology.HINTERGRUND: Es gibt vielfältige Anwendungsmöglichkeiten der strukturierten Befundung („structured reporting“, SR) und der künstlichen Intelligenz (KI) in der Radiologie. Die Anzahl der wissenschaftlichen Publikationen steigt seit vielen Jahren kontinuierlich. Es existiert ein umfangreiches Portfolio verfügbarer KI-Algorithmen, die z. B. für die automatisierte Detektion und Vorselektion von Pathologien oder für die Erleichterung von Arbeitsabläufen innerhalb des Befundungsworkflows angeboten werden. Auch Geräte nutzen bereits KI-Algorithmen für die Verbesserung des Bedienungskomforts.Die SR ist insbesondere für die Erfassung von maschinell auswertbaren, semantischen Daten aus radiologischen Befundberichten erforderlich. Vor dem Hintergrund von Zertifizierungsprozessen ist ihre Verwendung bereits Voraussetzung für die Akkreditierung der Deutschen Krebsgesellschaft als onkologisches Zentrum oder außerhalb Deutschlands als European Cancer Centre.Die mittels SR erfassten Daten können maschinell zu Zwecken der Patientenversorgung, Forschung, Lehre und Qualitätssicherung ausgewertet werden. Die Extraktion valider Informationen aus Befundberichten in Prosaform mittels NLP (neurolinguistisches Programmieren) ist aufgrund der großen Variabilität und v. a. fehlender Informationen deutlich erschwert. Vor dem Hintergrund des überwachten Lernens werden für das Training von KI-Algorithmen oder KNN („k-nearest neighbours“) große Mengen validierter Daten benötigt. Auch die semantischen Daten aus strukturierten Befundberichten können von KI verarbeitet und zum Training verwendet werden.KI und SR stellen somit Entitäten eines Kontinuums innerhalb der Radiologie dar, die sich zum Teil gegenseitig bedingen und vor allem sinnvoll ergänzen. Beide haben in diesem Feld ein großes Potenzial für tiefgreifende, anstehende Veränderungen und Weiterentwicklungen.

Conclusions: Meningiomas with histopathological CNS invasion show a higher proliferative activity.

Purpose: To investigate the diagnostic performance of in vivo ADC-based stratification of integrated molecular glioma grades. Materials and methods: Ninety-seven patients with histopathologically confirmed glioma were evaluated retrospectively. All patients underwent pre-interventional MRI-examination including diffusion-weighted imaging (DWI) with implemented b-values of 500, 1000, 1500, 2000, and 2500 s/mm2. Apparent Diffusion Coefficient (ADC), Mean Kurtosis (MK), and Mean Diffusivity (MD) maps were generated. The average values were compared among the molecular glioma subgroups of IDH-mutant and IDH-wildtype astrocytoma, and 1p/19q-codeleted oligodendroglioma. One-way ANOVA with post-hoc Games-Howell correction compared average ADC, MD, and MK values between molecular glioma groups. A Receiver Operating Characteristic (ROC) analysis determined the area under the curve (AUC). Results: Two b-value-dependent ADC-based evaluations presented statistically significant differences between the three molecular glioma sub-groups (p &lt, 0.001, respectively). Conclusions: High-b-value ADC from preoperative DWI may be used to stratify integrated molecular glioma subgroups and save time compared to diffusion kurtosis imaging. Higher b-values of up to 2500 s/mm2 may present an important step towards increasing diagnostic accuracy compared to standard DWI protocol.

The expression of somatostatin receptors in meningioma is well established. First, suggestions of a prognostic impact of SSTRs in meningioma have been made. However, the knowledge is based on few investigations in small cohorts. We recently analyzed the expression of all five known SSTRs in a large cohort of over 700 meningiomas and demonstrated significant correlations with WHO tumor grade and other clinical characteristics. We therefore expanded our dataset and additionally collected information about radiographic tumor recurrence and progression as well as clinically relevant factors (gender, age, extent of resection, WHO grade, tumor location, adjuvant radiotherapy, neurofibromatosis type 2, primary/recurrent tumor) for a comprehensive prognostic multivariate analysis (n = 666). The immunohistochemical expression scores of SSTR1, 2A, 3, 4, and 5 were scored using an intensity distribution score ranging from 0 to 12. For recurrence-free progression analysis, a cutoff at an intensity distribution score of 6 was used. Univariate analysis demonstrated a higher rate of tumor recurrence for increased expression scores for SSTR2A, SSTR3, and SSTR4 (p = 0.0312, p = 0.0351, and p = 0.0390, respectively), while high expression levels of SSTR1 showed less frequent tumor recurrences (p = 0.0012). In the Kaplan-Meier analysis, a higher intensity distribution score showed a favorable prognosis for SSTR1 (p = 0.0158) and an unfavorable prognosis for SSTR2A (0.0143). The negative prognostic impact of higher SSTR2A expression remained a significant factor in the multivariate analysis (RR 1.69, p = 0.0060). We conclude that the expression of SSTR2A has an independent prognostic value regarding meningioma recurrence.

Most meningiomas are slow growing tumors arising from the arachnoid cap cells and can be cured by surgical resection or radiation therapy in selected cases. However, recurrent and aggressive cases are also quite common and challenging to treat due to no established treatment alternatives. Assessment of the risk of recurrence is therefore of utmost importance and several prognostic clinical and molecular markers have been established. Additionally, the identification of invasive growth of meningioma cells into CNS tissue was demonstrated to lead to a higher risk of recurrence and was therefore integrated into the WHO classification of CNS tumors. However, the evidence for its prognostic impact has been questioned in subsequent studies and its exclusion from the next WHO classification proposed. We were recently able to show the prognostic impact of CNS invasion in a large comprehensive retrospective meningioma cohort including other established prognostic factors. In this review we discuss the growing experiences that have been gained on this matter, with a focus on the currently nonuniform histopathological assessment, imaging characteristics and intraoperative sampling as well as the overall outlook on the future role of this potential prognostic factor.

BackgroundThe novel advanced modeled iterative reconstruction (ADMIRE) algorithm in ultra-high-resolution (UHR) computed tomography (CT) of the temporal bone has not yet been systematically evaluat...

Purpose: This study aimed to assess the relationship between mean kurtosis (MK) and mean diffusivity (MD) values from whole-brain diffusion kurtosis imaging (DKI) parametric maps in preoperative magnetic resonance (MR) images from 2016 World Health Organization Classification of Tumors of the Central Nervous System integrated glioma groups. Methods: Seventy-seven patients with histopathologically confirmed treatment-naïve glioma were retrospectively assessed between 1 August 2013 and 30 October 2017. The area on scatter plots with a specific combination of MK and MD values, not occurring in the healthy brain, was labeled, and the corresponding voxels were visualized on the fluid-attenuated inversion recovery (FLAIR) images. Reversely, the labeled voxels were compared to those of the manually segmented tumor volume, and the Dice similarity coefficient was used to investigate their spatial overlap. Results: A specific combination of MK and MD values in whole-brain DKI maps, visualized on a two-dimensional scatter plot, exclusively occurs in glioma tissue including the perifocal infiltrative zone and is absent in tissue of the normal brain or from other intracranial compartments. Conclusions: A unique diffusion signature with a specific combination of MK and MD values from whole-brain DKI can identify diffuse glioma without any previous segmentation. This feature might influence artificial intelligence algorithms for automatic tumor segmentation and provide new aspects of tumor heterogeneity.

Calvarial lesions are rare and can present as a variety of different diseases. The lesions can be palpable on the skin and cause local pain and paraesthesia and, depending on the location, neurological deficits can also occur. This research aims to present an overview of typical imaging features as well as neurosurgical management. We examined the charts of patients who underwent surgery on a calvarial lesion in our department between 2004 and 2017 (n=133). Retrospectively, the pre-, intra-, and postoperative data were analyzed with morphological and histological findings and compared with each other. Pain, swelling, cosmetically disturbing, and neurological deficits were the main complaints. Seventy-seven lesions were limited to the bone, while another 56 lesions showed an infiltrating growth in the adjacent tissue. Depending on the clinical signs and suspected diagnosis, a biopsy, a partial removal, or a complete resection was performed. Histiocytosis (n=20), meningiomas (n=20), metastases (n=19), and osteomas (n=16) were the most common lesions. Fibrous dysplasia (n=6) and intraosseous hemangioma (n=9) were less common; other lesions were present only in isolated cases. Imaging features may suggest the lesion to be benign or malignant, but the diagnosis can be only confirmed by histological examination. The surgical strategy depends on the complaints, location of the lesion, and suspected diagnosis. Adjuvant treatment should be initiated according to the histological findings.

Rationale and Objectives: Advanced adjuvant therapy of diffuse gliomas can result in equivocal findings in follow-up imaging. We aimed to assess the additional value of dynamic susceptibility perfusion imaging in the differentiation of progressive disease (PD) from pseudoprogression (PsP) in different molecular glioma subtypes. Materials and Methods: 89 patients with treated diffuse glioma with different molecular subtypes (IDH wild type (Astro-IDHwt), IDH mutant astrocytomas (Astro-IDHmut) and oligodendrogliomas), and tumor-suspect lesions on post-treatment follow-up imaging were classified into two outcome groups (PD or PsP) retrospectively by histopathology or clinical follow-up. The relative cerebral blood volume (rCBV) was assessed in the tumor-suspect FLAIR and contrast-enhancing (CE) lesions. We analyzed how a multilevel classification using a molecular subtype, the presence of a CE lesion, and two rCBV histogram parameters performed for PD prediction compared with a decision tree model (DTM) using additional rCBV parameters. Results: The PD rate was 69% in the whole cohort, 86% in Astro-IDHwt, 52% in Astro-IDHmut, and 55% in oligodendrogliomas. In the presence of a CE lesion, the PD rate was higher with 82%, 94%, 59%, and 88%, respectively, if there was no CE lesion, however, the PD rate was only 44%, 60%, 40%, and 33%, respectively. The additional use of the rCBV parameters in the DTM yielded a prediction accuracy for PD of 99%, 100%, 93%, and 95%, respectively. Conclusion: Utilizing combined information about the molecular tumor type, the presence or absence of CE lesions and rCBV parameters increases PD prediction accuracy in diffuse glioma.

Die bei der Umformung der Gesichtswulste entstandenen beiden Riechgruben werden zu den primaren Nasenhohlen umgestaltet; die Riechgruben wachsen zunachst nach dorsokaudal und sind durch die Membrana buccopharyngea (Oronasalmembran) von der Mundhohle getrennt.

Schallwellen mit einer Frequenz zwischen 16 kHz und 1 GHz (diagnostisch gebrauchlich sind Frequenzen zwischen 3 und 10 MHz) werden von einem Sender durch Materie gesandt, regen die Materie zu Schwingungen an und werden an Grenzflachen (Dichteunterschiede) anteilig reflektiert („Echo“; wird von einem Empfanger detektiert und in ein Bildsignal umgewandelt).

Osophagus entwickelt sich aus: entodermalen Anteilen: Epithel der Schleimhaut, Gll. oesophageae mesodermalen Anteilen: Submukosa, die verschiedenen Muskelschichten, Adventitia

Die Gestalt der Lippen geht auf die Herkunft aus verschiedenen Gesichtswulsten zuruck (4. Embryonalwoche).

Die obere Halfte des Zungenbeins inkl. kleines Zungenbeinhorn gehen aus dem 2. Kiemenbogen (Hyoidbogen, Reichert-Knorpel) hervor.

Die Speicheldrusen entstehen in der 6. und 7. Embryonalwoche als Epithelsprossen aus der ektodermalen Mundbucht.

Structured reporting is an essential step in establishing standardized quality standards in diagnostic radiology. The German Society of Radiology and the German Society of Neuroradiology aim to provide templates for the structured reporting of different radiological examinations. The Information Technology working group of the German Society of Radiology developed structured templates for the radiological reporting of different indications in consensus with specialist support by experts. We present a template for the structured reporting of examinations of patients with acute ischemic stroke by non-contrast computed tomography, CT angiography, and CT perfusion. This template is provided on the website www.befundung.drg.de for free use. Implementation of the structured template may increase quality and provide a minimum standard for radiological reports in patients with acute ischemic stroke.· The German Society of Radiology and the German Society of Neuroradiology are providing support for the development of structured templates in German.. · We present a template for the structured reporting of examinations of patients with acute ischemic stroke by non-contrast computed tomography, CT angiography, and CT perfusion. This template is provided on the website www.befundung.drg.de for free use.. · Implementation of the structured template may increase quality and provide a minimum standard for radiological reports in patients with acute ischemic stroke..· Brendle C, Bender B, Selo N et al. Structured Reporting of Acute Ischemic Stroke - Consensus-Based Reporting Templates for Non-Contrast Cranial Computed Tomography, CT Angiography, and CT Perfusion. Fortschr Röntgenstr 2021; 193: 1315 - 1317. Die strukturierte Befundung ist ein wichtiger Bestandteil zur Verbesserung des Qualitätsstandards in der radiologischen Diagnostik. Die Deutsche Röntgengesellschaft und die Deutsche Gesellschaft für Neuroradiologie sind bestrebt, der Fachöffentlichkeit standardisierte Befundvorlagen für spezifische Fragestellungen zur Verfügung zu stellen. Die AG Informationstechnologie der Deutschen Röntgengesellschaft hat in Zusammenarbeit mit fachspezifischen Experten im Konsensverfahren Befundvorlagen für verschiedene radiologische Fragestellungen erarbeitet. Die hier vorgestellte strukturierte Befundvorlage zur computertomografischen Akutdiagnostik des ischämischen Schlaganfalls mittels nativer Computertomografie (CT), CT-Angiografie und CT-Perfusion wird online unter www.befundung.drg.de in einer frei zugänglichen Datenbank zur Verfügung gestellt und kann über strukturierte-befundung@drg.de bzw. https://github.com/DRGagit/ak_befundung kommentiert werden. Der Einsatz der strukturierten Befundvorlage soll einen Beitrag zur Steigerung der Qualität radiologischer Befunde und die Einhaltung eines Mindeststandards bei der Akutdiagnostik des Schlaganfalls leisten.· Die Deutsche Röntgengesellschaft (DRG) und die Deutsche Gesellschaft für Neuroradiologie (DGNR) fördern die deutschsprachige Entwicklung strukturierter Befundvorlagen.. · Die strukturierte Befundvorlage zur computertomografischen Akutdiagnostik des ischämischen Schlaganfalls mittels nativer Computertomografie (CT), CT-Angiografie und CT-Perfusion wird online unter www.befundung.drg.de frei zugänglich zur Verfügung gestellt.. · Der Einsatz der strukturierten Befundvorlage soll einen Beitrag zur Steigerung der Qualität radiologischer Befunde und die Einhaltung eines Mindeststandards bei der Akutdiagnostik des Schlaganfalls leisten..· Brendle C, Bender B, Selo N et al. Structured Reporting of Acute Ischemic Stroke – Consensus-Based Reporting Templates for Non-Contrast Cranial Computed Tomography, CT Angiography, and CT Perfusion. Fortschr Röntgenstr 2021; 193: 1315 – 1317.

Der VII. Hirnnerv hat als Nerv des 2. Kiemenbogens (Hyoidbogen, Reichert-Knorpel) 2 Anteile: N. facialis, N. intermedius → Bezeichnung als N. facialis oder N. intermediofacialis Der N. facialis innerviert die mimische Muskulatur und andere aus dem 2. Kiemenbogen hervorgegangene Muskeln Verlauf des N. facialis: Kerngebiet in der Rautengrube → Wurzelfasern winden sich um den Kern des VI. Hirnnervs (inneres Fazialisknie) → Austritt im Kleinhirnbruckenwinkel → Eintritt in das Felsenbein durch Porus und Meatus acusticus internus (zusammen mit VIII. Hirnnerv) → horizontaler Verlauf bis zum Ggl. geniculi (auseres Fazialisknie) → Abknickung nach kaudal → weiterer Verlauf im knochernen Fazialiskanal (Canalis Fallopii) der medialen Paukenhohlenwand → Austritt am Foramen stylomastoideum N. intermedius fuhrt die sensorischen, sensiblen und parasympathischen Anteile des 2. Kiemenbogennervs

26. Tag: Entwicklung des unteren Respirationstrakts nach Auftreten einer Furche (Laryngotrachealrinne) am Boden des Vorderdarms

Identification and localization of ischemic stroke (IS) lesions is routinely performed to confirm diagnosis, assess stroke severity, predict disability and plan rehabilitation strategies using magnetic resonance imaging (MRI). In basic research, stroke lesion segmentation is necessary to study complex peri-infarction tissue changes. Moreover, final stroke volume is a critical outcome evaluated in clinical and preclinical experiments to determine therapy or intervention success. Manual segmentations are performed but they require a specialized skill set, are prone to inter-observer variation, are not entirely objective and are often not supported by histology. The task is even more challenging when dealing with large multi-center datasets, multiple experimenters or large animal cohorts. On the other hand, current automatized segmentation approaches often lack histological validation, are not entirely user independent, are often based on single parameters, or in the case of complex machine learning methods, require vast training datasets and are prone to a lack of model interpretation. Methods: We induced IS using the middle cerebral artery occlusion model on two rat cohorts. We acquired apparent diffusion coefficient (ADC) and T2-weighted (T2W) images at 24 h and 1-week after IS induction. Subsets of the animals at 24 h and 1-week post IS were evaluated using histology and immunohistochemistry. Using a Gaussian mixture model, we segmented voxel-wise interactions between ADC and T2W parameters at 24 h using one of the rat cohorts. We then used these segmentation results to train a random forest classifier, which we applied to the second rat cohort. The algorithms' stroke segmentations were compared to manual stroke delineations, T2W and ADC thresholding methods and the final stroke segmentation at 1-week. Volume correlations to histology were also performed for every segmentation method. Metrics of success were calculated with respect to the final stroke volume. Finally, the trained random forest classifier was tested on a human dataset with a similar temporal stroke on-set. Manual segmentations, ADC and T2W thresholds were again used to evaluate and perform comparisons with the proposed algorithms' output. Results: In preclinical rat data our framework significantly outperformed commonly applied automatized thresholding approaches and segmented stroke regions similarly to manual delineation. The framework predicted the localization of final stroke regions in 1-week post-stroke MRI with a median Dice similarity coefficient of 0.86, Matthew's correlation coefficient of 0.80 and false positive rate of 0.04. The predicted stroke volumes also strongly correlated with final histological stroke regions (Pearson correlation = 0.88, P < 0.0001). Lastly, the stroke region characteristics identified by our framework in rats also identified stroke lesions in human brains, largely outperforming thresholding approaches in stroke volume prediction (P

The underlying etiology of ischemic stroke remains unknown in up to 30% of patients.Objectives: This study explored the causal role of complicated (American Heart Association-lesion type VI) nonstenosing carotid artery plaques (CAPs) in cryptogenic stroke (CS).Methods: CAPIAS (Carotid Plaque Imaging in Acute Stroke) is an observational multicenter study that prospectively recruited patients aged older than 49 years with acute ischemic stroke that was restricted to the territory of a single carotid artery on brain magnetic resonance imaging (MRI) and unilateral or bilateral CAP (≥2 mm, NASCET [North American Symptomatic Carotid Endarterectomy Trial]

The use of dynamic susceptibility contrast (DSC) perfusion and 11C-methionine positron emission tomography (MET-PET) for glioma grading is currently not standardized. The purpose of this study was to identify regions of interest (ROIs) that enable the best performance and clinical applicability in both methods, as well as to evaluate the complementarity of DSC perfusion and MET-PET in spatial hotspot definition. In 41 patient PET/MRI datasets, different ROIs were drawn: in T2-hyperintense tumour, in T2-hyperintense tumour and adjacent oedema and in tumour areas with contrast enhancement, altered perfusion or pathological radiotracer uptake. The performance of DSC perfusion and MET-PET using the different ROIs to distinguish high- and low-grade gliomas was assessed. The spatial overlap of hotspots identified by DSC perfusion and MET-PET was assessed visually. ROIs in T2 fluid attenuated inversion recovery (FLAIR) sequence-hyperintense tumour revealed the most significant differences between high- and low-grade gliomas and reached the highest diagnostic performance in both DSC perfusion (p = 0.046; area under the curve = 0.74) and MET-PET (p = 0.007; area under the curve = 0.80). The combination of methods yielded an area under the curve of 0.80. Hotspots were completely overlapped in one half of the patients, partially overlapped in one third of the patients and present in only one method in approximately 20% of the patients. For multi-parametric examinations with DSC perfusion and MET-PET, we recommend an ROI definition based on T2-hyperintense tumour. DSC perfusion and MET-PET contain complementary information concerning the spatial hotspot definition.

Purpose To assess the diagnostic performance of normalized and non-normalized diffusion kurtosis imaging (DKI) metrics extracted from different tumor volume data for grading glioma according to the integrated approach of the revised 2016 WHO classification. Materials and methods Sixty patients with histopathologically confirmed glioma, who provided written informed consent, were retrospectively assessed between 01/2013 and 08/2016 from a prospective trial approved by the local institutional review board. Mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were assessed by two blinded physicians from four different volumes of interest (VOI): whole solid tumor including (VOI tu-ed ) and excluding perifocal edema (VOI tu ), infiltrative zone (VOI ed ), and single slice of solid tumor core (VOI slice ). Intra-class correlation coefficient (ICC) was calculated to assess inter-rater agreement. One-way ANOVA was used to compare MK between 2016 CNS WHO tumor grades. Friedman's test compared MK and MD of each VOI. Spearman's correlation coefficient was used to correlate MK with 2016 CNS WHO tumor grades. ROC analysis was performed on MK for significant results. Results The MK assessment showed excellent inter-rater agreement for each VOI (ICC, 0.906–0.955). MK was significantly lower in IDH mutant astrocytoma (0.40 ± 0.07), than in 1p/19q-confirmed oligodendroglioma (0.54 ± 0.10, P = 0.001) or IDH wild-type glioblastoma (0.68 ± 0.13, P tu-ed , r = 0.684; VOI tu , r = 0.734; VOI ed , r = 0.625; VOI slice , r = 0.698; P Conclusions Non-normalized MK values obtained from VOI tu and VOI slice showed the best reproducibility and highest diagnostic performance for stratifying glioma according to the integrated approach of the recent 2016 WHO classification.

The updated 2016 CNS World Health Organization classification differentiates three main groups of diffuse glioma according to their molecular characteristics: astrocytic tumors with and without isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deleted oligodendrogliomas. The present study aimed to determine whether dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) is an independent prognostic marker within the molecular subgroups of diffuse glioma.Fifty-six patients with treatment-naive gliomas and advanced preoperative MRI examination were assessed retrospectively. The mean and maximal normalized cerebral blood volume values from DSC-MRI within the tumors were measured. Optimal cutoff values for the 1-year progression-free survival (PFS) were defined, and Kaplan-Meier analyses were performed separately for the three glioma subgroups.IDH wild-type astrocytic tumors had a higher mean and maximal perfusion than IDH-mutant astrocytic tumors and oligodendrogliomas. Patients with IDH wild-type astrocytic tumors and a low mean or maximal perfusion had a significantly shorter PFS than patients of the same group with high perfusion (p = 0.0159/0.0112). Furthermore, they had a significantly higher risk for early progression (hazard ratio = 5.6/5.1). This finding was independent of the methylation status of O6-methylguanin-DNA-methyltransferase and variations of the therapy. Within the groups of IDH-mutant astrocytic tumors and oligodendrogliomas, the PFS of low and highly perfused tumors did not differ.High perfusion upon initial diagnosis is not compellingly associated with worse short-term prognosis within the different molecular subgroups of diffuse glioma. Particularly, the overall highly perfused group of IDH wild-type astrocytic tumors contains tumors with low perfusion but unfavorable prognosis.

To evaluate arterial spin labeling (ASL) perfusion and dynamic contrast-enhanced (DCE) perfusion in glioma grading according to the previous WHO classification of 2007, as well as concerning isocitrate dehydrogenase (IDH) mutation status and ATRX expression as required by the new WHO 2016 brain tumor classification.The mean values of Ktrans, Kep, Ve, and Vp by DCE perfusion, and cerebral blood flow (CBF) by ASL perfusion were assessed retrospectively in 40 patients with initial glioma diagnosis. Perfusion parameters were correlated and compared concerning glioma grading, IDH mutation status and ATRX expression.The DCE and ASL perfusion parameters showed merely moderate correlation. The Ktrans, Ve, and CBF by DCE perfusion were different in low-grade and high-grade gliomas (p = 0.0018, p 0.0001, and p = 0.0038, respectively). Ve was useful in distinguishing high-grade from low-grade gliomas (p = 0.024, sensitivity = 1.00, specificity = 0.80). CBF by ASL perfusion enabled discrimination of astrocytomas with and without IDH mutation (p = 0.014, sensitivity = 0.75, specificity = 0.88) and showed a trend for the discrimination of astrocytomas with IDH mutation from oligodendrogliomas (p = 0.074).In conclusion, DCE and ASL perfusion are complementary in the differentiation of gliomas. The discrimination of low- and high-grade gliomas is possible by the DCE perfusion parameter Ve, while ASL perfusion shows potential for the differentiation of the IDH and ATRX mutation status of gliomas following the new WHO classification 2016. Both perfusion techniques might represent different aspects of brain tumor perfusion.

Objective Meningeal melanocytomas of the central nervous system are extremely rare, with an incidence of 1 per 10 million individuals. Cases of primary cerebellopontine angle melanocytoma (PCPAM) have only been described in single case reports. The goal of the present study was to analyze the surgical management of PCPAM, with a particular focus on early and late treatment outcomes and recurrence rates. Methods The patients who had undergone surgery for PCPAM from January 2004 to May 2018 were identified by a local database query. The patients were evaluated for initial symptoms, pre- and postoperative facial and cochlear nerve function, complications, and recurrence rate by reviewing the patients' medical records. Results We identified 4 patients with PCPAM of >1500 cerebellopontine angle lesions (∼0.2%) that had been surgically treated at our department in the past 14 years. Of the 4 patients, 2 were men and 2 were women, with a mean age of 47 years. Anatomical facial and cochlear nerve preservation was achieved in all 4 patients. One patient experienced a new moderate facial palsy immediately after surgery (House-Brackmann grade III). Of the 4 patients, 3 had undergone radiotherapy and 1 had undergone ion beam therapy for tumor recurrence (6 years after surgery). Of the 4 patients, 3 had presented with tumor recurrence at 2, 3, and 6 years of follow-up respectively. The long-term follow-up examination had not yet been conducted for 1 patient. Conclusions At long-term follow-up, 3 patients had developed recurrence. Because of the high recurrence rate of PCPAM, we believe that radiotherapy in addition to surgery should be considered in the future to avoid early recurrence.