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Background: The accurate differentiation of primary central nervous system lymphoma (PCNSL) from glioblastoma multiforme (GBM) is clinically crucial due to the different treatment strategies between them. Purpose: To define magnetic resonance imaging (MRI) perfusion findings in PCNSL to make a safe distinction from GBM with dynamic contrast-enhanced (DCE) T1 and DSC T2 MRI perfusion findings. Material and Methods: This retrospective analysis included 19 patients with histopathologically diagnosed PCNSL and 21 individuals with GBM. DCE T1 vascular permeability perfusion values including K-trans, Ve, Kep, IAUGC, and DSC T2 perfusion values including cerebral blood volume (CBV) and cerebral blood flow (CBF) in axial sections from the pathological lesion and contralateral normal brain parenchyma were measured quantitatively using region of interest analysis. Results: The study observed no statistically significant difference between patients with PCNSL (T/B cell) and GBM in the median values of DCE T1 perfusion ratios (P > 0.05). Nevertheless, the DSC T2 perfusion ratios showed a substantial distinction between the two groups. In contrast to patients with PCNSL (1.185 vs. 1.224, respectively), those with GBM had higher median levels of r-CBV and r-CBF (2.898 vs. 2.467, respectively; P 0.01). A cutoff value of ≤1.473 for r-CBV (Lesion/N) and ≤1.6005 for r-CBF (Lesion/N) was found to estimate the positivity of PCNSL. Conclusion: DSC T2 MRI perfusion values showed lower r-CBV and r-CBF values in PCNSL patients compared to GBM patients. According to the findings, r-CBV and r-CBF are the most accurate MRI perfusion parameters for distinguishing between PCSNL and GBM. [ABSTRACT FROM AUTHOR]

Introduction: Pathogenic variants in several genes encoding components of the mitochondrial respiratory chain have been linked to various clinical phenotypes such as progressive cavitating leukoencephalopathy (PCL). The association between PCL, previously linked to numerous gene mutations in the literature, and the NDUFV2 gene mutations has emerged as a recent and noteworthy discovery. PCL is generally diagnosed in symptomatic patients during the early years of life, mostly in infancy., Case Presentation: In a previously healthy 12-year-old Turkish girl, a computed tomography scan taken for minor head trauma incidentally revealed suspicious hypodense areas in the periventricular white matter. Subsequently, a magnetic resonance imaging evaluation was performed. There was no history of motor regression, irritability, or seizures up to the age of 12. The case exhibited normal neurological and cranial nerve examinations. Magnetic resonance imaging detected bilateral periventricular T2/FLAIR hyperintensities with cystic areas suggestive of PCL. Whole-exome sequencing revealed the presence of a homozygous p.R222C missense variant in the NDUFV2 gene. Over a 6-year follow-up period, the patient remained asymptomatic, and there were no discernible changes in the magnetic resonance imaging findings., Conclusion: This case underscores the association between a potentially causal variant at the NDUFV2 locus and PCL. It is worth noting that this novel variation in PCL can not only manifest with symptoms in the infantile period but also remain asymptomatic into adolescence., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 S. Karger AG, Basel.)

Background: The primary aim of this study was to evaluate the individual and combined efficacy of magnetic resonance imaging (MRI) parameters, which include MRI perfusion, MRI diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the grading of gliomas as low grade versus high grade. The pre-operative imaging-based grading of gliomas by multiparametric MRI was compared with the gold standard histopathological studies. Methods: A total of 22 patients referred to the radiology department for multiparametric MRI of the brain with presumptive diagnosis of glioma on computed tomography/MRI were included in the study. Conventional T1, T2 and fluid-attenuated inversion recovery images were obtained followed by perfusion MRI using gadopentetate dimeglumine (Magnevist) administration. This was followed by DWI and MRS. Results: Our statistical analysis demonstrated that a cut-off of apparent diffusion coefficient value of 954.085 (10–6 mm2/Sec) provides a sensitivity and specificity of 87.5% and 85.7%, respectively, in differentiating low-grade gliomas (LGGs) from high-grade gliomas (HGGs). A choline/creatine ratio cut-off value of 2 provides sensitivity and specificity of 100% and 92.9%, respectively, while a cut-off value of 1.45 of choline/N-acetylaspartate ratio provides both sensitivity and specificity of 100% in differentiating LGG from HGG. A cut-off of 1.9 for maximum relative cerebral blood volume (rCBV) value provides both sensitivity and specificity of 100% in differentiating LGGs from HGGs. Conclusions: We concluded that perfusion MRI (rCBV) was the best parameter among perfusion MRI, DWI and MRI spectroscopy in differentiating HGGs from LGGs. Combined multiparametric results showed a diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 86.4%, 82.4%, 100%, 100% and 62.5%, respectively, on comparison with gold standard histopathological grading.

Background: The primary aim of this study was to evaluate the individual and combined efficacy of magnetic resonance imaging (MRI) parameters, which include MRI perfusion, MRI diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the grading of gliomas as low grade versus high grade. The pre-operative imaging-based grading of gliomas by multiparametric MRI was compared with the gold standard histopathological studies. Methods: A total of 22 patients referred to the radiology department for multiparametric MRI of the brain with presumptive diagnosis of glioma on computed tomography/MRI were included in the study. Conventional T1, T2 and fluid-attenuated inversion recovery images were obtained followed by perfusion MRI using gadopentetate dimeglumine (Magnevist) administration. This was followed by DWI and MRS. Results: Our statistical analysis demonstrated that a cut-off of apparent diffusion coefficient value of 954.085 (10-6 mm2/Sec) provides a sensitivity and specificity of 87.5% and 85.7%, respectively, in differentiating low-grade gliomas (LGGs) from high-grade gliomas (HGGs). A choline/creatine ratio cut-off value of 2 provides sensitivity and specificity of 100% and 92.9%, respectively, while a cut-off value of 1.45 of choline/N-acetylaspartate ratio provides both sensitivity and specificity of 100% in differentiating LGG from HGG. A cut-off of 1.9 for maximum relative cerebral blood volume (rCBV) value provides both sensitivity and specificity of 100% in differentiating LGGs from HGGs. Conclusions: We concluded that perfusion MRI (rCBV) was the best parameter among perfusion MRI, DWI and MRI spectroscopy in differentiating HGGs from LGGs. Combined multiparametric results showed a diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 86.4%, 82.4%, 100%, 100% and 62.5%, respectively, on comparison with gold standard histopathological grading. [ABSTRACT FROM AUTHOR]

Context: Electrophysiological and hemodynamic data can be integrated to accurately identify the generators of abnormal electrical activity in drug-resistant focal epilepsy. Arterial Spin Labeling (ASL), a magnetic resonance imaging (MRI) technique for quantitative noninvasive measurement of cerebral blood flow (CBF), can provide a direct measure of variations in cerebral perfusion associated with the epileptogenic zone. Aims: 1. To evaluate usefulness of ASL for detecting interictal temporal hypoperfusion to localize the epileptogenic zone in patients of drug resistant mesial temporal lobe epilepsy (MTLE). 2. Correlation of localization of epileptogenic zone on ASL MR perfusion with structural MRI and EEG. Methods and Materials: 30 patients with MTLE and10 age and gender matched normal controls were studied. All patients underwent ictal video EEG monitoring non-invasively, MR imaging with epilepsy protocol and pseudocontinuous ASL (PCASL) perfusion study. Relative CBF (rCBF) values in bilateral mesial temporal lobes were measured utilizing quantitative analysis of perfusion images. A perfusion asymmetry index (AI) was calculated for each region. Results: In patients, ipsilateral mesial temporal rCBF was significantly decreased compared with contralateral mesial temporal rCBF (p = 0.021). Mesial temporal blood flow was more asymmetric in patients than in normal control participants (p = 0.000). Clear perfusion asymmetry on PCASL-MRI was identified despite normal structural-MRI in 5 cases, agreeing with EEG laterality. Conclusions: Pseudo-continuous ASL offers a promising approach to detect interictal hypoperfusion in TLE and as a clinical alternative to SPECT and PET due to non-invasiveness and easy accessibility. Incorporation of ASL into routine pre-surgical evaluation protocols can help to localize epileptogenic zone in surgical candidates.

Background: Sorafenib is the currently recommended therapy in patients with advanced hepatocellular carcinoma (HCC). Among the several biomarkers available for the evaluation of the therapeutic response and prognosis, there is perfusion magnetic resonance imaging (p-MRI) that, through measurement of the vascular permeability unit (ktrans), may retrieve useful information regarding the microvascular properties of focal liver lesions. The aim of this study was to evaluate the impact of sorafenib therapy in patients with advanced HCC using the p-MRI technique. Materials and Methods: In this retrospective study, 27 patients with the diagnosis of advanced HCC were included for palliative therapy using sorafenib. MRI of the liver was performed before the beginning of the oral therapy (T0), after 3 (T3), and after 6 months (T6). Dynamic acquisitions of the tumor (n = 50, during the first 2 min after contrast injection) were obtained in the coronal plane and were used to compute the parametric perfusion maps, acquiring the ktrans value using the extended Tofts pharmacokinetic model. Results: The value of ktrans obtained at T0 was significantly different from the value of ktrans obtained at T6 (p = 0.028). There were no significant differences between T0 and T3 (p = 0.115) or a correlation between ktrans at T0 and the size of the lesion (p = 0.376). The ktrans value at T0 in patients with progression-free survival (PFS) > 6 months was not significantly different from the ktrans value in patients with PFS ≤6 months (p = 0.113). The ktrans value at T0 was not significantly different between patients who were previously submitted to chemoembolization and those who were not submitted (p = 0.587). Conclusion: In this pilot study, the ktrans value may serve as a biomarker of tumor response to antiangiogenic therapy, but only 6 months after its initiation. Clinical outcomes such as PFS were not predicted before the initiation of treatment.

Context: Electrophysiological and hemodynamic data can be integrated to accurately identify the generators of abnormal electrical activity in drug-resistant focal epilepsy. Arterial Spin Labeling (ASL), a magnetic resonance imaging (MRI) technique for quantitative noninvasive measurement of cerebral blood flow (CBF), can provide a direct measure of variations in cerebral perfusion associated with the epileptogenic zone. Aims: 1. To evaluate usefulness of ASL for detecting interictal temporal hypoperfusion to localize the epileptogenic zone in patients of drug resistant mesial temporal lobe epilepsy (MTLE). 2. Correlation of localization of epileptogenic zone on ASL MR perfusion with structural MRI and EEG. Methods and Materials: 30 patients with MTLE and10 age and gender matched normal controls were studied. All patients underwent ictal video EEG monitoring non-invasively, MR imaging with epilepsy protocol and pseudocontinuous ASL (PCASL) perfusion study. Relative CBF (rCBF) values in bilateral mesial temporal lobes were measured utilizing quantitative analysis of perfusion images. A perfusion asymmetry index (AI) was calculated for each region. Results: In patients, ipsilateral mesial temporal rCBF was significantly decreased compared with contralateral mesial temporal rCBF (p = 0.021). Mesial temporal blood flow was more asymmetric in patients than in normal control participants (p = 0.000). Clear perfusion asymmetry on PCASL-MRI was identified despite normal structural-MRI in 5 cases, agreeing with EEG laterality. Conclusions: Pseudo-continuous ASL offers a promising approach to detect interictal hypoperfusion in TLE and as a clinical alternative to SPECT and PET due to non-invasiveness and easy accessibility. Incorporation of ASL into routine pre-surgical evaluation protocols can help to localize epileptogenic zone in surgical candidates. [ABSTRACT FROM AUTHOR]

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Background: Sorafenib is the currently recommended therapy in patients with advanced hepatocellular carcinoma (HCC). Among the several biomarkers available for the evaluation of the therapeutic response and prognosis, there is perfusion magnetic resonance imaging (p-MRI) that, through measurement of the vascular permeability unit (ktrans), may retrieve useful information regarding the microvascular properties of focal liver lesions. The aim of this study was to evaluate the impact of sorafenib therapy in patients with advanced HCC using the p-MRI technique., Materials and Methods: In this retrospective study, 27 patients with the diagnosis of advanced HCC were included for palliative therapy using sorafenib. MRI of the liver was performed before the beginning of the oral therapy (T0), after 3 (T3), and after 6 months (T6). Dynamic acquisitions of the tumor ( n = 50, during the first 2 min after contrast injection) were obtained in the coronal plane and were used to compute the parametric perfusion maps, acquiring the ktrans value using the extended Tofts pharmacokinetic model., Results: The value of ktrans obtained at T0 was significantly different from the value of ktrans obtained at T6 ( p = 0.028). There were no significant differences between T0 and T3 ( p = 0.115) or a correlation between ktrans at T0 and the size of the lesion ( p = 0.376). The ktrans value at T0 in patients with progression-free survival (PFS) > 6 months was not significantly different from the ktrans value in patients with PFS ≤6 months ( p = 0.113). The ktrans value at T0 was not significantly different between patients who were previously submitted to chemoembolization and those who were not submitted ( p = 0.587)., Conclusion: In this pilot study, the ktrans value may serve as a biomarker of tumor response to antiangiogenic therapy, but only 6 months after its initiation. Clinical outcomes such as PFS were not predicted before the initiation of treatment., Competing Interests: The authors have no conflicts of interest to declare.