Factors affecting hospitalization, imaging severity, and complications in posterior reversible encephalopathy syndrome.

PURPOSE: Assess factors in posterior reversible encephalopathy syndrome (PRES) related to intensive care unit (ICU) admissions, mechanical ventilation, and length of stay (LoS). METHODS: Retrospectively, we collected clinical, biochemical, and imaging data of PRES patients. MRI studies were assessed for imaging severity, and complications, including restricted diffusion and hemorrhage. Univariate and multivariate regression analyses were performed for factors associated with ICU admission, mechanical ventilation, and LoS. We assessed for association between clinical and biochemical factors and imaging severity grading systems and complications. RESULTS: We had 57 subjects with mean ± SD age of 56.3 ± 14.5 years and 68.3% were females. In 60 cases, 36.7% had hypertension, 23.3% had chronic renal disease, 18.3% had sepsis, 16.7% were on active chemotherapy, 10% underwent hematopoietic stem cell transplantation (HSCT), 10% with active cancer, 6.7% were eclampsia/preeclampsia, and 1.7% had radiotherapy. We had 17 (26.6%) grade 1, 26 (46.8%) grade 2, 17 (26.6%) grade 3 PRES based on vasogenic edema extent, and 28 (46.7%) severe PRES (≥ 5 areas) cases. 19 (31.7%) had restricted diffusion with hemorrhage in 19 (31.7%) cases. On multivariate analysis, ICU admissions showed significant association with hypertension (OR = 5.57, 95% CI: 0.96-32.23; p = 0.05), and raised INR (OR = 119, 95% CI: 1.1-1244.3; p = 0.04); LoS with HSCT, mean arterial pressure (MAP), intraparenchymal hematoma, and sepsis; and extent of vasogenic edema with restricted diffusion (OR = 4.31, 95% CI: 1.5-12.33; p < 0.01). CONCLUSION: In summary, PRES with hypertension and elevated INR are associated with ICU admissions. HSCT, MAP, intraparenchymal hematoma, and sepsis correlated with LoS. Imaging severity grading based on vasogenic edema extent may be better due to association with restricted diffusion.

Management of Primary Central Nervous System Lymphoma Using Intra-Arterial Chemotherapy With Osmotic Blood-Brain Barrier Disruption: Retrospective Analysis of the Sherbrooke Cohort.

BACKGROUND: Primary central nervous system lymphomas (PCNSL) are rare and aggressive CNS tumors. Current management involves high-dose methotrexate (HD-MTX) typically administered intravenously (IV), despite the existence of the blood-brain barrier (BBB), which significantly decreases its bioavailability. Cerebral intra-arterial chemotherapy (CIAC) coupled with osmotic BBB disruption (OBBBD) can theoretically circumvent this issue. METHODS: We performed a retrospective analysis of patients with newly diagnosed PCNSL treated with HD-MTX-based CIAC+OBBBD at our center between November 1999 and May 2018. OBBBD was achieved using a 25% mannitol intra-arterial infusion. Patients were followed clinically and radiologically every month until death or remission. Demographics, clinical and outcome data were collected from the medical record. All imaging studies were reviewed for evidence of complication and outcome assessment. Kaplan-Meier analyses were used to compute remission, progression-free survival (PFS) as well as overall survival times. Subgroup analyses were performed using the log rank test. RESULTS: Forty-four patients were included in the cohort. Median follow-up was 38 months. Complete response was achieved in 34 patients (79%) at a median of 7.3 months. Actuarial median survival and PFS were 45 months and 24 months, respectively. Age, ECOG and lesion location did not impact outcome. Complications included thrombocytopenia (39%), neutropenia (20%), anemia (5%), seizures (11%), stroke (2%), and others (20%). CONCLUSION: CIAC using HD-MTX-based protocols with OBBBD is a safe and well-tolerated procedure for the management of PCNSL. Our data suggests better PFS and survival outcomes compared to IV protocols with less hematologic toxicity and good tolerability, especially in the elderly.

Comparison of MRI- and CT-based semiautomated liver segmentation: a validation study.

PURPOSE: To compare the repeatability, agreement, and efficiency of MRI- and CT-based semiautomated liver segmentation for the assessment of total and subsegmental liver volume. METHODS: This retrospective study was conducted in 31 subjects who underwent contemporaneous liver MRI and CT. Total and subsegmental liver volumes were segmented from contrast-enhanced 3D gradient-recalled echo MRI sequences and CT images. Semiautomated segmentation was based on variational interpolation and Laplacian mesh optimization. All segmentations were repeated after 2 weeks. Manual segmentation of CT images using an active contour tool was used as the reference standard. Repeatability and agreement of the methods were evaluated with intra-class correlation coefficients (ICC) and Bland-Altman analysis. Total interaction time was recorded. RESULTS: Intra-reader ICC were ≥0.987 for MRI and ≥0.995 for CT. Intra-reader repeatability was 30 ± 217 ml (bias ± 1.96 SD) (95% limits of agreement: -187 to 247 ml) for MRI and -10 ± 143 ml (-153 to 133 ml) for CT. Inter-method ICC between semiautomated and manual volumetry were ≥0.995 for MRI and ≥0.986 for CT. Inter-method segmental ICC varied between 0.584 and 0.865 for MRI and between 0.596 and 0.890 for CT. Inter-method agreement was -14 ± 136 ml (-150 to 122 ml) for MRI and 50 ± 226 ml (-176 to 276 ml) for CT. Inter-method segmental agreement ranged from 10 ± 47 ml (-37 to 57 ml) to 2 ± 214 ml (-212 to 216 ml) for MRI and 9 ± 45 ml (-36 to 54 ml) to -46 ± 183 ml (-229 to 137 ml) for CT. Interaction time (mean ± SD) was significantly shorter for MRI-based semiautomated segmentation (7.2 ± 0.1 min, p < 0.001) and for CT-based semiautomated segmentation (6.5 ± 0.2 min, p < 0.001) than for CT-based manual segmentation (14.5 ± 0.4 min). CONCLUSION: MRI-based semiautomated segmentation provides similar repeatability and agreement to CT-based segmentation for total liver volume.

Validation of a semiautomated liver segmentation method using CT for accurate volumetry.

RATIONALE AND OBJECTIVES: To compare the repeatability and agreement of a semiautomated liver segmentation method with manual segmentation for assessment of total liver volume on CT (computed tomography). MATERIALS AND METHODS: This retrospective, institutional review board-approved study was conducted in 41 subjects who underwent liver CT for preoperative planning. The major pathologies encountered were colorectal cancer metastases, benign liver lesions and hepatocellular carcinoma. This semiautomated segmentation method is based on variational interpolation and 3D minimal path-surface segmentation. Total and subsegmental liver volumes were segmented from contrast-enhanced CT images in venous phase. Two image analysts independently performed semiautomated segmentations and two other image analysts performed manual segmentations. Repeatability and agreement of both methods were evaluated with intraclass correlation coefficients (ICC) and Bland-Altman analysis. Interaction time was recorded for both methods. RESULTS: Bland-Altman analysis revealed an intrareader agreement of -1 ± 27 mL (mean ± 1.96 standard deviation) with ICC of 0.999 (P < .001) for manual segmentation and 12 ± 97 mL with ICC of 0.991 (P < .001) for semiautomated segmentation. Bland-Altman analysis revealed an interreader agreement of -4 ± 22 mL with ICC of 0.999 (P < .001) for manual segmentation and 5 ± 98 mL with ICC of 0.991 (P < .001) for semiautomated segmentation. Intermethod agreement was found to be 3 ± 120 mL with ICC of 0.988 (P < .001). Mean interaction time was 34.3 ± 16.7 minutes for the manual method and 8.0 ± 1.2 minutes for the semiautomated method (P < .001). CONCLUSIONS: A semiautomated segmentation method can substantially shorten interaction time while preserving a high repeatability and agreement with manual segmentation.

Effects of Insulin Glargine and Liraglutide Therapy on Liver Fat as Measured by Magnetic Resonance in Patients With Type 2 Diabetes: A Randomized Trial.

OBJECTIVE: This study determined the effects of insulin versus liraglutide therapy on liver fat in patients with type 2 diabetes inadequately controlled with oral agents therapy, including metformin. RESEARCH DESIGN AND METHODS: Thirty-five patients with type 2 diabetes inadequately controlled on metformin monotherapy or in combination with other oral antidiabetic medications were randomized to receive insulin glargine or liraglutide therapy for 12 weeks. The liver proton density fat fraction (PDFF) was measured by MRS. The mean liver PDFF, the total liver volume, and the total liver fat index were measured by MRI. The Student t test, the Fisher exact test, and repeated-measures ANOVA were used for statistical analysis. RESULTS: Insulin treatment was associated with a significant improvement in glycated hemoglobin (7.9% to 7.2% [62.5 to 55.2 mmol/mol], P = 0.005), a trend toward a decrease in MRS-PDFF (12.6% to 9.9%, P = 0.06), and a significant decrease in liver mean MRI-PDFF (13.8% to 10.6%, P = 0.005), liver volume (2,010.6 to 1,858.7 mL, P = 0.01), and the total liver fat index (304.4 vs. 209.3 % ⋅ mL, P = 0.01). Liraglutide treatment was also associated with a significant improvement in glycated hemoglobin (7.6% to 6.7% [59.8 to 50.2 mmol/mol], P < 0.001) but did not change MRS-PDFF (P = 0.80), liver mean MRI-PDFF (P = 0.15), liver volume (P = 0.30), or the total liver fat index (P = 0.39). CONCLUSIONS: The administration of insulin glargine therapy reduced the liver fat burden in patients with type 2 diabetes. However, the improvements in the liver fat fraction and glycemia control were not significantly different from those in the liraglutide group.