Changes in the distribution of the magnetic resonance (MR)-observable brain metabolites N-acetyl aspartate (NAA), total choline (Cho), and total creatine (Cre), following mild-to-moderate closed-head traumatic brain injury (mTBI) were evaluated using volumetric proton MR spectroscopic imaging (MRSI). Studies were carried out during the subacute time period following injury, and associations of metabolite indices with neuropsychological test (NPT) results were evaluated. Twenty-nine subjects with mTBI and Glasgow Coma Scale (GCS) scores of 10-15 were included. Differences in individual metabolite and metabolite ratio distributions relative to those of age-matched control subjects were evaluated, as well as analyses by hemispheric lobes and tissue types. Primary findings included a widespread decrease of NAA and NAA/Cre, and increases of Cho and Cho/NAA, within all lobes of the TBI subject group, and with the largest differences seen in white matter. Examination of the association between all of the metabolite measures and the NPT scores found the strongest negative correlations to occur in the frontal lobe and for Cho/NAA. No significant correlations were found between any of the MRSI or NPT measures and the GCS. These results demonstrate that significant and widespread alterations of brain metabolites occur as a result of mild-to-moderate TBI, and that these measures correlate with measures of cognitive performance.
OBJECTIVE.
The objective of our study was to assess the growth rate and
enhancement of renal masses before and after treatment with stereotactic
body radiotherapy (SBRT).
MATERIALS AND METHODS.
This retrospective study included all patients with renal masses who
underwent SBRT during a 5-year period. Orthogonal measurements of renal
masses were obtained on pre- and posttreatment CT or MRI. Pre- and
posttreatment growth rates were compared for renal mass diameter and volume
using the t test. Pre- and posttreatment tumor enhancement
values were compared for tumors that underwent multiphasic contrast-enhanced
MRI.
RESULTS.
Forty patients underwent SBRT for the treatment of 41 renal tumors:
clear cell renal cell carcinomas (RCCs) (n = 16), papillary
RCCs (n = 6), oncocytic neoplasms (n = 8),
unclassified RCCs (n = 2), urothelial carcinoma
(n = 1), and no pathologic diagnosis
(n = 8). The mean maximum tumor diameter before
treatment was 3.9 cm (range, 1.6–8.3 cm). Three hundred thirty-eight
pre- and posttreatment imaging studies were analyzed: 214 MRI studies and
124 CT studies. The mean pre- and posttreatment lengths of observation were
416 days (range, 2–1800 days) and 561 days (83–1366 days),
respectively. The mean pretreatment tumor growth rate of 0.68 cm/y decreased
to –0.37 cm/y post treatment (p < 0.0001),
and the mean tumor volume growth rate of 21.2 cm3/y before
treatment decreased to –5.35 cm3/y after treatment
(p = 0.002). Local control—defined as less than
5 mm of growth—was achieved in 38 of 41 (92.7%) tumors. The Response
Evaluation Criteria in Solid Tumors (RECIST) 1.1 showed progression in one
tumor (2.4%), stability in 31 tumors (75.6%), partial response in eight
tumors (19.5%), and complete response in one tumor (2.4%). No statistically
significant change in tumor enhancement was shown (mean follow-up, 142 days;
range, 7–581 days).
CONCLUSION.
Renal tumors treated with SBRT show statistically significant
reductions in growth rate and tumor size after treatment but do not show
statistically significant differences in enhancement in the initial (mean,
142 days) posttreatment period.
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