Background Recent epidemiological studies have suggested that sexual dimorphism influences treatment response and prognostic outcome in Glioblastoma (GBM). To this end, we sought to (1) identify distinct sex-specific radiomic phenotypes, from tumor sub-compartments (peri-tumoral edema, enhancing tumor, and necrotic-core) using pretreatment MRI scans, that are prognostic of overall survival (OS) in GBMs, and (2) investigate radiogenomic associations of the MRI-based phenotypes with corresponding transcriptomic data, to identify the signaling pathways that drive sex-specific tumor biology and treatment response in GBM. Methods In a retrospective setting, 313 GBM patients (male=196, female=117) were curated from multiple institutions for radiomic analysis, where 130 were used for training and independently validated on a cohort of 183 patients. For the radiogenomic analysis, 147 GBM patients (male=94, female = 53) were used, with 125 patients in training and 22 cases for independent validation. Results Cox regression models of radiomic features from Gd-T1w MRI allowed for developing more precise prognostic models, when trained separately on male and female cohorts. Our radiogenomic analysis revealed higher expression of Laws energy features that capture spots and ripples-like patterns (representative of increased heterogeneity) from the enhancing tumor region, as well as aggressive biological processes of cell adhesion, and angiogenesis to be more enriched in the ‘high-risk’ group of poor OS in the male population. In contrast, higher expressions of Laws energy features (that detect levels and edges) from the necrotic core with significant involvement of immune related signaling pathways was observed in the ‘low-risk’ group of the female population. Conclusions Sexually-dimorphic radiogenomic models could help risk-stratify GBM patients for personalized treatment decisions.
Extraosseous Ewing’s sarcoma (EES), first described in 1969, is a malignant mesenchymal tumor just like its intraosseous counterpart. Although Ewing’s sarcomas are common bone tumors in young children, EESs are rarer and more commonly found in older children/adults, often carrying a poorer prognosis. We discuss the multimodality imaging features of EES and the differential diagnosis of an aggressive appearing mass in proximity to skeletal structures, with pathologic correlates. This review highlights the need to recognize the variability of radiologic findings in EES such as the presence of hemorrhage, rich vascularity, and cystic or necrotic regions and its imaging similarity to other neoplasms that are closely related pathologically.
Mesenchymal chondrosarcoma is a rare and aggressive chondrogenic neoplasm arising from the bone or the soft tissue. Mesenchymal chondrosarcomas develop outside the osseous structures in about one-third of cases, and the majority of these occur in the meninges and the brain parenchyma. Intramuscular extraskeletal mesenchymal chondrosarcoma (EMC) is exceedingly rare, with very few cases reported in the literature. Although mesenchymal chondrosarcoma has a high potential for metastasis, there have been no reports of pulmonary metastasis from an EMC of intramuscular origin. Here, we describe a patient who came to our facility with a history of progressively worsening left lower extremity pain and swelling, and was found to have pathology-proven EMC originating in the left adductor magnus, with complete workup demonstrating multiple bilateral pulmonary metastases in addition to a possible metastatic focus in the right adrenal gland discovered during the interval surveillance period.
OBJECTIVE Severe traumatic brain injury (TBI) is associated with intracranial hypertension (ICHTN). The Rotterdam CT score (RS) can predict clinical outcomes following TBI, but the relationship between the RS and ICHTN is unknown. The purpose of this study was to investigate clinical and radiological factors that predict ICHTN in patients with severe TBI. METHODS The authors performed a single-center retrospective review of patients who, between 2018 and 2021, had an intracranial pressure (ICP) monitor placed following TBI. Radiological and clinical characteristics related to the TBI and ICP monitoring were collected. The main outcome of interest was ICHTN, which was a dichotomous outcome (yes or no) defined on a per-patient basis as an ICP > 22 mm Hg that persisted for at least 5 minutes and required an escalation of treatment. ICHTN included both elevated opening pressure on initial monitor placement and ICP elevations later during hospitalization. Multivariate logistic regression was performed to determine variables associated with ICHTN. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS Seventy patients with severe TBI and an ICP monitor were included in this study. There was a predominance of male patients (94.0%), and the mean patient age was 40 years old. Most patients (67%) had an intraparenchymal catheter placed, whereas 33% of patients had a ventriculostomy catheter placed. In the multivariate logistic regression analysis, the RS was an independent predictor of ICHTN (OR 2.0, 95% CI 1.2–3.5, p = 0.014). No instances of ICHTN were observed in patients with an RS of 2 or less and no sulcal effacement. The AUROC of the RS and sulcal effacement was higher than the AUROC of the RS alone for predicting ICHTN (0.76 vs 0.71, p = 0.003, z-test). CONCLUSIONS The RS was predictive of ICHTN in patients with severe TBI, and the diagnostic accuracy of the model was improved with the inclusion of sulcal effacement at the vertex on CT of the head. Patients with a low RS and no sulcal effacement are likely at low risk for the development of ICHTN.
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