Magnetic resonance imaging (MRI) is the cornerstone for evaluating patients with brain masses such as primary and metastatic tumors. Important challenges in effectively detecting and diagnosing brain metastases and in accurately characterizing their subsequent response to treatment remain. These difficulties include discriminating metastases from potential mimics such as primary brain tumors and infection, detecting small metastases, and differentiating treatment response from tumor recurrence and progression. Optimal patient management could be benefited by improved and well-validated prognostic and predictive imaging markers, as well as early response markers to identify successful treatment prior to changes in tumor size. To address these fundamental needs, newer MRI techniques including diffusion and perfusion imaging, MR spectroscopy, and positron emission tomography (PET) tracers beyond traditionally used 18-fluorodeoxyglucose are the subject of extensive ongoing investigations, with several promising avenues of added value already identified. These newer techniques provide a wealth of physiologic and metabolic information that may supplement standard MR evaluation, by providing the ability to monitor and characterize cellularity, angiogenesis, perfusion, pH, hypoxia, metabolite concentrations, and other critical features of malignancy. This chapter reviews standard and advanced imaging of brain metastases provided by computed tomography, MRI, and amino acid PET, focusing on potential biomarkers that can serve as problem-solving tools in the clinical management of patients with brain metastases.

/pdf/brain-metastases-neuroimaging-3hjjdng1si.pdf

Brain metastases: neuroimaging.

Pseudophenomena, that is, imaging alterations due to therapy rather than tumor evolution, have an important impact on the management of glioma patients and the results of clinical trials. RANO (response assessment in neurooncology) criteria, including conventional MRI (cMRI), addressed the issues of pseudoprogression after radiotherapy and concomitant chemotherapy and pseudoresponse during antiangiogenic therapy of glioblastomas (GBM) and other gliomas. The development of cancer immunotherapy forced the identification of further relevant response criteria, summarized by the iRANO working group in 2015. In spite of this, the unequivocal definition of glioma progression by cMRI remains difficult particularly in the setting of immunotherapy approaches provided by checkpoint inhibitors and dendritic cells. Advanced MRI (aMRI) may in principle address this unmet clinical need. Here, we discuss the potential contribution of different aMRI techniques and their indications and pitfalls in relation to biological and imaging features of glioma and immune system interactions.

/pdf/mri-in-glioma-immunotherapy-evidence-pitfalls-and-2zmi8jjmzm.pdf

MRI in Glioma Immunotherapy: Evidence, Pitfalls, and Perspectives

Primary lymphoma of the central nervous system (PL-CNS) is a tumor the incidence of which has increased in the last ten years and is frequently associated to immunosuppressed states. It is a non-Hodgkin lymphoma, usually diffuse and of type B. The clinical presentation form is nonspecific and for its diagnosis CT scan data are usefull although it is necessary to confirm this diagnosis with a biopsy. Treatment consists on holocranial radiotherapy associated to chemotherapy. Prognosis is obscure since local relapses are very frequent although its extension to other sites outside the CNS is rare.

Primary lymphoma of the central nervous system

Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastasis using arterial spin labeling and dynamic contrast-enhanced magnetic resonance imaging

PURPOSE Susceptibility-weighted imaging (SWI) has significantly increased our sensitivity in detecting hemorrhagic brain lesions. We sought to explore the prevalence of intratumoral hemorrhage as detected by SWI in brain metastases from melanoma and breast cancer. METHODS Lesions with a size of 0.1 cm were categorized as micrometastases, whereas larger lesions were categorized as macrometastases. Susceptibility-weighted imaging findings on locations corresponding to enhancing lesions were categorized as either positive or negative based on presence/absence of signal dropout. The percentage of SWI positivity was then estimated as a function of lesion size. Two-tailed Fisher exact test was performed to examine differences in the contingency tables. RESULTS Magnetic resonance imaging studies from 73 patients with 1173 brain metastases, which enhanced on postcontrast T1-weighted imaging (T1WI) were selected for analysis. Of these lesions, 952 had SWI data available, and 342 of 952 were micrometastases. Only 10 of the 342 micrometastases and 410 (67.2%) of the 610 macrometastases were SWI positive (P < 0.0001). When examined by tumor type, 76.9% (melanoma) versus 55.6% (breast cancer) were SWI positive (P < 0.0001), regardless of tumor size. All melanoma lesions (8/8) and only 1 of 15 breast cancer lesions larger than 1.5 cm were SWI positive. CONCLUSION With the use of combined SWI and contrast-enhanced high-resolution T1 imaging, we found that presence of intratumoral brain hemorrhage is uncommon in micrometastases but common in metastases greater than 0.1 cm from breast cancer or melanoma. Large metastases commonly harbored hemorrhage, and this occurred more frequently in patients with melanoma than with breast cancer.

/pdf/use-of-susceptibility-weighted-imaging-swi-in-the-detection-3v2hus3hqk.pdf

Use of Susceptibility-Weighted Imaging (SWI) in the Detection of Brain Hemorrhagic Metastases from Breast Cancer and Melanoma.

Background and Purpose

Conventional MRI is often difficult to distinguish between primary central nervous system lymphomas (PCNSLs), high-grade gliomas and brain metastases due to the similarity of their appearance. The aim of this study was to investigate whether the susceptibility-weighted imaging (SWI) has higher sensitivity than conventional MRI in detecting hemorrhage between PCNSLs, high-grade gliomas and brain metastases, and can be used to differentiate the diagnosis between these tumors.



Methods

The number of lesions with hemorrhage was quantified by both the conventional MR imaging and SWI. The number of micro-hemorrhage and vessels within lesions were counted on SWI.



Results

The detection rate of hemorrhage on SWI was significantly higher than that on the conventional MR imaging. The intralesional hemorrhagic burden and the number of the vessels within lesions detected by SWI were significantly higher in high-grade gliomas and brain metastases than those in PCNSLs. There was no significant difference in these two parameters between high-grade gliomas and brain metastases. The best predictor to differentiate PCNSLs from high-grade gliomas and brain metastases was intralesional vessel number that yielded the best ROC characteristics and highest classification accuracy.



Conclusions

SWI is useful in differentiating of PCNSLs from high-grade gliomas and brain metastases.

Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastases using susceptibility-weighted imaging

Abstract The immunity of patients who recover from coronavirus disease 2019 (COVID-19) could be long lasting but persist at a lower level. Thus, recovered patients still need to be vaccinated to prevent reinfection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or its mutated variants. Here, we report that the inactivated COVID-19 vaccine can stimulate immunity in recovered patients to maintain high levels of anti-receptor-binding domain (RBD) and anti-nucleocapsid protein (NP) antibody titers within 9 months, and high neutralizing activity against the prototype, Delta, and Omicron strains was observed. Nevertheless, the antibody response decreased over time, and the Omicron variant exhibited more pronounced resistance to neutralization than the prototype and Delta strains. Moreover, the intensity of the SARS-CoV-2-specific CD4 + T cell response was also increased in recovered patients who received COVID-19 vaccines. Overall, the repeated antigen exposure provided by inactivated COVID-19 vaccination greatly boosted both the potency and breadth of the humoral and cellular immune responses against SARS-CoV-2, effectively protecting recovered individuals from reinfection by circulating SARS-CoV-2 and its variants. 

/pdf/covid-19-vaccination-boosts-the-potency-and-breadth-of-the-1ywf82gr.pdf

COVID-19 vaccination boosts the potency and breadth of the immune response against SARS-CoV-2 among recovered patients in Wuhan

Biological activity of a new recombinant human coagulation factor VIII and its efficacy in a small animal model.

Association of Optimal Gestational Weight Gain with Pregnancy Outcomes in Twin Pregnancies in China：A Multicenter Retrospective Study

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Differentiation of primary central nervous system lymphoma from high-grade glioma and brain metastases using susceptibility-weighted imaging

COVID-19 vaccination boosts the potency and breadth of the immune response against SARS-CoV-2 among recovered patients in Wuhan

Biological activity of a new recombinant human coagulation factor VIII and its efficacy in a small animal model.

Association of Optimal Gestational Weight Gain with Pregnancy Outcomes in Twin Pregnancies in China：A Multicenter Retrospective Study