The management of incidental low-grade gliomas using magnetic resonance imaging: systematic review and optimal treatment paradigm

2011 ◽  
Vol 31 (6) ◽  
pp. E12 ◽  
Author(s):  
Ashish H. Shah ◽  
Karthik Madhavan ◽  
Deborah Heros ◽  
Daniel M. S. Raper ◽  
J. Bryan Iorgulescu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mr Imaging ◽  
Active Surveillance ◽  
Case Series ◽  
Treatment Decisions ◽  
Low Grade ◽  
Management Options ◽  
Low Grade Gliomas ◽  
Presenting Symptoms ◽  
Radiological Evidence

Object The discovery of incidental low-grade gliomas (LGGs) on MR imaging is rare, and currently there is no existing protocol for management of these lesions. Various studies have approached the dilemma of managing patients with incidental LGGs. While some advocate surgery and radiotherapy, others reserve surgery until there is radiological evidence of growth. For neurosurgeons and radiologists, determining the course of action after routine brain imaging poses not only a medical but also an ethical dilemma. The authors conducted a systematic review of case reports and case series in hopes of enhancing the current understanding of the management options for these rare lesions. Methods A PubMed search was performed to include all relevant MR imaging studies in which management of suspected incidental LGG was reported. Comparisons were made between the surgical treatment arm and the active surveillance arm in terms of outcome, mode of discovery, reasons for treatment, and histology. Results Nine studies with 72 patients were included in this study (56 in the surgical arm and 16 in the active surveillance arm). Within the surgical arm, 49% remained deficit free after treatment, 25% showed evidence of tumor progression, 13% underwent a second treatment, and 7% died. The active surveillance group resulted in no unanticipated adverse events, with serial imaging revealing no tumor growth in all cases. Lesion regression was reported in 31% of this group. The surgical arm's mortality rate was 7% compared with 0% in the active surveillance arm. Conclusions Treatment decisions for incidental LGG should be individualized based on presenting symptoms and radiological evidence of growth. The asymptomatic patient may be monitored safely with serial MR imaging and occasionally PET scanning before treatment is initiated. In patients presenting with nonspecific symptoms or concurrent symptomatic lesions, treatment may be initiated earlier to reduce potential morbidity. All treatment decisions must be tempered by patient factors and expectations of anticipated benefit.

scholarly journals Management of low-grade glioma: a systematic review and meta-analysis

2018 ◽  
Vol 6 (4) ◽  
pp. 249-258 ◽  
Author(s):  
Timothy J Brown ◽  
Daniela A Bota ◽  
Martin J van Den Bent ◽  
Paul D Brown ◽  
Elizabeth Maher ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Low Grade Glioma ◽  
World Health ◽  
Subtotal Resection ◽  
Low Grade ◽  
Evidence Based ◽  
Free Survival ◽  
Low Grade Gliomas

Abstract Background Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.

Advanced MR imaging in hemispheric low-grade gliomas before surgery; the indications and limits in the pediatric age

2016 ◽  
Vol 32 (10) ◽  
pp. 1813-1822 ◽  
Author(s):  
Simona Gaudino ◽  
Rosellina Russo ◽  
Tommaso Verdolotti ◽  
Massimo Caulo ◽  
Cesare Colosimo
Keyword(s):  
Mr Imaging ◽  
Low Grade ◽  
Pediatric Age ◽  
Low Grade Gliomas

Signs and symptoms associated with synthetic cannabinoid toxicity: systematic review

2016 ◽  
Vol 24 (6) ◽  
pp. 598-601 ◽  
Author(s):  
Julie Courts ◽  
Virginia Maskill ◽  
Andrew Gray ◽  
Paul Glue
Keyword(s):  
Systematic Review ◽  
Emergency Services ◽  
Case Reports ◽  
Synthetic Cannabinoids ◽  
Case Series ◽  
Signs And Symptoms ◽  
Synthetic Cannabinoid ◽  
Symptom Reporting ◽  
Presenting Symptoms ◽  
Study Population

Aims: Use of synthetic cannabinoids is associated with significant physical and psychological harms. This research quantified reported toxicities from published reports and assessed the influence of size of the reported study population on rates of symptom reporting. Methods: Systematic review of published case reports and case series of toxicity associated with use of synthetic cannabinoids. Results: Symptoms associated with synthetic cannabinoid toxicity were reported for 3695 individuals, predominantly young males. Symptoms included physiological (e.g. tachycardia, hypertension, nausea/vomiting), emotional (e.g. agitation, irritability, paranoia), behavioural (e.g. drowsiness, aggression) and perceptual (e.g. hallucinations) domains. Most common symptoms were tachycardia (30.2% of cases), agitation (13.5%), drowsiness (12.3%), nausea/vomiting (8.2%) and hallucinations (7.6%). Death or serious medical complications were uncommon (e.g. death 0.2%, stroke 0.1%, myocardial infarction 0.09%). Case reports/smaller case series ( n<10) reported statistically significantly higher rates for 29/34 symptoms than larger case series ( n≥10), which could represent selection bias. Conclusions: Symptoms of synthetic cannabinoid toxicity are variable and cover a number of physical and psychological domains. Symptom reporting varies by study population size. Due to the variable presenting symptoms of synthetic cannabinoid toxicity, clinicians in emergency services should consider synthetic cannabinoid toxicity when evaluating young adult male patients presenting with unexplained agitation or cardiovascular symptoms.

scholarly journals Comparison of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Arterial Spin Labeling MR Imaging in Gliomas

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Yuankai Lin ◽  
Jianrui Li ◽  
Zhiqiang Zhang ◽  
Qiang Xu ◽  
Zhenyu Zhou ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
White Matter ◽  
Mr Imaging ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Intravoxel Incoherent Motion ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
High Grade Gliomas

Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (D∗), slow diffusion coefficient (D), fractional perfusion-related volume (f), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF andD∗were higher in the high grade gliomas, whereas ADC,D, andfwere lower (allP<0.05). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) ofD∗, CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated withfin tumor (r=-0.619,P=0.001). ADC was positively correlated withDin both tumor and white matter (r=0.887,P=0.000andr=0.824,P=0.000, resp.). There was no correlation between CBF andD∗in both tumor and white matter (P>0.05). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas.

scholarly journals Myocarditis associated with Covid-19 disease: a systematic review of published Case reports and Case series

2021 ◽  
Author(s):  
Sawai Singh Rathore ◽  
Gianpier Alonzo Rojas ◽  
Manush Sondhi ◽  
Suveenkrishna Pothuru ◽  
Reshma Pydi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Acute Myocarditis ◽  
Case Series ◽  
Cardiac Biomarkers ◽  
Pulmonary Tissue ◽  
Mortality And Morbidity ◽  
Presenting Symptoms ◽  
St Segment ◽  
Inflammatory Infiltrates

Background: Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. Although this disease primarily involves pulmonary tissue, rapidly advancing research has established cardiac involvement in Covid-19 patients. Objective: This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. Results: Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being male. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and Brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were Non-specific and included ST-segment and T-wave changes. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. Conclusion: Due to the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Bed rest: outdated following traumatic solid organ injury?

2020 ◽  
pp. bmjmilitary-2019-001374
Author(s):  
James Ashcroft ◽  
M Khan
Keyword(s):  
Systematic Review ◽  
Case Series ◽  
Bed Rest ◽  
Healthcare Services ◽  
Organ Injury ◽  
Cochrane Library ◽  
Low Grade ◽  
Solid Organ ◽  
Solid Organ Injury ◽  
Early Ambulation

IntroductionThis systematic review aimed to evaluate early ambulation protocols implemented for traumatic solid organ injury.MethodsThe electronic databases PubMed, Medline (Ovid), Embase and Cochrane Library were searched without time constraint to identify prospective and retrospective analyses, randomised controlled trials, cohort studies, and case series that investigated early ambulation in solid organ trauma.ResultsSix studies met the predefined inclusion criteria and were reviewed. Three studies investigated early ambulation protocols in direct comparison with bed rest. The remaining three studies were early ambulation case series. In all studies there was no convincing evidence to suggest differences in clinical outcomes between early ambulation and bed rest protocols. In all studies early ambulation resulted in a reduced length of hospitalisation and decreased cost to national healthcare services.ConclusionsThis systematic review has found preliminary evidence that suggests bed rest has no clinical benefit in those with low-grade to mid-grade (grades 1–2) solid organ injury. Further studies are required to inform guidance to improve trauma patient outcomes.

Circumferential sulcus-guided resection technique for improved outcomes of low-grade gliomas

2022 ◽  
pp. 1-11
Keyword(s):  
Extent Of Resection ◽  
Neurological Complications ◽  
Low Grade ◽  
Newly Diagnosed ◽  
Imaging Data ◽  
Volumetric Imaging ◽  
Exact Test ◽  
Low Grade Gliomas ◽  
Presenting Symptoms ◽  
Piecemeal Resection

OBJECTIVE Many neurosurgeons resect nonenhancing low-grade gliomas (LGGs) by using an inside-out piecemeal resection (PMR) technique. At the authors’ institution they have increasingly used a circumferential, perilesional, sulcus-guided resection (SGR) technique. This technique has not been well described and there are limited data on its effectiveness. The authors describe the SGR technique and assess the extent to which SGR correlates with extent of resection and neurological outcome. METHODS The authors identified all patients with newly diagnosed LGGs who underwent resection at their institution over a 22-year period. Demographics, presenting symptoms, intraoperative data, method of resection (SGR or PMR), volumetric imaging data, and postoperative outcomes were obtained. Univariate analyses used ANOVA and Fisher’s exact test. Multivariate analyses were performed using multivariate logistic regression. RESULTS Newly diagnosed LGGs were resected in 519 patients, 208 (40%) using an SGR technique and 311 (60%) using a PMR technique. The median extent of resection in the SGR group was 84%, compared with 77% in the PMR group (p = 0.019). In multivariate analysis, SGR was independently associated with a higher rate of complete (100%) resection (27% vs 18%) (OR 1.7, 95% CI 1.1–2.6; p = 0.03). SGR was also associated with a statistical trend toward lower rates of postoperative neurological complications (11% vs 16%, p = 0.09). A subset analysis of tumors located specifically in eloquent brain demonstrated SGR to be as safe as PMR. CONCLUSIONS The authors describe the SGR technique used to resect LGGs and show that SGR is independently associated with statistically significantly higher rates of complete resection, without an increase in neurological complications, than with PMR. SGR technique should be considered when resecting LGGs.

Low-Grade Gliomas: Dynamic Susceptibility-weighted Contrast-enhanced Perfusion MR Imaging—Prediction of Patient Clinical Response

Radiology ◽  
2006 ◽  
Vol 238 (2) ◽  
pp. 658-667 ◽  
Author(s):  
Meng Law ◽  
Sarah Oh ◽  
James S. Babb ◽  
Edwin Wang ◽  
Matilde Inglese ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Clinical Response ◽  
Low Grade ◽  
Dynamic Susceptibility ◽  
Low Grade Gliomas ◽  
Contrast Enhanced ◽  
Perfusion Mr ◽  
Perfusion Mr Imaging

Low-Grade Gliomas: Do Changes in rCBV Measurements at Longitudinal Perfusion-weighted MR Imaging Predict Malignant Transformation?

Radiology ◽  
2008 ◽  
Vol 247 (1) ◽  
pp. 170-178 ◽  
Author(s):  
Nasuda Danchaivijitr ◽  
Adam D. Waldman ◽  
Daniel J. Tozer ◽  
Christopher E. Benton ◽  
Gisele Brasil Caseiras ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Malignant Transformation ◽  
Low Grade ◽  
Low Grade Gliomas
Sign in / Sign up

Export Citation Format

Share Document