Task-Based and Resting-State Functional MRI in Observing Eloquent Cerebral Areas Personalized for Epilepsy and Surgical Oncology Patients: A Review of the Current Evidence.

Functional magnetic resonance imaging (fMRI) is among the newest techniques of advanced neuroimaging that offer the opportunity for neuroradiologists, neurophysiologists, neuro-oncologists, and neurosurgeons to pre-operatively plan and manage different types of brain lesions. Furthermore, it plays a fundamental role in the personalized evaluation of patients with brain tumors or patients with an epileptic focus for preoperative planning. While the implementation of task-based fMRI has increased in recent years, the existing resources and evidence related to this technique are limited. We have, therefore, conducted a comprehensive review of the available resources to compile a detailed resource for physicians who specialize in managing patients with brain tumors and seizure disorders. This review contributes to the existing literature because it highlights the lack of studies on fMRI and its precise role and applicability in observing eloquent cerebral areas in surgical oncology and epilepsy patients, which we believe is underreported. Taking these considerations into account would help to better understand the role of this advanced neuroimaging technique and, ultimately, improve patient life expectancy and quality of life.

Pediatric Stroke from Bench to Bedside: A Single-Center Experience in Saudi Arabia.

Purpose: Stroke is a leading cause of severe long-term disability and death worldwide. This study aimed to determine the genetic background, causative factors, and diagnostic and outcome measures of pediatric stroke in an area endemic to sickle cell disease (SCD). Patients and Methods: This retrospective review analyzed pediatric patients with acute stroke who were admitted to King Fahd Hospital of the University, Eastern Province, Saudi Arabia, between January and June 2019. We assessed 49 cases based on computed tomography (CT) and magnetic resonance imaging (MRI) findings. Patients with incomplete records or unavailable radiological images were excluded. Results: A high likelihood of familial coexistence of stroke was detected in patients with affected siblings (33%). Among various central nervous system manifestations, motor weakness (28.6%) and headache (20.4%) were the most common symptoms/signs. Hypoxic-ischemic encephalopathy (HIE) (28.6%), SCD (22.5%), and moyamoya disease (14.3%) were the most prevalent underlying etiologies. CT without intravenous contrast was the most used initial imaging technique (92.5%). An arterial blockage was more prevalent (53.4%) than a venous infarct (46.6%) (p = 0.041), while arterial ischemic stroke was more prevalent (56.5%) than hemorrhagic stroke (43.5%). The middle cerebral artery (MCA) was most affected (63.5%), followed by the anterior cerebral artery (22.7%) and posterior cerebral artery (13.6%). Most patients were managed with medical treatment (86.1%). No mortalities occurred during the initial hospital stay. The mean length of hospital stay was 12 days. Conclusion: HIE was the most prevalent etiology of pediatric stroke. Motor weakness and headache were the most common initial manifestations. Arterial ischemic stroke was more prevalent than venous or hemorrhagic stroke. Considering the rarity of pediatric stroke, future studies should be performed with a aborative effort nationally and internationally.

Can apparent diffusion coefficient values help distinguish between different types of pediatric brain tumors?

RATIONALE AND OBJECTIVES: Classifying brain tumors is challenging, but recently developed imaging techniques offer the opportunity for neuroradiologists and neurosurgeons to diagnose, differentiate, and manage different types of brain tumors. Such advances will be reflected in improvements in patients' life expectancy and quality of life. Among the newest techniques, the apparent diffusion coefficient (ADC), which tracks the rate of microscopic water diffusion within tissues, has become a focus of investigation. Recently, ADC has been used as a preoperative diffusion-weighted magnetic resonance imaging (MRI) parameter that facilitates tumor diagnosis and grading. Here, we aimed to determine the ADC cutoff values for pediatric brain tumors (PBTs) categorized according to the World Health Organization (WHO) classification of brain tumors. MATERIALS AND METHODS: We retrospectively reviewed 80 cases, and assessed them based on their MRI-derived ADC. These results were compared with those of WHO classification-based histopathology. RESULTS: Whole-lesion ADC values ranged 0.225-1.240 × 10-3 mm2/s for ependymal tumors, 0.107-1.571 × 10-3 mm2/s for embryonal tumors, 0.1065-2.37801 × 10-3 mm2/s for diffuse astrocytic and oligodendroglial tumors, 0.5220-0.7840 × 10-3 mm2/s for other astrocytic tumors, and 0.1530-0.8160 × 10-3 mm2/s for meningiomas. These findings revealed the usefulness of ADC in the differential diagnosis of PBT, as it was able to discriminate between five types of PBTs. CONCLUSION: The application of an ADC diagnostic criterion would reduce the need for spectroscopic analysis. However, further research is needed to implement ADC in the differential diagnosis of PBT.