Radiomics Outperforms Clinical and Radiologic Signs in Predicting Spontaneous Basal Ganglia Hematoma Expansion: A Pilot Study.

Prediction of the hematoma expansion (HE) of spontaneous basal ganglia hematoma (SBH) from the first non-contrast CT can result in better management, which has the potential of improving outcomes. This study has been designed to compare the performance of "Radiomics analysis," "radiology signs," and "clinical-laboratory data" for this task. We retrospectively reviewed the electronic medical records for clinical, demographic, and laboratory data in patients with SBH. CT images were reviewed for the presence of radiologic signs, including black-hole, blend, swirl, satellite, and island signs. Radiomic features from the SBH on the first brain CT were extracted, and the most predictive features were selected. Different machine learning models were developed based on clinical, laboratory, and radiology signs and selected Radiomic features to predict hematoma expansion (HE). The dataset used for this analysis included 116 patients with SBH. Among different models and different thresholds to define hematoma expansion (10%, 20%, 25%, 33%, 40%, and 50% volume enlargement thresholds), the Random Forest based on 10 selected Radiomic features achieved the best performance (for 25% hematoma enlargement) with an area under the curve (AUC) of 0.9 on the training dataset and 0.89 on the test dataset. The models based on clinical-laboratory and radiology signs had low performance (AUCs about 0.5-0.6).

Neuroimaging of the Pituitary Gland: Practical Anatomy and Pathology.

The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.

New ischemic lesions on brain magnetic resonance imaging in patients with blunt traumatic cerebrovascular injury.

BACKGROUND: Patients with blunt cerebrovascular injuries are at risk of thromboembolic stroke. Although primary prevention with antithrombotic therapy is widely used in this setting, its effectiveness is not well defined and requires further investigation. The aim of this study was to evaluate the utility of magnetic resonance imaging (MRI)-detected ischemic brain lesions as a possible future outcome for randomized clinical trials in this patient population. METHODS: This prospective observational study included 20 adult blunt trauma patients admitted to a level I trauma center with a screening neck CTA showing extracranial carotid or vertebral artery injury. All subjects lacked initial evidence of an ischemic stroke and were managed with antithrombotic therapy and observation and then underwent brain MRI within 30 days of the injury to assess for ischemic lesions. The MRI scans included diffusion, susceptibility, and Fluid-attenuated Inversion Recovery (FLAIR) sequences, and were reviewed by two neuroradiologists blinded to the computed tomography angiography (CTA) findings. RESULTS: Eleven CTAs were done in the emergency department upon admission. There were 12 carotid artery dissections and 11 unilateral or bilateral vertebral artery injuries. Median interval between injury and MRI scan was 4 days (range, 0.1-14; interquartile range, 3-7 days). Diffusion-weighted imaging evidence of new ischemic lesions was present in 10 (43%) of 23 of the injured artery territories. In those injuries with ischemic lesions, the median number was 8 (range, 2-25; interquartile range, 5-8). None of the lesions were symptomatic. Blunt cerebrovascular injury was associated with a higher mean ischemic lesion count (mean count of 3.17 vs. 0.14, p < 0.0001), with the association remaining after adjusting for injury severity score (p < 0.0001). CONCLUSION: In asymptomatic blunt trauma patients with CTA evidence of extracranial cerebrovascular injury and treated with antithrombotic therapy, nearly half of arterial injuries are associated with ischemic lesions on MRI. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

Cauda equina syndrome in an ovarian malignant-mixed müllerian tumor with leptomeningeal spread.

Leptomeningeal metastasis is extremely rare in patients with ovarian cancer, but should be considered in patients presenting with neurologic deficits such as cauda equine syndrome. Given its poor prognosis and lack of data currently on management, additional studies are needed to optimize treatment regimens and improve outcomes.