Brent D Weinberg

• MD, PhD
• Professor (Assistant) at Emory University

Patient: Female, 63-year-old Final Diagnosis: Anaplastic hemangiopericytoma, or Solitary Fibrour Tumor WHO grade III Symptoms: Asymptomatic Clinical Procedure: Trans-nasal transsphenoidal adenectomy Specialty: Neurology Objective Rare disease Background Sellar solitary fibrous tumors (SFT) are uncommon brain tumors belonging to the fibroblastic a...

Background: Spectroscopic MRI (sMRI) is a quantitative imaging technique that maps infiltrated tumors in the brain without contrast injections. In a previous study (NCT03137888), sMRI-guided radiation treatment extended patient survival, showing promise for clinical translation. The spectral fitting of individual voxels in an sMRI dataset generate...

“Just Accepted” papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could aff...

The prognosis and treatment planning of Glioblastoma Multiforme (GBM) involves a holistic analysis of imaging, clinical, and molecular data. The correlation of imaging and molecular features has garnered much interest due to its potential to reduce the number of invasive procedures on a patient and resource utilization of the overall prognostic and...

Background and Objectives: Acute aortic dissection (AD) is a life-threatening condition in which early detection can significantly improve patient outcomes and survival. This study evaluates the clinical benefits of integrating a deep learning (DL)-based application for the automated detection and prioritization of AD on chest CT angiographies (CTA...

Background and Objectives: Acute aortic dissection (AD) is a life-threatening condition and early detection can significantly improve patient outcomes and survival. This study evaluates the clinical benefits of integrating a deep-learning (DL)-based application for automated detection and prioritisation of AD on chest CT angiographies (CTAs), focus...

Background and purpose: The Brain Tumor Reporting and Data System (BT-RADS) is a structured radiology reporting algorithm that was introduced to provide uniformity in post-treatment primary brain tumor follow-up and reporting, but its interrater reliability (IRR) assessment has not been widely studied. Our goal is to evaluate the IRR among neurora...

Simple Summary This report aims to demonstrate the value of spectroscopic MRI in glioma diagnostics and therapeutics planning. We first demonstrate clinical translatability by showing a biopsy case of a lower-grade glioma patient. The biopsy target was delineated via spectroscopy. Then, we conducted a secondary analysis of our clinical trial treati...

Background and purpose: Brain imaging plays an important role in investigating patients with cognitive decline and ruling out secondary causes of dementia. This study compares the diagnostic value of quantitative hippocampal volumes derived from automated volumetric software and structured scoring scales in differentiating Alzheimer disease, mild...

Simple Summary With several previous efforts to segment pre-surgical brain tumor lesions from MRI, we sought to shine a different light on the problem. Radiation treatment planning post-surgery still relies heavily on manual contouring of T1-weighted contrast-enhanced and T2-weighted fluid-attenuated inversion recovery MRI. This is one of the first...

Simple Summary Due to the infiltrative nature of glioblastoma, standard MRI techniques, such as T1-weighted contrast-enhanced (T1w-CE) and T2-weighted fluid-attenuated inversion recovery (FLAIR), imperfectly delineate radiation-targeted tumor volume. With spectroscopic MRI, the ratio of choline elevation, a tumor biomarker and N-acetylaspartate red...

Accurate radiation therapy (RT) targeting is crucial for glioblastoma treatment but may be challenging using clinical imaging alone due to the infiltrative nature of glioblastomas. Precise targeting by whole-brain spectroscopic MRI, which maps tumor metabolites including choline (Cho) and N-acetylaspartate (NAA), can quantify early treatment-induce...

Histone deacetylase inhibitors (HDACis) are drugs that target the epigenetic state of cells by modifying the compaction of chromatin through effects on histone acetylation. Gliomas often harbor a mutation of isocitrate dehydrogenase (IDH) 1 or 2 that leads to changes in their epigenetic state presenting a hypermethylator phenotype. We postulated th...

Multidisciplinary tumor boards (TB) are an essential part of brain tumor care, but quantifying the impact of imaging on patient management is challenging due to treatment complexity and a lack of quantitative outcome measures. This work uses a structured reporting system for classifying brain tumor MRIs, the brain tumor reporting and data system (B...

Background and purpose: Spontaneous intracranial hypotension (SIH) is a known cause of headaches and neurologic symptoms, but the frequency of cranial nerve symptoms and abnormalities on magnetic resonance imaging (MRI) has not been well described. The purpose of this study was to document cranial nerve findings in patients with SIH and determine...

Glioblastoma (GBM) is a fatal disease, with poor prognosis exacerbated by difficulty in assessing tumor extent with imaging. Spectroscopic MRI (sMRI) is a non-contrast imaging technique measuring endogenous metabolite levels of the brain that can serve as biomarkers for tumor extension. We completed a three-site study to assess survival benefits of...

CT myelography is an important imaging modality that combines the advantages of myelography and the high resolution of CT. It provides a detailed delineation of pathologic spine conditions, especially those involving the thecal sac and its contents. However, the role of CT myelography has dramatically and appropriately decreased with the advent of...

Many radiology departments have successfully increased trainee research involvement by providing protected academic time for research, offering travel funding for conferences, and developing research-focused curriculum via resident research tracks and other mechanisms. A departmental platform for trainees to share their scholarly projects can foste...

Glioblastoma (GBM) is highly aggressive and has a poor prognosis. Belinostat is a histone deacetylase inhibitor with blood–brain barrier permeability, anti-GBM activity, and the potential to enhance chemoradiation. The purpose of this clinical trial was to assess the efficacy of combining belinostat with standard-of-care therapy. Thirteen patients...

BACKGROUND Glioblastomas (GBMs) are aggressive brain tumors despite radiation therapy (RT) to 60 Gy and temozolomide (TMZ). Spectroscopic magnetic resonance imaging (sMRI), which measures levels of specific brain metabolites, can delineate regions at high-risk for GBM recurrence not visualized on contrast-enhanced (CE) MRI. We conducted a clinical...

DESCRIPTION Magnetic resonance imaging (MRI) has an important role to play in the care of patients with brain injury or disease, but other forms of clinical imaging are also useful. For cancer patients, MRI is often used in initial diagnosis, treatment planning, and continued follow-up. Here, the many variations of MRI, from contrast-enhanced T1-we...

Purpose/Objective(s) Low-dose radiotherapy (LD-RT) is a well-established treatment for multiple human inflammatory conditions. Whole-lung LD-RT may be effective in COVID-19-related pneumonia. Materials/Methods Patients hospitalized with COVID-19-related pneumonia receiving supportive care, glucocorticosteroids, and/or remdesivir were administered...

Background Low-dose radiotherapy (LD-RT) has produced anti-inflammatory effects in both animal models and early human trials of COVID-19-related pneumonia. The role of whole-lung LD-RT within existing treatment paradigms merits further study. Methods A phase II prospective trial studied the addition of LD-RT to standard drug treatments. Hospitaliz...

PURPOSE Glioblastomas (GBMs) are highly aggressive brain tumors with poor prognosis. Belinostat is a histone deacetylase inhibitor with blood–brain barrier permeability, anti-GBM activity, and potential to enhance chemoradiation. This clinical trial sought to determine a tolerable dose of concurrent belinostat and assess the clinical efficacy of co...

Background and Purpose Percutaneous trigeminal tractotomy is an ablative procedure that can be used to treat trigeminal neuralgia in patients who have failed prior pharmacologic and surgical treatments. Using perioperative computed tomography (CT) guidance, ablation of the descending spinal trigeminal nucleus and trigeminal tract can be performed p...

PurposeGlioblastoma (GBM) is highly aggressive with poor prognosis. Belinostat is a histone deacetylase inhibitor with blood–brain barrier permeability, anti-GBM activity, and potential to enhance chemoradiation. The purpose of this clinical trial was to assess the clinical efficacy of combining belinostat with standard-of-care therapy for GBMs. Me...

Glioblastoma (GBM) is the most common and deadly primary brain tumor in adults. Some of the genetic variations identified thus far, such as IDH mutation and MGMT promotor methylation, have implications for survival and response to therapy. A recent analysis of long-term GBM survivors showed that concurrent gain of chromosomes 19 and 20 (19/20 co-ga...

PurposeMRI is the standard imaging modality used for diagnosis, treatment planning, and post-treatment management of gliomas. Contrast-enhanced T1-weighted (CE-T1w) MRI is used to plan biopsy and radiation for grade IV gliomas but is less effective for grade II and III gliomas (i.e., low-to-intermediate grade gliomas) which may have minimal or no e...

2018 Background: Glioblastoma (GBM) is the most common adult primary malignant brain tumor. These pts have poor outcomes [median overall survival (OS) ̃ 16 months] despite radiation therapy (RT) to 60 Gy and temozolomide (TMZ). Magnetic resonance spectroscopy (MRS) measures levels of specific metabolites in the brain including choline (Cho) and N-a...

Hirayama disease is a cervical flexion myelopathy that typically causes upper extremity weakness in young male patients. We present two male patients (age 15 and 29) with MRI findings of thoracic ligamentous laxity similar in appearance to Hirayama disease. However, patients presented with atypical symptoms, specifically back pain and paresthesia o...

Non-small cell lung cancer (NSCLC) commonly presents with metastasis to the brain. When brain metastases are treated with stereotactic radiosurgery (SRS), longitudinal imaging to monitor treatment response may identify radiation necrosis, metastasis progression, and/or another primary brain malignancy. A 60-year-old female with metastatic NSCLC inv...

Magnetic resonance spectroscopy (MRS) is a valuable tool for imaging brain tumors, primarily as an adjunct to conventional imaging and clinical presentation. MRS is useful in initial diagnosis of brain tumors, helping differentiate tumors from possible mimics such as metastatic disease, lymphoma, demyelination, and infection, as well as in the subs...

Background: Phase I/II clinical trials have explored whole-lung low-dose radiotherapy (LD-RT) as a potential treatment for patients with COVID-19-related acute respiratory distress syndrome (ARDS). Initial findings require reproduction. Concomitant LD-RT administration with existing therapies requires safety evaluation. Methods: Patients with COVID...

Background The rapid spread of coronavirus disease 2019 (COVID-19) revealed significant constraints in critical care capacity. In anticipation of subsequent waves, reliable prediction of disease severity is essential for critical care capacity management and may enable earlier targeted interventions to improve patient outcomes. The purpose of this...

Purpose/Objective Phase I clinical trials have established low-dose, whole-lung radiotherapy (LD-RT) as safe for patients with COVID-19-related pneumonia. By focally dampening cytokine hyperactivation, LD-RT may improve disease outcomes through immunomodulation. Methods and Materials Patients with COVID-19-related pneumonia were treated with 1.5 G...

INTRODUCTION Glioblastoma (GBM) is highly aggressive with poor prognosis. Belinostat is a histone deacetylase inhibitor with blood–brain barrier permeability that has anti-GBM activity and may enhance effects of chemoradiation. Our institution conducted a clinical trial evaluating clinical efficacy of belinostat with standard-of-care therapy for GB...

Background Individuals of advanced age with comorbidities face a higher risk of death from coronavirus disease 2019 (COVID‐19), especially once they are ventilator‐dependent. Respiratory decline in patients with COVID‐19 is precipitated by a lung‐mediated aberrant immune cytokine storm. Low‐dose lung radiation was used to treat pneumonia in the pre...

Introduction: Individuals with advanced age and comorbidities face risk of death from COVID-19, especially once ventilator-dependent, precipitated by an immune cytokine storm in the lungs. Lymphocytes, a mediator of cytokine storms, are exquisitely sensitive to ionizing radiation. Low doses of radiation therapy (LD-RT) were used to treat infectious...

Background: Safety of whole-lung low-dose radiation therapy (LD-RT) for COVID-19 pneumonia has been established in two phase I trials. By focally dampening pulmonary cytokine hyperactivation, LD-RT may improve outcomes in hospitalized and oxygen-dependent COVID-19 patients. Methods: Patients with COVID-19 pneumonia were treated with 1.5 Gy whole-lu...

Background: Individuals with advanced age and comorbidities face higher risk of death from COVID-19, especially once ventilator-dependent. Respiratory decline in COVID-19 is mediated by a pneumonic aberrant immune cytokine storm. Low-dose radiation was used to treat pneumonia in the pre-antibiotic era. Radiation immunomodulatory effects may improve...

The aim of this study is to develop an automated classification method for Brain Tumor Reporting and Data System (BT-RADS) categories from unstructured and structured brain magnetic resonance imaging (MR) reports. This retrospective study included 1410 BT-RADS structured reports dated from January 2014 to December 2017 and a test set of 109 unstruc...

Glioblastoma is a common and aggressive form of brain cancer affecting up to 20,000 new patients in the US annually. Despite rigorous therapies, current median survival is only 15-20 months. Patients who complete initial treatment undergo follow-up imaging at routine intervals to assess for tumor recurrence. Imaging is a central part of brain tumor...

While deep learning approaches have shown remarkable performance in many imaging tasks, most of these methods rely on availability of large quantities of data. Medical image data, however, is scarce and fragmented. Generative Adversarial Networks (GANs) have recently been very effective in handling such datasets by generating more data. If the data...

Background: The rapid spread of coronavirus disease 2019 (COVID-19) revealed significant constraints in critical care capacity. In anticipation of subsequent waves, reliable prediction of disease severity is essential for critical care capacity management and may enable earlier targeted interventions to improve patient outcomes. The purpose of this...

High-grade tumors of the brainstem in adults and children, excluding diffuse intrinsic pontine glioma (DIPG), are rare. In adults, these tumors are almost exclusively malignant gliomas, while in children approximately 60% are high-grade gliomas and 40% are embryonal tumors. In almost all cases, the most common presenting symptoms are cranial neurop...

Background: Recent epidemiological evidence has demonstrated a higher rate of COVID-19 hospitalizations and deaths among minorities. This pattern of race-ethnic disparities emerging throughout the United States raises the question of what social factors may influence spread of a highly transmissible novel coronavirus. The purpose of this study is t...

Secondary glioblastoma is a rare brain tumor characterized by a mutation in isocitrate dehydrogenase, which is reported to lead to epigenetic modification. Patients with secondary glioblastoma experience poor survival and quality-of-life outcomes due to the disease’s aggressiveness and a lack of targeted therapies. In this report, a patient with a...

CT myelography is an important imaging modality that combines the advantages of myelography and the high resolution of CT. It provides a detailed delineation of pathologic spine conditions, especially those involving the thecal sac and its contents. However, the role of CT myelography has dramatically and appropriately decreased with the advent of...

Purpose: Melanoma brain metastases (MBM) occur in ∼50% of melanoma patients. While both Radiation Therapy (RT) and immune checkpoint inhibitor (ICI) are used alone or in combination for MBM treatment, the role of combination and how these treatments could best be sequenced, remains unclear. Methods and materials: We conducted a retrospective ana...

Background and purpose: Noncontrast head CTs are routinely acquired for patients with neurologic symptoms in the emergency department setting. Anecdotally, noncontrast head CTs performed in patients with prior negative findings with the same clinical indication are of low diagnostic yield. We hypothesized that the rate of acute findings in noncont...

Background: The Brain Tumor Reporting and Data System (BT-RADS) is a proposed standardized radiology reporting scheme for magnetic resonance imagings in brain tumor patients. A website was created to introduce the classification system and to promote its use during daily radiology readouts with trainees. Objectives: To demonstrate how a website...

A 44-year-old man initially presented with a right thalamic brain tumor that was confirmed with stereotactic biopsy to be glioblastoma (GBM). The patient was treated with radiotherapy and temozolomide for 6 weeks. At 1 month after completing chemoradiation therapy, the patient underwent follow-up imaging that revealed the primary lesion had mildly...

Melanoma brain metastases (MBM) occur in ~50% of advanced melanoma patients. It is unclear if systemic therapies synergize with radiotherapy (RT) and what the impact of RT timing has on efficacy. We find that RT followed by ICI (immune checkpoint inhibitors) (RTàICI) improves MBM patient survival compared to other combination strategies, also shown...

The standard of care for glioblastoma is neurosurgical resection followed by radiation therapy (RT) and temozolomide (TMZ) chemotherapy. Although RT is effective for glioblastoma, attempts to improve survival using RT dose escalation above 60 Gy have been largely unsuccessful. This may be because prior attempts have been targeted to resection cavit...

Glioblastomas are highly aggressive, grade IV tumors of glial cells that arise either as de novo primary tumors or as secondary tumors, which malignantly transformed from lower grade gliomas. Secondary glioblastomas have a relatively low incidence making up 5–10% of all glioblastoma diagnoses and tend to occur in younger patients. However, these tu...

INTRODUCTION Longitudinal imaging evaluation of brain tumor patients with MRI is a challenging endeavor, as there is considerable overlap between imaging findings of tumor progression and treatment related changes. There is felt to be a high degree of variation between individual interpreters, particularly in complex cases. Structured reporting sys...

Glioblastoma is the most aggressive primary adult brain tumor, with median survival of 15 months despite surgery and chemoradiation. MRI is used to guide treatment decisions, but imaging interpretation is challenging because of subtle findings with overlap between treatment effect and disease progression. The most frequently used quantitative brain...

Primary brain tumors are serious and life-threatening; thus, accurate histopathologic diagnosis is critical for determining the proper clinical treatment regimen. Grade II/III gliomas (lower grade gliomas, or LGGs), including astrocytomas and oligodendrogliomas, are heterogeneous and potentially contain low- and high-grade areas within the same tum...

Background and purpose: Diffuse midline gliomas with histone H3 K27M mutation are biologically aggressive tumors with poor prognosis defined as a new diagnostic entity in the 2016 World Health Organization Classification of Tumors of the Central Nervous System. There are no qualitative imaging differences (enhancement, border, or central necrosis)...

A brief introduction is provided of the different imaging modalities encountered in the intensive care unit (ICU). The spectrum of intracranial pathology as well as potential postsurgical complications is reviewed, with a focus on pearls and pitfalls. A brief overview also is provided of imaging of the spine in an ICU patient.

Glioblastoma is the most aggressive primary brain tumor in adults. Limited treatment options and the intense nature of therapy make determining the appropriate treatment course for each patient difficult. The appearance of transient worsening of imaging findings, known as treatment effect, after chemoradiation further complicates clinical decision-...

Rationale and Objectives Determine the objective benefits of structured reporting of brain tumors through Brain tumor-RADS (BT-RADS) by analyzing discrete quantifiable metrics of the reports themselves. Materials and Methods Following Institutional Review Board approval, post-treatment glioma reports were acquired from two matched 3-month time per...

Rationale and objectives: Analyze the impact of implementing a structured reporting system for primary brain tumors, the Brain Tumor Reporting and Data System, on attitudes toward radiology reports at a single institution. Materials and methods: Following Institutional Review Board approval, an initial 22 question, 5 point (1-worst to 5-best), s...

Purpose Gliosarcoma is a histologic variant of glioblastoma (GBM), and like GBM carries a poor prognosis. Median survival is less than one (1) year with less than 5% of patients alive after 5 years. Although there is no cure, standard treatment includes surgery, radiation and chemotherapy. While very similar to GBM, gliosarcoma exhibits several dis...

Fogging is a deceptive phenomenon that can partially or completely obscure a subacute infarct on noncontrast head CT. We present the appearance of infarct fogging on CT perfusion through 3 cases. At time of fogging, the subacute infarctions demonstrated variable mean transit time with increased cerebral blood volume and cerebral blood flow on CT pe...

Background and purpose: Spontaneous intracranial hypotension (SIH) is a significant, treatable cause of postural headache, although the best diagnostic approach to diagnosing cerebrospinal fluid (CSF) leaks remains uncertain. The aim of this study is to evaluate the most common techniques used to diagnose leaks, the most frequent leak sites, and ep...

Background and Purpose Interview selection of candidates for academic radiology faculty positions is variable and subject to unconscious biases. The purpose of this study was to retrospectively apply a quantitative curriculum vitae (CV) rubric as a screening tool to identify qualified candidates for further consideration in the hiring process. Mat...

Radiographic assessment with magnetic resonance imaging (MRI) is widely used to characterize gliomas, which represent 80% of all primary malignant brain tumors. Unfortunately, glioma biology is marked by heterogeneous angiogenesis, cellular proliferation, cellular invasion, and apoptosis. This translates into varying degrees of enhancement, edema,...

Radiographic assessment with magnetic resonance imaging (MRI) is widely used to characterize gliomas, which represent 80% of all primary malignant brain tumors. Unfortunately, glioma biology is marked by heterogeneous angiogenesis, cellular proliferation, cellular invasion, and apoptosis. This translates into varying degrees of enhancement, edema,...

In brain tumor patients, worsening of imaging findings in the first 6 months after surgical debulking and chemoradiation can occur in the absence of tumor growth, a phenomenon known as pseudoprogression. Awareness of pseudoprogression is important as it can lead to unnecessary additional changes in patient management. In this case, a patient with b...

Dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC MRI) is widely used for studying blood perfusion in brain tumors. While the time-dependent change of MRI signals related to the concentration of the tracer is used to derive the hemodynamic parameters such as regional blood volume and flow into tumors, the tissue-specific info...

Glioblastoma has poor prognosis with inevitable local recurrence despite aggressive treatment with surgery and chemoradiation. Radiation therapy (RT) is typically guided by contrast-enhanced T1-weighted magnetic resonance imaging (MRI) for defining the high-dose target and T2-weighted fluid-attenuation inversion recovery MRI for defining the modera...

Histone deacetylases regulate a wide variety of cellular functions and have been implicated in redifferentiation of various tumors. Histone deacetylase inhibitors (HDACi) are potential pharmacologic agents to improve outcomes for patients with gliomas. We assessed the therapeutic efficacy of belinostat (PXD-101), an HDACi with blood-brain barrier p...

Radiation therapy (RT) plays a critical role in the overall management of many central nervous system (CNS) tumors. Advances in RT treatment planning, with techniques such as intensity modulated radiation therapy, volumetric modulated arc therapy, and stereotactic radiosurgery, now allow the delivery of highly conformal dose with great precision. T...

Epidermal growth factor receptor (EGFR) is overexpressed or mutated in a variety of malignancies, most notably non-small cell lung cancer, colorectal cancer and glioblastoma (GBM). Glioblastoma is an aggressive primary brain tumor and 35–50% of glioblastomas show amplification of the EGFR locus (7p11.2). Interestingly, gliosarcoma, a histologic var...

The standard of care for glioblastoma is neurosurgical resection followed by radiation therapy (RT) and temozolomide (TMZ) chemotherapy. Previous RT with TMZ dose escalation attempts with RT doses up to 75 Gy targeted gadolinium contrast enhancing portions of tumor. These studies generated no significant benefits in recurrence or survival, but this...

Background and purpose: Convolutional neural networks are a powerful technology for image recognition. This study evaluates a convolutional neural network optimized for the detection and quantification of intraparenchymal, epidural/subdural, and subarachnoid hemorrhages on noncontrast CT. Materials and methods: This study was performed in 2 phas...

Glioblastomas are aggressive brain tumors that frequently recur in the subventricular zone (SVZ) despite maximal treatment. The purpose of this study was to evaluate imaging patterns of subventricular progression and impact of recurrent subventricular tumor involvement and radiation dose to patient outcome. Retrospective review of 50 patients diagn...

Background and purpose: The World Health Organization has recently placed new emphasis on the integration of genetic information for gliomas. While tissue sampling remains the criterion standard, noninvasive imaging techniques may provide complimentary insight into clinically relevant genetic mutations. Our aim was to train a convolutional neural...

Objective: The purpose of this review is to summarize advances in the molecular analysis of gliomas, the role genetics plays in MRI features, and how machine-learning approaches can be used to survey the tumoral environment. Conclusion: The genetic profile of gliomas influences the course of treatment and clinical outcomes. Though biopsy is the...

Background and purpose: The entorhinal cortex, a critical gateway between the neocortex and hippocampus, is one of the earliest regions affected by Alzheimer disease-associated neurofibrillary tangle pathology. Although our prior work has automatically delineated an MR imaging-based measure of the entorhinal cortex, whether antemortem entorhinal c...

Purpose: The objective of this paper is to assess the volume, accuracy, and timeliness of radiology resident preliminary reports as part of an independent call system. This study seeks to understand the relationship between resident year in training, study modality, and discrepancy rate. Methods: Resident preliminary interpretations on radiograp...

Fluoroscopically guided procedures are an area of radiology in which radiation exposure to the patient is highly operator dependent. Modern fluoroscopy machines display a variety of information, including technique factors, field of view, operating geometry, exposure mode, fluoroscopic time, air kerma at the reference point (RAK), and air kerma are...