Andrei I Holodny

Memorial Sloan-Kettering Cancer Center, New York, New York, United States

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Publications (136)308.49 Total impact

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    ABSTRACT: Background: Glioblastomas treated with bevacizumab may develop low-signal apparent diffusion coefficient (low-ADC) lesions, which may reflect increased tumor cellularity or atypical necrosis. The purpose of this study was to examine the relationship between low-ADC lesions and overall survival (OS). We hypothesized that growing low-ADC lesions would be associated with shorter OS. Methods: We retrospectively identified 52 patients treated with bevacizumab for the first (n = 42, 81%) or later recurrence of primary glioblastoma, who had low-ADC lesions and 2 post-bevacizumab scans ≤90 days apart. Low-ADC lesion volumes were measured, and normalized 5th percentile histogram low-ADC values were recorded. Using OS as the primary endpoint, semiparametric Cox models were fitted to ascertain univariate and multivariate hazard ratios (HRs) with significance at P = .05. Results: Median OS was 9.1 months (95% CI = 7.2-14.3). At the second post-bevacizumab scan, the volume of the low-ADC lesion (median: 12.94 cm(3)) was inversely associated with OS, with larger volumes predicting shorter OS (HR = 1.014 [95% CI = 1.003-1.025], P = .009). The percent change in low-ADC volume (median: 6.8%) trended toward increased risk of death with growing volumes (P = .08). Normalized 5th percentile low-ADC value and its percent change were not associated with OS (P > .51). Also correlated with shorter OS were the pre-bevacizumab nonenhancing volume (P = .025), the first post-bevacizumab enhancing volume (P = .040), and the second post-bevacizumab enhancing volume (P = .004). Conclusions: The volume of low-ADC lesions at the second post-bevacizumab scan predicted shorter OS. This suggests that low-ADC lesions may be considered important imaging markers and included in treatment decision algorithms.
    Neuro-Oncology 11/2015; DOI:10.1093/neuonc/nov268 · 5.56 Impact Factor
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    ABSTRACT: Background and purpose: Epidermal growth factor receptor variant III is a common mutation in glioblastoma, found in approximately 25% of tumors. Epidermal growth factor receptor variant III may accelerate angiogenesis in malignant gliomas. We correlated T1-weighted dynamic contrast-enhanced MR imaging perfusion parameters with epidermal growth factor receptor variant III status. Materials and methods: Eighty-two consecutive patients with glioblastoma and known epidermal growth factor receptor variant III status who had dynamic contrast-enhanced MR imaging before surgery were evaluated. Volumes of interest were drawn around the entire enhancing tumor on contrast T1-weighted images and then were transferred onto coregistered dynamic contrast-enhanced MR imaging perfusion maps. Histogram analysis with normalization was performed to determine the relative mean, 75th percentile, and 90th percentile values for plasma volume and contrast transfer coefficient. A Wilcoxon rank sum test was applied to assess the relationship between baseline perfusion parameters and positive epidermal growth factor receptor variant III status. The receiver operating characteristic method was used to select the cutoffs of the dynamic contrast-enhanced MR imaging perfusion parameters. Results: Increased relative plasma volume and increased relative contrast transfer coefficient parameters were both significantly associated with positive epidermal growth factor receptor variant III status. For epidermal growth factor receptor variant III-positive tumors, relative plasma volume mean was 9.3 and relative contrast transfer coefficient mean was 6.5; for epidermal growth factor receptor variant III-negative tumors, relative plasma volume mean was 3.6 and relative contrast transfer coefficient mean was 3.7 (relative plasma volume mean, P < .001, and relative contrast transfer coefficient mean, P = .008). The predictive powers of relative plasma volume histogram metrics outperformed those of the relative contrast transfer coefficient histogram metrics (P < = .004). Conclusions: Dynamic contrast-enhanced MR imaging shows greater perfusion and leakiness in epidermal growth factor receptor variant III-positive glioblastomas than in epidermal growth factor receptor variant III-negative glioblastomas, consistent with the known effect of epidermal growth factor receptor variant III on angiogenesis. Quantitative evaluation of dynamic contrast-enhanced MR imaging may be useful as a noninvasive tool for correlating epidermal growth factor receptor variant III expression and related tumor neoangiogenesis. This potential may have implications for monitoring response to epidermal growth factor receptor variant III-targeted therapies.
    American Journal of Neuroradiology 09/2015; DOI:10.3174/ajnr.A4484 · 3.59 Impact Factor
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    ABSTRACT: Examining how left-hemisphere brain tumors might impact both the microstructure of the corpus callosum (CC) as measured by fractional anisotropy (FA) values in diffusion tensor imaging (DTI) as well as cortical language lateralization measured with functional MRI (fMRI). fMRI tasks (phonemic fluency and verb generation) were performed in order to detect activation in Broca's and Wernicke's area. Twenty patients with left-hemisphere brain tumors were investigated. fMRI results were divided into left dominant (LD), right dominant (RD), or codominant (CD) for language function. DTI was performed to generate FA maps in the anterior and posterior CC. FA values were correlated with the degree of language dominance. Patients who were LD or RD for language in Broca's area had lower FA in the anterior CC than those who were CD for language (median for CD = .72, LD = .66, RD = .65, P < .09). Lateralized versus CD group level analysis also showed that CD patients had higher FA in the anterior CC than patients who displayed strong lateralization in either hemisphere (median for CD = .72, lateralized = .65, P < .05). Our preliminary observations indicate that the greater FA in CD patients may reflect a more directional microstructure for the CC in this region, suggesting a greater need for interhemispheric transfer of information. Because brain tumors can cause compensatory codominance, our findings may suggest a mechanism by which interhemispheric transfer is facilitated during plasticity in the presence of a tumor. Copyright © 2015 by the American Society of Neuroimaging.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 08/2015; DOI:10.1111/jon.12275 · 1.73 Impact Factor
  • M Jenabi · K K Peck · R J Young · N Brennan · A I Holodny ·
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    ABSTRACT: The corticobulbar tract of the face and tongue, a critical white matter tract connecting the primary motor cortex and the pons, is rarely detected by deterministic DTI fiber tractography. Detection becomes even more difficult in the presence of a tumor. The purpose of this study was to compare identification of the corticobulbar tract by using deterministic and probabilistic tractography in patients with brain tumor. Fifty patients with brain tumor who underwent DTI were studied. Deterministic tractography was performed by using the fiber assignment by continuous tractography algorithm. Probabilistic tractography was performed by using a Monte Carlo simulation method. ROIs were drawn of the face and tongue motor homunculi and the pons in both hemispheres. In all subjects, fiber assignment by continuous tractography was ineffectual in visualizing the entire course of the corticobulbar tract between the face and tongue motor cortices and the pons on either side. However, probabilistic tractography successfully visualized the corticobulbar tract from the face and tongue motor cortices in all patients on both sides. No significant difference (P < .08) was found between both sides in terms of the number of voxels or degree of connectivity. The fractional anisotropy of both the face and tongue was significantly lower on the tumor side (P < .03). When stratified by tumor type, primary-versus-metastatic tumors, no differences were observed between tracts in terms of the fractional anisotropy and connectivity values (P > .5). Probabilistic tractography successfully reconstructs the face- and tongue-associated corticobulbar tracts from the lateral primary motor cortex to the pons in both hemispheres. © 2015 American Society of Neuroradiology.
    American Journal of Neuroradiology 08/2015; 36(11). DOI:10.3174/ajnr.A4430 · 3.59 Impact Factor
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    ABSTRACT: To compare glioblastoma and brain metastases using T1-weighted dynamic contrast-enhanced (DCE)-MRI perfusion technique. 26 patients with glioblastoma and 32 patients with metastatic brain lesions with no treatment who underwent DCE-MRI were, retrospectively, analyzed. DCE perfusion parameters K(trans) and Vp were calculated for the whole tumor. Signal intensity time curves were quantified by calculating the area under the curve (AUC) and the logarithmic slope of the washout phase to explore the heterogeneous tumor characteristics. Glioblastoma did not differ from all brain metastases in K(trans) (P = .34) or Vp (P = .47). Glioblastoma and melanoma metastases differed from hypovascular metastases in AUC and log slope of the washout phase of the signal intensity time curve (P < .05); however, glioblastoma and melanoma metastases did not differ from each other (AUC: P = .78, Log slope: P = .77). Glioblastoma and melanoma metastases differed from hypovascular metastases in the ratio of Voxelneg /Voxelpos (P< .03); however, they did not differ from each other. Glioblastoma and melanoma metastases differed from each other in Voxelneg_threshold at higher negative log slope threshold. DCE-MRI showed that it has a potential to differentiate glioblastomas, melanoma metastases and hypovascular brain tumors. Logarithmic slope of the washout phase and AUC of the signal intensity time curve were shown to be the best discriminator between hypervascular and hypovascular neoplasms. Copyright © 2015 by the American Society of Neuroimaging.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 08/2015; DOI:10.1111/jon.12281 · 1.73 Impact Factor

  • Cancer Research 08/2015; 75(15 Supplement):1498-1498. DOI:10.1158/1538-7445.AM2015-1498 · 9.33 Impact Factor
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    ABSTRACT: To evaluate whether breath-holding (BH) blood oxygenation level-dependent (BOLD) fMRI can quantify differences in vascular reactivity (VR), as there is a need for improved contrast mechanisms in gliomas. 16 patients (gliomas, grade II = 5, III = 2, IV = 9) were evaluated using the BH paradigm: 4-second single deep breath followed by 16 seconds of BH and 40 seconds of regular breathing for five cycles. VR was defined as the difference in BOLD signal between the minimal signal seen at the end of the deep breath and maximal signal seen at the end of BH (peak-to-trough). VR was measured for every voxel and compared for gray versus white matter and tumor versus normal contralateral brain. VR maps were compared to the areas of enhancement and FLAIR/T2 abnormality. VR was significantly lower in normal white matter than gray matter (P < .05) and in tumors compared to the normal, contralateral brain (P < 0.002). The area of abnormal VR (1103 ± 659 mm(2) ) was significantly greater (P = .019) than the enhancement (543 ± 530 mm(2) ), but significantly smaller (P = .0011) than the FLAIR abnormality (2363 ± 1232 mm(2) ). However, the variability in the areas of gadolinium contrast enhancement versus VR abnormality indicates that the contrast mechanism elicited by BH (caused by abnormal arteriolar smooth muscles) appears to be fundamentally different from the contrast mechanism of gadolinium enhancement (caused by the presence of "leaky" gap junctions). BH maps based on peak-to-trough can be used to characterize VR in brain tumors. VR maps in brain tumor patients appear to be caused by a different mechanism than gadolinium enhancement. Copyright © 2015 by the American Society of Neuroimaging.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 07/2015; DOI:10.1111/jon.12278 · 1.73 Impact Factor
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    ABSTRACT: The diagnosis of leptomeningeal metastasis (LM) has increased in frequency, as new therapies have lengthened the survival of patients with cancer. Early diagnosis and intervention help improve quality of life and prevent further neurological deterioration in LM. The detection of LM is often established by magnetic resonance imaging examinations, cerebrospinal fluid analysis, or both. We present a series of cases where LM was identified on fluid-attenuated inversion recovery or T2-weighted image but was nonenhancing on the traditionally more sensitive postcontrast T1-weighted sequences. Nonenhancing LM is unusual and not yet fully understood but should be considered in the appropriate clinical context and may become more common with increased utilization of antiangiogenic therapies.
    06/2015; DOI:10.1177/1941874415591702
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    ABSTRACT: Neurosurgery of the supplementary motor area (SMA) is associated with transient speech defects. We investigated whether SMA laterality correlates with postoperative speech defects. The authors reviewed 17 patients with SMA-area lesion resection and preoperative language fMRI. SMA laterality was calculated by comparison of voxel activation in paired SMAs by hand-drawn regions of interest (ROIs) (drawn by a neuroradiologist), and compared with qualitative assessment by two neuroradiologists. Postoperative speech defects before and after surgery were assessed by chart review. Six patients developed new speech defects that resolved within several months. Two of the patients had a pre-existing speech defect that had developed after prior SMA-area surgery. All these patients had left-sided lesions, while none of the four patients with a right-sided lesion developed a speech defect. Neuroradiologists' assessment of SMA laterality agreed with ROI calculation for the SMAs that were lateralized. However, for the SMAs in the "codominant" range by ROI, the neuroradiologists felt that all but one of the cases clearly lateralized, with the exception deemed indeterminate or codominant. No correlation between laterality of SMA and speech defect was identified. Twelve patients showed lateralization contralateral to the lesion. fMRI lateralization does not correlate with transient speech defects that developed from SMA-area surgery. Qualitative/visual assessment of SMA laterality was superior to ROI calculation because of the close proximity and possible overlap of signal from midline SMA. A majority of patients showed SMA lateralization contralateral to the SMA lesion. © The Author(s) 2015.
    06/2015; 28(3):281-8. DOI:10.1177/1971400915589681
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    ABSTRACT: Accurate localization of the foot/leg motor homunculus is essential because iatrogenic damage can render a patient wheelchair- or bed-bound. We hypothesized the following: 1) Readers would identify the foot motor homunculus <100% of the time on routine MR imaging, 2) neuroradiologists would perform better than nonradiologists, and 3) those with fMRI experience would perform better than those without it. Thirty-five attending-level raters (24 neuroradiologists, 11 nonradiologists) evaluated 14 brain tumors involving the frontoparietal convexity. Raters were asked to identify the location of the foot motor homunculus and determine whether the tumor involved the foot motor area and/or motor cortex by using anatomic MR imaging. Results were compared on the basis of prior fMRI experience and medical specialty by using Mann-Whitney U test statistics. No rater was 100% correct. Raters correctly identified whether the tumor was in the foot motor cortex 77% of the time. Raters with fMRI experience were significantly better than raters without experience at foot motor fMRI centroid predictions (13 ± 6 mm versus 20 ± 13 mm from the foot motor cortex center, P = 2 × 10(-6)) and arrow placement in the motor gyrus (67% versus 47%, P = 7 × 10(-5)). Neuroradiologists were significantly better than nonradiologists at foot motor fMRI centroid predictions (15 ± 8 mm versus 20 ± 14 mm, P = .005) and arrow placement in the motor gyrus (61% versus 46%, P = .008). The inability of experienced readers to consistently identify the location of the foot motor homunculus on routine MR imaging argues for using fMRI in the preoperative setting. Experience with fMRI leads to improved accuracy in identifying anatomic structures, even on routine MR imaging. © 2015 American Society of Neuroradiology.
    American Journal of Neuroradiology 04/2015; 36(8). DOI:10.3174/ajnr.A4292 · 3.59 Impact Factor
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    ABSTRACT: Accurate glioma grading is crucial for treatment planning and predicting prognosis. We performed a quantitative volumetric analysis to assess the diagnostic accuracy of histogram analysis of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) T1-weighted perfusion imaging in the preoperative evaluation of gliomas. Sixty-three consecutive patients with pathologically confirmed gliomas who underwent baseline DWI and DCE-MRI were enrolled. The patients were classified by histopathology according to tumor grade: 20 low-grade gliomas (grade II) and 43 high-grade gliomas (grades III and IV). Volumes-of-interest were calculated and transferred to DCE perfusion and apparent diffusion coefficient (ADC) maps. Histogram analysis was performed to determine mean and maximum values for Vp and Ktrans , and mean and minimum values for ADC. Comparisons between high-grade and low-grade gliomas, and between grades II, III, and IV, were performed. A Mann-Whitney U test at a significance level of corrected P ≤ .01 was used to assess differences. All perfusion parameters could differentiate between high-grade and low-grade gliomas (P < .001) and between grades II and IV, grades II and III, and grades III and IV. Significant differences in minimum ADC were also found (P < .01). Mean ADC only differed significantly between high and low grades and grades II and IV (P < .01). There were no differences between grades II and III (P = .1) and grades III and IV (P = .71). When derived from whole-tumor histogram analysis, DCE-MRI perfusion parameters performed better than ADC in noninvasively discriminating low- from high-grade gliomas. Copyright © 2015 by the American Society of Neuroimaging.
    Journal of neuroimaging: official journal of the American Society of Neuroimaging 04/2015; 25(5). DOI:10.1111/jon.12239 · 1.73 Impact Factor
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    ABSTRACT: PurposeTo differentiate pathologic from benign vertebral fractures, which can be challenging. We hypothesized that dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can aid in the noninvasive distinction between pathologic and benign fractures.Materials and Methods Consecutive patients with vertebral fractures who underwent DCE-MRI, biopsy, and kyphoplasty were reviewed. Forty-seven fractures were separated into pathologic and benign fractures. Benign fractures were in turn separated into acute and chronic fractures for further comparison. Regions of interest (ROIs) were placed over fractured vertebral bodies. Perfusion parameters: plasma volume (Vp), Ktrans, wash-in slope, peak enhancement, and area under the curve (AUC) were measured and compared between the three different groups of fractures. A Mann–Whitney U-test was conducted to assess the difference between the groups.ResultsPathologic fractures had significantly higher (P < 0.01) perfusion parameters (Vp, Ktrans, wash-in slope, peak enhancement, and AUC) compared with benign fractures. We also found significant differences (P < 0.001) in all parameters between chronic and acute fractures. Vp and Ktrans were able to differentiate between pathologic and acute fractures (P < 0.01). No significant differences were found with peak enhancement (P = 0.21) and AUC (P = 0.4) between pathologic and acute fractures.Conclusion Our data demonstrate that T1-weighted DCE-MRI has potential to differentiate between pathologic vs. benign, acute vs. chronic, and most important, benign acute vs. pathologic vertebral fractures. J. Magn. Reson. Imaging 2015.
    Journal of Magnetic Resonance Imaging 02/2015; 42(4). DOI:10.1002/jmri.24863 · 3.21 Impact Factor
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    ABSTRACT: Objectives Small cell lung cancers (SCLCs) are characterized by aberrantly-methylated O6-methyl-guanine-DNA methyltransferase (MGMT). Epigenetic silencing of MGMT is associated with loss of MGMT activity and improved sensitivity to alkylating agents in glioblastomas. We have reported the activity of temozolomide, a non-classical alkylating agent, in patients with relapsed sensitive or refractory SCLCs, given at 75 mg/m2/day for 21 of 28 days. However, prolonged myelosuppression was noted. We therefore evaluated a 5-day dosing schedule of temozolomide and examined MGMT as a predictive biomarker for temozolomide treatment in SCLC. Materials and Methods Patients with sensitive or refractory SCLCs and progression after one or two prior chemotherapy regimens received temozolomide 200 mg/m2/day for 5 consecutive days in 28-day cycles. The primary endpoint was tolerability. We also assessed MGMT promoter methylation status by PCR and MGMT expression by immunohistochemistry in tumor specimens. Results Of 25 patients enrolled, 5 experienced grade 3 or 4 toxicity (anemia, thrombocytopenia, neutropenia, and constipation). The partial response rate was 12% [95% CI: 3-31%], with partial responses in 2 refractory patients. We were able to obtain tumor samples for more than half of patients for MGMT testing. Conclusion Temozolomide 200 mg/m2/day for 5 days in 28-day cycles is tolerable and active in patients with relapsed SCLCs. No treatment-limiting prolonged cytopenias were observed, making this our preferred schedule for further studies. Acquisition of archived biospecimens is feasible and necessary in order to continue evaluating the role of MGMT as a predictive biomarker in SCLCs.
    Lung Cancer 11/2014; 86(2). DOI:10.1016/j.lungcan.2014.08.007 · 3.96 Impact Factor
  • Meredith Gabriel · Nicole P. Brennan · Kyung K. Peck · Andrei I. Holodny ·
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    ABSTRACT: Functional magnetic resonance imaging (fMRI) has become a common tool for presurgical sensorimotor mapping, and is a significant preoperative asset for tumors located adjacent to the central sulcus. fMRI has changed surgical options for many patients. This noninvasive tool allows for easy display and integration with other neuroimaging techniques. Although fMRI is a useful preoperative tool, it is not perfect. Tumors that affect the normal vascular coupling of neuronal activity will affect fMRI measurements. This article discusses the usefulness of blood oxygen level dependent (BOLD) fMRI with regard to preoperative motor mapping. Copyright © 2014 Elsevier Inc. All rights reserved.
    Neuroimaging Clinics of North America 11/2014; 24(4). DOI:10.1016/j.nic.2014.07.003 · 1.53 Impact Factor
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    ABSTRACT: Thirty-six metastases in 22 patients were studied prospectively using computed tomography perfusion. Regions of interests were drawn around: the enhancing part of the tumor, necrotic central part, periphery, peritumoral edema, and normal white matter. Cerebral blood volume, cerebral blood flow, and mean transit time were calculated for each zone. The enhancing part of the tumor significantly differed from the other zones in 11 of 12. Metastases of different primaries can be differentiated from one another with statistically significance (P<.05) by at least one perfusion parameter in 57% of cases. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinical Imaging 10/2014; 39(1). DOI:10.1016/j.clinimag.2014.10.006 · 0.81 Impact Factor
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    ABSTRACT: Intra-axial brain schwannomas are very rare. Several case reports have described the difficulty in differentiating these lesions from more common brain tumors using conventional imaging. We present the first report documenting the MR perfusion, MR spectroscopy, and FDG-PET/CT characteristics of an intra-axial schwannoma. Although our conclusions are limited to a single case, it appears that advanced imaging may potentially be helpful in differentiating intra-axial schwannomas from other tumors that look similar on routine imaging.
    09/2014; 4(3). DOI:10.3174/ng.3140088
  • Atin Saha · Kyung K Peck · Eric Lis · Andrei I Holodny · Yoshiya Yamada · Sasan Karimi ·
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    ABSTRACT: Study Design. Total of 40 patients with spinal metastases from renal cell carcinomas (RCC) or prostate carcinomas (PC) were studied using DCE (Dynamic contrast-enhanced) MRI.Objective. Our aim was to evaluate spinal metastases from RCC and PC to assess the sensitivity and specificity of perfusion parameters obtained by quantitative and semi-quantitative methods, which would allow for noninvasive discrimination between hypovascular and hypervascular lesions.Summary of Background Data. Conventional MRI can be inconclusive in assessing diagnostically complex spinal lesions in cancer patients in whom fibrosis, infarction, edema related to compression fractures, and infection may simulate malignant neoplasm. Conventional MRI is also of limited value in assessing tumor vascularity and identifying hypervascular tumors. DCE MRI offers an advantage over conventional MRI in that it provides anatomical, physiological, and hemodynamic information about neoplastic lesions.Methods. DCE perfusion parameters: vascular permeability (Ktrans), plasma volume (Vp), wash-in slope, and peak-enhancement were measured to assess their potential as discriminators of tumor vascularity. A Mann-Whitney test (at p≤0.01), was performed to quantify and compare significance of perfusion parameters between the two groups.Results. Of the four perfusion parameters studied, Vp was observed to have the largest difference in mean (μ) between PC (μ = 3.29/sec) and RCC metastases (μ = 5.92/sec). This was followed by the peak-enhancement, Ktrans, and wash-in parameters. A Mann-Whitney test showed a significant difference between Vp values for PC and RCC lesions (p≤0.001). Similarly, peak-enhancement showed a significant difference between the two histologies (p≤0.001), as did Ktrans (p≤0.01). The receiver operating characteristic curve showed that Vp recorded the highest area under the curve (0.867).Conclusion. Vp was shown to be the best discriminator between spinal metastases from PC and RCC with the mean Vp of RCC metastasis being 1.8 times that of the PC lesions, thus discriminating between hyper- and hypovascular metastases, which has important clinical implications.
    Spine 08/2014; 39(24). DOI:10.1097/BRS.0000000000000570 · 2.30 Impact Factor
  • Conference Paper: Neuroradiology
    Andrei I. Holodny ·
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    ABSTRACT: LEARNING OBJECTIVES View learning objectives under main course title.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE Dynamic contrast enhancement MR imaging (DCE-MRI) offers noninvasive characterization of the vascular microenvironment and hemodynamics. In this study, we hypothesize that DCE-MRI can be used to evaluate treatment response and predict tumor recurrence in patients with spinal metastases undergoing high dose radiotherapy (RT). METHOD AND MATERIALS We conducted a retrospective study of 30 patients with spinal metastases who underwent DCE-MRI before and after RT. 20 patients received single-fraction SRS (24 Gy), while 10 received hypofractionated SRS (27-30 Gy total). Kaplan-Meier analysis was used to estimate the actuarial local recurrence rates, which were compared using a log-rank test. Two compartment model-based perfusion parameters (Ktrans: vascular permeability and Vp: plasma volume) were measured for each metastasis, relative to normal-appearing bone marrow. Percent change in parameter values from pre- to post-treatment were calculated and statistically compared. RESULTS At 20-month median follow-up, 5/30 (17%) patients had pathological evidence of local recurrence (LR). 3/10 (30%) patients treated with hypofractionated SRS had LR, while 2/20 (10%) patients with single-fraction SRS had LR. 1- and 3-year actuarial local recurrence rates were 24% and 44% for the hypofractionated SRS group vs. 5% and 16% for the single-fraction SRS group (p=0.20). The average change in Vp and Ktrans for patients without LR vs. those with LR was -76% (range, -99% to -12%) and -66% (range, -99% to -9%) vs. +28% (range, -19% to +102%) and -14% (range, -50% to +84%) (p<0.01 for both). For patients with LR, positive changes in perfusion parameters were observed on average 6.6 months earlier than the LR was detected on standard imaging. CONCLUSION We demonstrated that changes in perfusion, particularly Vp, reflect tumor responses to high dose RT in spinal bone metastases. Additionally, these changes predicted local tumor recurrence on average >6 months earlier than standard imaging did. CLINICAL RELEVANCE/APPLICATION The ability of DCE-MRI to detect early treatment response and predict local recurrence has the potential to improve patient care and outcome.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Objective: Post-operative delirium is associated with pre-operative cognitive difficulties and diminished functional independence, both of which suggest that brain pathology may be present in affected individuals prior to surgery. Currently, there are few studies that have examined imaging correlates of post-operative delirium. To our knowledge, none have examined the association of delirium with existing structural pathology in pre-operative cancer patients. Here, we present a novel, retrospective strategy to assess pre-operative structural brain pathology and its association with post-operative delirium. Standard of care structural magnetic resonance imaging (MRIs) from a cohort of surgical candidates prior to surgery were analyzed for white matter hyperintensities and cerebral atrophy. Methods: We identified 23 non-small cell lung cancer patients with no evidence of metastases in the brain pre-operatively, through retrospective chart review, who met criteria for post-operative delirium within 4 days of surgery. 24 age- and gender-matched control subjects were identified for comparison to the delirium sample. T1 and fluid-attenuated inversion recovery sequences were collected from standard of care pre-operative MRI screening and assessed for white matter pathology and atrophy. Results: We found significant differences in white matter pathology between groups with the delirium group exhibiting significantly greater white matter pathology than the non-delirium group. Measure of cerebral atrophy demonstrated no significant difference between the delirium and non-delirium group. Conclusions: In this preliminary study utilizing standard of care pre-operative brain MRIs for assessment of structural risk factors to delirium, we found white matter pathology to be a significant risk factor in post-operative delirium. Limitations and implications for further investigation are discussed.
    Psycho-Oncology 09/2013; 22(9). DOI:10.1002/pon.3262 · 2.44 Impact Factor

Publication Stats

2k Citations
308.49 Total Impact Points


  • 2002-2015
    • Memorial Sloan-Kettering Cancer Center
      • • Department of Radiology
      • • Department of Psychiatry & Behavioral Sciences
      New York, New York, United States
  • 2012
    • Weill Cornell Medical College
      New York, New York, United States
  • 2009
    • University of Ottawa
      Ottawa, Ontario, Canada
  • 2005
    • Cornell University
      Итак, New York, United States
  • 2003-2004
    • Rutgers New Jersey Medical School
      • Department of Radiology
      Newark, New Jersey, United States
  • 1997
    • University of Oslo
      Kristiania (historical), Oslo, Norway
  • 1995
    • CUNY Graduate Center
      New York, New York, United States