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Background Conventional MR imaging has limited value in identifying H3 K27M mutations. We aimed to investigate the capacity of quantitative MR imaging variables in identifying the H3 K27M mutation status of diffuse midline glioma. Materials and Methods Twenty‐three patients with H3 K27M mutation and thirty‐two wild‐type patients were recruited in this retrospective study, all of whom underwent multimodal MR imaging. Clinical data and quantitative MR imaging variables were explored by subgroup analysis stratified by age (juveniles and adults). Then, a logistic model for all patients was constructed to identify potential variables for predicting K27M mutation status. Besides, a retrospective validation set including 13 patients was recruited. The C‐index and F1 score were used to evaluate the performance of the prediction model. Results It turned out that patients with H3 K27M mutation were younger in the adult subgroup. In the mutation group, some relative apparent diffusion coefficient (rADC) histogram parameters and myo‐inositol/creatine plus phosphocreatine (Ins/tCr) ratio were lower than in the wild‐type group of both juveniles and adults (p

Background Conventional MRI cannot be used to identify H3 K27M mutation status. This study aimed to investigate the feasibility of predicting H3 K27M mutation status by applying an automated machine learning (autoML) approach to the MR radiomics features of patients with midline gliomas. Methods This single-institution retrospective study included 100 patients with midline gliomas, including 40 patients with H3 K27M mutations and 60 wild-type patients. Radiomics features were extracted from fluid-attenuated inversion recovery images. Prior to autoML analysis, the dataset was randomly stratified into separate 75% training and 25% testing cohorts. The Tree-based Pipeline Optimization Tool (TPOT) was applied to optimize the machine learning pipeline and select important radiomics features. We compared the performance of 10 independent TPOT-generated models based on training and testing cohorts using the area under the curve (AUC) and average precision to obtain the final model. An independent cohort of 22 patients was used to validate the best model. Results Ten prediction models were generated by TPOT, and the accuracy obtained with the best pipeline ranged from 0.788 to 0.867 for the training cohort and from 0.60 to 0.84 for the testing cohort. After comparison, the AUC value and average precision of the final model were 0.903 and 0.911 in the testing cohort, respectively. In the validation set, the AUC was 0.85, and the average precision was 0.855 for the best model. Conclusions The autoML classifier using radiomics features of conventional MR images provides high discriminatory accuracy in predicting the H3 K27M mutation status of midline glioma.

A woman with hypertension and hyperglycemia was diagnosed a metastatic brain carotid body paraganglioma. Her blood pressure, glucose, and norepinephrine were normal after craniotomy. Although most carotid body tumors are benign, a few show distant metastasis. This is the first reported case of intracerebral metastases from a carotid body tumor.

Non-Hodgkin's lymphomas (NHL) with intracranial origin are very rare and constitutes about 1-2% of primary central nervous system lymphomas (PCNSL). Diffuse large B cell lymphoma (DLBCL) is the most common subtype of NHL and mostly seen in immunocompromised patients. Therefore, the occurrence of giant solitary DLBCL in an immunocompetent patient is puzzling. We present a case of 68-year-old man who was admitted at our facility with a history of "hypomnesia of two (2) months" duration. Magnetic resonance imaging (MRI) revealed a space occupying lesion in the bilateral frontal lobe and corpus callosum measuring about 5.4cm * 4.6cm * 3.8cm with mixed signal intensities and vasogenic edema around the mass. Radiological, this mass was mistaken for meningioma until histopathological studies revealed DLBCL. Giant solitary primary intracranial lymphomas are very rare and can be mistake for meningioma even with very experience radiologist or neurosurgeon since the radiological features of PCNSL can be very unspecific. We achieved to total resection because of the giant and solitary nature of our case. The prognosis of PCNSL is general very poor when the patient is immunocompromised. In immunocompetent patients, who are well managed with surgery and chemotherapy, the overall survival and quality of life can very encouraging.Keywords: Lymphomas, meningioma, immunocompetent, intracranial, parenchyma

Objective To perform a survival analysis of human immunodeficiency virus (HIV)–patients with glioma and to assess the relationship between various prognostic factors and overall survival (OS). Methods We reported in detail the management and prognosis of 2 HIV-infected patients with glioma in our hospital and performed a quantitative and comprehensive systematic literature review of patients with HIV-associated glioma. We combined our treatment experience with retrospectively obtained treatment information and studied the survival time to statistically analyze whether age, sex, World Health Organization (WHO) grade, surgery, radiotherapy, chemotherapy, and combined radiotherapy and chemotherapy could predict patient survival. Result The study included 34 cases, including our own 2 cases. The median survival was 9 months. On survival analysis, among the aforementioned parameters, WHO grade (low-grade glioma/high-grade glioma), surgery (surgical resection/stereotactic biopsy), and radiotherapy showed a significant association with OS by univariate analysis. Multivariate analysis showed WHO grade and surgery were significant predictors of OS. Conclusions Most patients had astrocytoma or high-grade glioma. The median survival of all HIV-infected patients with gliomas was shorter than that of GBM patients with glioblastoma multiforme. Surgery and WHO grade were independent prognostic factors for OS.

To determine the diagnostic potential of apparent diffusion coefficient (ADC) and intravoxel incoherent motion (IVIM)-derived parameters for the differentiation of benign, intermediate, and malignant solid soft-tissue tumors.The Institutional Review Board approved this prospective study, and informed consent was obtained. IVIM imaging was performed in 64 patients including 44 benign, 6 intermediate, and 14 malignant solid soft-tissue tumors at 1.5T. The IVIM parameters of the soft-tissue tumors were assessed using the Kruskal-Wallis test. The diagnostic performance of the parameters was evaluated using receiver operating characteristic (ROC) analysis.The ADC and true diffusion coefficient (D) values of malignancies (1.28 ± 0.31, 1.06 ± 0.23 [×10IVIM imaging may be helpful for differentiating benign, intermediate, and malignant solid soft-tissue tumors.1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017;46:1611-1618.

A 5-year-old girl presented with an 8 × 10-cm dumbbell-shaped mass in her left occipitoparietal region (figure 1). A preoperative CT angiogram demonstrated a large subcutaneous mass with abundant blood vessels (figure 2A). MRI revealed a giant extracranial–intracranial space-occupying lesion (figure 2, B–D). After endovascular embolization, we resected the tumor (figure 2E). The postoperative pathologic diagnosis was primitive neuroectodermal tumor (figure 2F). Primitive neuroectodermal tumor extension to the brain is rare; imaging is not pathognomonic and requires confirmation by pathology. Early intervention is preferable.

A 46-year-old man presented with a 4-year history of headache and visual field defect. Physical examination revealed a large patch of pigmented skin with alopecia areata measuring 10 × 12 cm in the right occipitotemporal region (figure 1A). Imaging showed a large intracranial space-occupying mass (figure 1, B–D). Pitch-black, chocolate-like substance was found during the surgery (figure 2A). The wound was repaired using split-skin graft (figure 2B). Pathologic examination confirmed the diagnosis of pigmented nevus. Giant pigmented nevus is a congenital melanocytic lesion originating from the neural crest.1 Intracranial spread is extremely rare2 and may represent a malignant transformation.

It is recognized that expression of AQP4 protein is much greater in gliomas than in normal tissue. The relationship between AQP4 and glioma-associated brain edema is affected by osmotic pressure and hypoxia. In this study, we detected changes of AQP4 expression in tumor and peritumoral edematous tissues to analyze the relationship between AQP4 protein and the edema index (EI). We also detected expression of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor-1α (HIF-1α) to investigate their relationship with AQP4 protein, and thus to uncover the molecular biological mechanisms of AQP4 expression in glioma-associated brain edema. Sixty-five patients with brain glioma were divided into tumor and peritumor groups. Fresh tumor specimens, including six cases of grade I glioma, 18 of grade II, 11 of grade III and 30 of grade IV, and peritumoral edematous tissue specimens (1 cm distant from the tumor) were resected from these patients, and AQP4 protein expression levels were detected by western blot. Different AQP4 expression in the tumor and peritumor groups were compared. The relationship between AQP4 expression levels and the degree of peritumoral edema, and expression differences in different grades, were analyzed. Immunofluorescence cytochemistry was used to detect positive expression of AQP4 protein, VEGF protein, and HIF-1α protein in tumor tissue, and differences between expression were analyzed. Western blot showed that AQP4 expression in the peritumor (0.7697 ± 0.0941) and tumor (0.6934 ± 0.0625) groups was higher than in the control group (0.6215 ± 0.0884), and was highest in the peritumor group (both P0.01). AQP4 expression level in the peritumor group was positively correlated with EI (r = 0.677, P0.001) whereas AQP4 expression level in the tumor group was not correlated with EI (r = 0.096, P0.05). AQP4 expression increased with higher tumor grades in the peritumor group, but differences were not significant in the tumor group. Immunofluorescence cytochemical staining revealed that AQP4 protein in normal brain tissue was mainly expressed in the cell membrane surface, and that cytoplasm and nuclear staining was shallow. In glioma cells, AQP4 was widely distributed in the cytoplasm, particularly in the edematous area around the tumor. AQP4 protein expression in the tumor was significantly positively correlated with both VEGF protein (r = 0.877, P0.001) and HIF-1α protein (r = 0.876, P0.001). AQP4 expression was higher in brain tumor, especially peritumor. The degree of peritumoral edema correlates with AQP4 protein expression only in peritumor, whereas AQP4 expression is in accordance with expression of VEGF and HIF-1α. In glioma-associated brain edema, AQP4 is coregulated by osmotic pressure and hypoxia, with predominance of osmotic regulation, and is redistributed in glioma cells, mainly in the cytoplasm, and its expression level increased with higher glioma grades.

Radially encoded MR imaging (MRI) has gained increasing attention in applications such as hyperpolarized gas imaging, contrast-enhanced MR angiography, and dynamic imaging, due to its motion insensitivity and improved artifact properties. However, since the technique collects k-space samples nonuniformly, multidimensional (especially 3D) radially sampled MRI image reconstruction is challenging. The balance between reconstruction accuracy and speed becomes critical when a large data set is processed. Kaiser-Bessel gridding reconstruction has been widely used for non-Cartesian reconstruction. The objective of this work is to provide an alternative reconstruction option in high dimensions with on-the-fly kernels calculation. The work develops general multi-dimensional least square nonuniform fast Fourier transform (LS-NUFFT) algorithms and incorporates them into a k-space simulation and image reconstruction framework. The method is then applied to reconstruct the radially encoded k-space, although the method addresses general nonuniformity and is applicable to any non-Cartesian patterns. Performance assessments are made by comparing the LS-NUFFT based method with the conventional Kaiser-Bessel gridding method for 2D and 3D radially encoded computer simulated phantoms and physically scanned phantoms. The results show that the LS-NUFFT reconstruction method has better accuracy-speed efficiency than the Kaiser-Bessel gridding method when the kernel weights are calculated on the fly. The accuracy of the LS-NUFFT method depends on the choice of scaling factor, and it is found that for a particular conventional kernel function, using its corresponding deapodization function as scaling factor and utilizing it into the LS-NUFFT framework has the potential to improve accuracy. When a cosine scaling factor is used, in particular, the LS-NUFFT method is faster than Kaiser-Bessel gridding method because of a quasi closed-form solution. The method is successfully applied to 2D and 3D in vivo studies on small animals.

Cerebral sparganosis is a rare parasitic disease of thecentral nervous system that is caused by sparganum.Cerebral sparganosis occurs worldwide, but it is foundmore frequently in China, Japan, and Southeastern Asia (1-2). Sparganum, the second-stage larva of Spirometra mansoni,can produce chronic active inflammation through slowmigration in the brain (1). They can also parasitize othersites of the human body, such as the subcutaneous tissue,body cavities and eyes, and survive for 5-20 years (3).In this paper, we report a case of cerebral sparganosis,including the magnetic resonance imaging (MRI) character-istics of local migration and the surgical finding of a liveworm. A new pathological finding, a tunnel-like structure,was observed and most likely represented a sparganummigration path.

Cryptococcal infection in CNS is frequently seen in HIV patients and those with other immunosuppressed conditions. However, cryptococcal granuloma in CNS in immunocompetent patient is rare. We present one new case of cryptococcoma and review literature to illustrate diagnosis and treatment of these lesions. We conducted literature search in Pubmed search engine of the National Center for Biotechnology Information. Seventeen cases of CNS cryptoccoma in immunocompetent patients, including ours, have been reported to date. Of them, two patients had lesions inside spinal cord, and C. neoformans var. gattii was identified in three cases. All patients were symptomatic with normal immunocompetency although two patients had type 2 diabetes mellitus and one had torsades de pointes. Eight patients received surgical treatment and all were given antifungal agents except one suspected of teniasis. With literature reports and our experiences, we suggest that ring shaped enhancement of mass lesion with or without cystic changes in MR scan may indicate cryptococcoma, but definitive diagnosis relies on pathology study of lesion specimen. Open surgery and anti-fungal therapy should be scheduled, and outcome of cryptococcoma is largely determined by its locations.

Ganglioglioma is a lesion rarely encountered in the suprasellar region. Here we present a case of suprasellar region ganglioglioma that was totally removed by surgery. The patient was a 15-year-old female who complained of seizure for about 1 year, polyuria and eyesight descent for about 6 months. The neurological examination was without positive findings except bi-papilledema. By MRI, a huge cystic mass lesion was found in the suprasellar region, which caused slight obstructive hydrocephalus. The size of the mass was determined to be 4 cm x 3 cm x 3 cm. The levels of GH, PRL, ACTH, TSH, LH, FSH, TT3, TT4, CORT-1 were normal. We resected this lesion totally by trans-anterior portion of the foramen of right lateral ventricle. The postoperative paraffin section and immunohistochemistry showed ganglioglioma, GFAP(+), CK(-), NF(+). The follow-up time was 10 months; the patient was in good condition and enjoyed high quality of survival. This tumor has special embryological origins, clinical manifestations, and pathological features. Ganglioglioma of the suprasellar region will be of relatively favorable prognosis if it is diagnosed and resected in the early stage.