Time-dependent MR diffusion analysis of functioning and nonfunctioning pituitary adenomas/pituitary neuroendocrine tumors Kiyohisa Kamimura, Tomohiro Tokuda, Junki Kamizono, Tsubasa Nakano, Tomohito Hasegawa, et al. Journal of Neuroimaging, 2025 Background and PurposeDifferentiation between functioning and nonfunctioning pituitary adenomas/pituitary neuroendocrine tumors (PAs) is clinically relevant. The goal of this study was to determine the feasibility of using time‐dependent diffusion MRI (dMRI) for microstructural characterization of PAs.MethodsThe study included 54 participants, 24 with functioning PA and 30 with nonfunctioning PA. Time‐dependent dMRI of the pituitary gland was performed using an inner field‐of‐view echo‐planar imaging based on 2‐dimensional‐selective radiofrequency excitations with oscillating gradient and pulsed gradient preparation (effective diffusion time: 7.1 and 36.3 ms) at b‐values of 0 and 1000 seconds/mm2. Each tumor had its apparent diffusion coefficients (ADCs) measured at two diffusion times (ADC7.1 ms and ADC36.3 ms), its ADC change (cADC), and relative ADC change. The mean values of diffusion parameters were compared between functioning and nonfunctioning PAs. We compared the diffusion parameters of nonfunctioning PAs with those of each type of hormone‐producing PAs. The diagnostic performances of the diffusion parameters were assessed.ResultsThe cADC was significantly higher in functioning PAs than nonfunctioning PAs (p = .0124). The receiver operating characteristic (ROC) curve analysis revealed that cADC (area under the ROC curve [AUC] = .677, p = .017) is effective in distinguishing between functioning and nonfunctioning PAs. The cADC was significantly higher in growth hormone (GH)‐producing PAs compared to nonfunctioning PAs (p = .006). The ROC curve analysis indicated that cADC (AUC = .771, p < .001) effectively distinguishes between GH‐producing and nonfunctioning PAs.ConclusionsThe cADC derived from time‐dependent dMRI could distinguish between functioning and nonfunctioning PAs, particularly those producing GH.
Primary spinal cord gliomas: Pathologic features associated with prognosis Yuki Tanaka, Manabu Natsumeda, Masayuki Ohashi, Rie Saito, Nayuta Higa, et al. Journal of Neuropathology and Experimental Neurology, 2024 Primary spinal cord gliomas are rare and are associated with high mortality. Unlike brain tumors, the clinicopathological features of spinal cord gliomas are not well defined. We analyzed clinical, histopathology, and immunohistochemical features and overall survival (OS) of 25 patients with primary spinal cord gliomas treated between 1994 and 2023 at 4 institutions. IDH1 R132H, H3K27M, and p53 were assessed by immunohistochemistry (IHC). Four (16%), 5 (20%), 2 (8%), and 13 (52%) patients were diagnosed as having grades 1, 2, 3, and 4 gliomas according to the World Health Organization (WHO) 2021 classification, respectively. One case (4%), with a circumscribed diffuse midline glioma, H3K27-altered, had a rare molecular profile and could not be graded. IHC demonstrated H3K27M positivity, indicative of H3F3A K27M or HIST1H3B K27M mutation, in 9 (36%) patients. H3K27me3-loss was evident in 13 (52%) patients. In one patient with a grade 1 tumor that showed negative staining for H3K27M and H3K27me3 loss, numbers of EZHIP-positive cells were increased, suggesting diffuse midline glioma, H3K27-altered (WHO grade 4). H3K27me3 loss, frequency of p53 positive cells (≥10%), MIB-1 index (≥10%), and high histopathological grades significantly correlated with poor OS. These results indicate the pathological and immunohistochemical characteristics of primary spinal cord gliomas that impact prognosis.
A pituitary gland squeezed upward by intrasellar kissing carotid arteries: Mimicking a pituitary microadenoma Eri Inoue, Shingo Fujio, Hiroshi Hosoyama, Shinichiro Yoshimura, FM Moinuddin, et al. Surgical Neurology International, 2024 Background: Intrasellar kissing carotid arteries are a rare variant in which bilateral internal carotid arteries run very near each other at their cavernous sinus portion. We encountered a woman with the pituitary gland mimicking a pituitary microadenoma because the pituitary gland was compressed bilaterally by intrasellar kissing carotid arteries. Case Description: A 61-year-old woman with a chronic headache underwent magnetic resonance imaging, which revealed a sellar mass measuring 10.2 mm in height, 8.2 mm in length, and 4.0 mm in width at the midintercarotid level. Blood levels of all pituitary and target-organ hormones were within normal range. The height and superior convex shape of the sellar mass suggested that it was a nonfunctioning microadenoma, which was monitored over the past 16 years. A recent three-dimensional reconstruction of magnetic resonance angiography clearly showed that the pituitary gland was squeezed upward, compressed bilaterally, and extended superiorly by intrasellar kissing carotid arteries. Conclusion: The pituitary gland can be squeezed upward by intrasellar kissing carotid arteries and mimic pituitary tumor.
Age-independent benefits of postoperative rehabilitation during chemoradiotherapy on functional outcomes and survival in patients with glioblastoma Keisuke Natsume, Akira Yoshida, Harutoshi Sakakima, Hajime Yonezawa, Kentaro Kawamura, et al. Journal of Neuro Oncology, 2024 Purpose To investigate the impact of early and continuous postoperative inpatient rehabilitation during chemoradiotherapy on functional outcomes and overall survival (OS) in patients with glioblastoma (GBM), particularly in different age groups. Methods This retrospective cohort study at a university hospital (2011–2016) included 75 of 119 consecutive patients newly diagnosed with GBM who underwent standardized treatment and postoperative rehabilitation. Patients were divided into older (≥ 65 years, n = 45) and younger (< 65 years, n = 30) groups, engaging in a 50-day rehabilitation program. We assessed rehabilitation progress, Barthel Index (BI), Brunnstrom Recovery Stage (BRS), adverse events, and OS. BI at discharge and survival were analyzed using multivariate and Cox regression models, respectively. Results The mean age was 72.5 ± 6.3 and 52.4 ± 7.8 years in the older and younger groups, respectively. Both groups demonstrated significant improvements in BI and BRS. Despite more adverse events in the older group, no significant difference existed in median OS (older group: 18.7 months vs. younger group: 18.3 months, p = 0.87). Early walking training, reduced fatigue during chemoradiotherapy, and high Karnofsky Performance Status at admission significantly impacted the BI at discharge. Cox regression analysis identified the BI at discharge as a significant predictor of survival (hazard ratio [HR] 0.98, 95% confidence interval [CI] 0.97–0.99, p = 0.008). Conclusion Integrated rehabilitation improves functional outcomes, and enhanced ADL at discharge is associated with improved survival outcomes in patients with GBM, regardless of age. This highlights the need for personalized rehabilitation in treatment protocols. Further prospective studies are warranted to confirm these findings.
Cerebrospinal fluid protein concentration in patients with lumbar spinal stenosis Hitoshi Yamahata, Kosei Ijiri, Fumito Tanabe, Kyoichi Murasumi, Yushi Nagano, et al. Surgical Neurology International, 2024 Background: In this study, we examined the impact and degree of lumbar stenosis on cerebrospinal fluid (CSF) protein concentration. Methods: In this retrospective study, we analyzed protein concentrations in CSF samples of 61 patients with lumbar spinal stenosis (LSS) obtained during pre-operative myelography. Patients were divided into two groups: those showing no block to contrast (Group A) versus those showing medium block to contrast below the lumbar puncture level (Group B). Results: The CSF protein concentration in Group B (104.3 ± 59 g/dL) patients with medium block was significantly greater than that in Group A (65.1 ± 33 g/dL) patients without medium block. Conclusion: A higher average CSF protein concentration was seen in Group B patients with significant lumbar stenosis versus Group A patients without significant lumbar stenosis. Theoretically, damage to the cauda equina in patients with LSS may cause these elevated CSF protein levels.
