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  1. Article: Characterization of pediatric brain tumors using pre-diagnostic neuroimaging.

    Green, Shannon / Vuong, Victoria D / Khanna, Paritosh C / Crawford, John R

    Frontiers in oncology

    2022  Volume 12, Page(s) 977814

    Abstract: Purpose: To evaluate for predictive neuroimaging features of pediatric brain tumor development and quantify tumor growth characteristics in patients who had neuroimaging performed prior to a diagnosis of a brain tumor.: Methods: Retrospective review ... ...

    Abstract Purpose: To evaluate for predictive neuroimaging features of pediatric brain tumor development and quantify tumor growth characteristics in patients who had neuroimaging performed prior to a diagnosis of a brain tumor.
    Methods: Retrospective review of 1098 consecutive pediatric patients at a single institution with newly diagnosed brain tumors from January 2009 to October 2021 was performed to identify patients with neuroimaging prior to the diagnosis of a brain tumor. Pre-diagnostic and diagnostic neuroimaging features (e.g., tumor size, apparent diffusion coefficient (ADC) values), clinical presentations, and neuropathology were recorded in those patients who had neuroimaging performed prior to a brain tumor diagnosis. High- and low-grade tumor sizes were fit to linear and exponential growth regression models.
    Results: Fourteen of 1098 patients (1%) had neuroimaging prior to diagnosis of a brain tumor (8 females, mean age at definitive diagnosis 8.1 years, imaging interval 0.2-8.7 years). Tumor types included low-grade glioma (n = 4), embryonal tumors (n = 2), pineal tumors (n=2), ependymoma (n = 3), and others (n = 3). Pre-diagnostic imaging of corresponding tumor growth sites were abnormal in four cases (28%) and demonstrated higher ADC values in the region of high-grade tumor growth (p = 0.05). Growth regression analyses demonstrated R
    Conclusions: This is the first study to test feasibility in utilizing pre-diagnostic neuroimaging to demonstrate that linear and exponential growth rate models can be used to estimate pediatric brain tumor growth velocity and should be validated in a larger multi-institutional cohort.
    Language English
    Publishing date 2022-10-17
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2649216-7
    ISSN 2234-943X
    ISSN 2234-943X
    DOI 10.3389/fonc.2022.977814
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  2. Article ; Online: Hemorrhagic Transformation Following Childhood Cardioembolic Stroke Is Not Increased in Anticoagulated Patients.

    Ko, Pin-Yi / Khalatbari, Hedieh / Hatt, Danielle / Coufal, Nicole / Barry, Dwight / Wainwright, Mark S / Khanna, Paritosh C / Amlie-Lefond, Catherine

    Journal of child neurology

    2022  Volume 37, Issue 4, Page(s) 273–280

    Abstract: Objective: To characterize the risk of hemorrhagic transformation following cardioembolic stroke in childhood, and whether anticoagulation impacts that risk.: Methods: Ninety-five children (1 month-18 years) with cardioembolic arterial ischemic ... ...

    Abstract Objective: To characterize the risk of hemorrhagic transformation following cardioembolic stroke in childhood, and whether anticoagulation impacts that risk.
    Methods: Ninety-five children (1 month-18 years) with cardioembolic arterial ischemic stroke between January 1, 2009, and December 31, 2019, at 2 institutions were identified for retrospective chart review. Neuroimaging was reviewed to assess for hemorrhagic transformation.
    Results: There were 11 cases of hemorrhagic transformation; 8 occurred within 2 days of stroke diagnosis. Risk of hemorrhagic transformation did not differ in patients with and without anticoagulation use (15% vs 9%, estimated risk difference 5%; CI -9%, 19%). Stroke size did not predict hemorrhagic transformation (OR 1.004, 95% CI 0.997, 1.010). Risk of hemorrhagic transformation was higher in strokes that occurred in the inpatient compared with the outpatient setting (16% vs 6%).
    Conclusion: Hemorrhagic transformation occurred in 11% of pediatric cardioembolic ischemic stroke, usually within 2 days of stroke diagnosis, and was not associated with anticoagulation or stroke size.
    MeSH term(s) Anticoagulants/adverse effects ; Child ; Embolic Stroke ; Humans ; Neuroimaging ; Retrospective Studies ; Stroke/complications ; Stroke/diagnostic imaging ; Stroke/drug therapy
    Chemical Substances Anticoagulants
    Language English
    Publishing date 2022-01-13
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639288-x
    ISSN 1708-8283 ; 0883-0738
    ISSN (online) 1708-8283
    ISSN 0883-0738
    DOI 10.1177/08830738211025866
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  3. Article ; Online: Atypical Molecular Features of Pediatric Tectal Glioma: A Single Institutional Series.

    Yakir, Maayan Joy / Elster, Jennifer D / Paul, Megan R / Khanna, Paritosh C / Malicki, Denise M / Levy, Michael L / Crawford, John Ross

    Journal of pediatric hematology/oncology

    2022  Volume 45, Issue 3, Page(s) e410–e414

    Abstract: We present 4 children (diagnosed between 1 and 8 y, 3 females and 1 male) with molecularly distinct tectal gliomas (2 KRAS mutant, 1 EGFR mutant, 1 SRGAP3-RAF-1 fusion) that contributes to the growing literature of this uncommonly biopsied tumor. The ... ...

    Abstract We present 4 children (diagnosed between 1 and 8 y, 3 females and 1 male) with molecularly distinct tectal gliomas (2 KRAS mutant, 1 EGFR mutant, 1 SRGAP3-RAF-1 fusion) that contributes to the growing literature of this uncommonly biopsied tumor. The patient with EGFR R222C mutation had a more severe course, earlier diagnosis, subsequent leptomeningeal metastatic disease, required more aggressive therapies, and died 9 years after diagnosis. Patients with KRAS mutations and SRGAP3-RAF-1 fusion had a more indolent course. Our series expands the molecular phenotype of tectal glioma with the potential for leptomeningeal dissemination. Future studies on establishing genotypic/phenotypic correlation from those who undergo biopsy are needed.
    MeSH term(s) Female ; Male ; Humans ; Glioma/genetics ; Glioma/pathology ; Brain Stem Neoplasms/genetics ; Brain Stem Neoplasms/diagnosis ; Brain Stem Neoplasms/pathology ; Proto-Oncogene Proteins p21(ras)/genetics ; ErbB Receptors/genetics ; Mutation ; Brain Neoplasms/genetics
    Chemical Substances Proto-Oncogene Proteins p21(ras) (EC 3.6.5.2) ; ErbB Receptors (EC 2.7.10.1)
    Language English
    Publishing date 2022-11-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000002596
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  4. Article ; Online: Single-agent Bevacizumab in the Treatment of Symptomatic Newly Diagnosed and Recurrent/Refractory Pediatric Cervicomedullary Brainstem Low-grade Gliomas: A Single Institutional Experience.

    Sridhar, Sunita / Paul, Megan Rose / Yeh-Nayre, Lanipua / Khanna, Paritosh C / Elster, Jennifer / Aristizabal, Paula / Crawford, John R

    Journal of pediatric hematology/oncology

    2022  Volume 45, Issue 1, Page(s) e21–e25

    Abstract: Bevacizumab-based therapies have been utilized as single or combination therapy of refractory/recurrent pediatric low-grade gliomas. Its efficacy for symptomatic cervicomedullary low-grade gliomas (cmLGGs) in the upfront and the recurrent setting is less ...

    Abstract Bevacizumab-based therapies have been utilized as single or combination therapy of refractory/recurrent pediatric low-grade gliomas. Its efficacy for symptomatic cervicomedullary low-grade gliomas (cmLGGs) in the upfront and the recurrent setting is less known. We report our retrospective single institutional experience from 2015 to 2021 with single-agent bevacizumab for symptomatic cmLGG. Six consecutive patients (4 female, ages 2 to 12 y) with newly diagnosed (n=3) and recurrent/refractory (n=3) symptomatic nondisseminated cmLGG (5/6 biopsy-proven, 2 BRAFV600E, 2 BRAF-KIAA1549) were treated with single-agent bevacizumab. All demonstrated radiographic response most pronounced on post-gadolinium T1-weighted magnetic resonance imaging (2 complete, 4 partial) at a median of 8 weeks (range: 2 to 12 wk). Clinical response was seen in all patients with improvement in cranial nerve abnormalities (3 recurrent/refractory, 1 newly diagnosed), strength (2 recurrent/refractory, 2 newly diagnosed), pain (2 recurrent/refractory), and anorexia (1 newly diagnosed). Four patients (2 recurrent/refractory, 2 newly diagnosed) experienced disease progression on subsequent adjunct therapies, 2 of which (the 2 newly diagnosed patients) are currently being rechallenged. At a mean follow-up of 7 months, all patients are clinically stable without disease progression. Single-agent bevacizumab may be effective in the management of symptomatic newly diagnosed and recurrent/refractory cmLGG and warrants further evaluation in a clinical trial setting.
    MeSH term(s) Child ; Child, Preschool ; Female ; Humans ; Angiogenesis Inhibitors ; Antibodies, Monoclonal, Humanized/therapeutic use ; Bevacizumab/therapeutic use ; Brain Neoplasms/pathology ; Brain Stem/pathology ; Disease Progression ; Glioma/drug therapy ; Glioma/pathology ; Neoplasm Recurrence, Local/drug therapy ; Retrospective Studies ; Male
    Chemical Substances Angiogenesis Inhibitors ; Antibodies, Monoclonal, Humanized ; Bevacizumab (2S9ZZM9Q9V)
    Language English
    Publishing date 2022-04-13
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1231152-2
    ISSN 1536-3678 ; 1077-4114 ; 0192-8562
    ISSN (online) 1536-3678
    ISSN 1077-4114 ; 0192-8562
    DOI 10.1097/MPH.0000000000002462
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  5. Article ; Online: Imaging of pediatric head and neck tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper.

    Abramson, Zachary R / Nagaraj, Usha D / Lai, Lillian M / Liu, Christopher Cheng-Yu / Schroeder, Jason W / Khanna, Paritosh C / Chuang, Nathaniel A / Strauss, Sara / Gomez, Gabriel / Clarke, Rebekah / Singh, Sumit / Choudhri, Asim F / Whitehead, Matthew T

    Pediatric blood & cancer

    2022  Volume 70 Suppl 4, Page(s) e30151

    MeSH term(s) Child ; Humans ; Surface Plasmon Resonance ; Head and Neck Neoplasms/diagnostic imaging ; Medical Oncology ; Diagnostic Imaging
    Language English
    Publishing date 2022-12-22
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2131448-2
    ISSN 1545-5017 ; 1545-5009
    ISSN (online) 1545-5017
    ISSN 1545-5009
    DOI 10.1002/pbc.30151
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  6. Article ; Online: Brain Magnetic Resonance Imaging Findings in Poorly Controlled Homocystinuria.

    Li, Charles Q / Barshop, Bruce A / Feigenbaum, Annette / Khanna, Paritosh C

    Journal of radiology case reports

    2018  Volume 12, Issue 1, Page(s) 1–8

    Abstract: Homocystinuria is an inherited metabolic disorder most commonly caused by cystathionine β-synthase deficiency. Severe cases can cause white matter abnormalities that can mimic other vascular, toxic and metabolic disorders on computed tomography and ... ...

    Abstract Homocystinuria is an inherited metabolic disorder most commonly caused by cystathionine β-synthase deficiency. Severe cases can cause white matter abnormalities that can mimic other vascular, toxic and metabolic disorders on computed tomography and magnetic resonance imaging. We present such a case which demonstrates not only extensive white matter abnormalities on magnetic resonance imaging, but also previously unreported basal ganglia signal abnormalities and imaging manifestations of increased intracranial pressure, likely caused by elevated methionine and betaine therapy. We also review the literature and discuss the potential underlying biologic mechanisms of these imaging findings.
    MeSH term(s) Biomarkers/analysis ; Brain Edema/diagnostic imaging ; Female ; Homocystinuria/diagnostic imaging ; Humans ; Infant ; Magnetic Resonance Imaging/methods ; Spinal Puncture
    Chemical Substances Biomarkers
    Language English
    Publishing date 2018-01-31
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2586384-8
    ISSN 1943-0922 ; 1943-0922
    ISSN (online) 1943-0922
    ISSN 1943-0922
    DOI 10.3941/jrcr.v12i1.3207
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  7. Article ; Online: Clinical and Neuroimaging Features of Magnetic Resonance-Guided Stereotactic Laser Ablation for Newly Diagnosed and Recurrent Pediatric Brain Tumors: A Single Institutional Series.

    Pehlivan, Katherine C / Khanna, Paritosh C / Elster, Jennifer D / Paul, Megan Rose / Levy, Michael L / Crawford, John R / Gonda, David D

    World neurosurgery

    2021  Volume 150, Page(s) e378–e387

    Abstract: Objective: We describe our single-institutional experience with magnetic resonance-guided stereotactic laser ablation (SLA) for the treatment of newly diagnosed and recurrent pediatric brain tumors.: Methods: Eighteen consecutive ablation procedures ... ...

    Abstract Objective: We describe our single-institutional experience with magnetic resonance-guided stereotactic laser ablation (SLA) for the treatment of newly diagnosed and recurrent pediatric brain tumors.
    Methods: Eighteen consecutive ablation procedures were performed in 17 patients from March 2016-April 2020. Patient demographics, indications, procedures, neuroimaging features, and outcomes were reviewed retrospectively.
    Results: Seventeen patients (mean age of 11.4 years, 11 boys, 6 girls) underwent SLA with a mean follow-up of 24 months (range: 3-45 months). Tumor histologies included pilocytic astrocytoma (n = 5), ganglioglioma (n = 3), low-grade glioma not otherwise specified (n = 4), glioblastoma (n = 2), meningioma (n = 1), medulloblastoma (n = 1), and metastatic malignant peripheral nerve sheath tumor (n = 1). SLA was first-line therapy in 10 patients. Mean procedure duration including anesthesia time was 328 minutes (range: 244-529 minutes), and mean postoperative length of stay was 1.5 days (range 1-5 days). The complication rate was 29%, which included 3 patients who experienced postoperative motor changes, which resolved within several weeks of surgery, 1 patient with self-limited intraoperative bradycardia and hypotension, and 1 patient who died postoperatively due to intracranial hemorrhage from a distant lesion. Twelve of 17 patients had a neuroimaging response after SLA (4 complete responses, 8 partial responses, 1 stable disease). Percentage of tumor shrinkage from baseline ranged from 33%-100% (mean 75%). Patients with low-grade glioma exhibited the best responses to SLA (range 3%-100% decrease; mean 90%; 36% complete response rate).
    Conclusions: SLA is a minimally invasive modality for the treatment of newly diagnosed and recurrent low-grade pediatric brain tumors. Low-grade glioma exhibited the best responses. Identification of ideal candidates for SLA, mitigation of perioperative complications, and demonstration of long-term outcomes need to be better defined in a clinical trial setting.
    MeSH term(s) Adolescent ; Anesthesia ; Brain Neoplasms/surgery ; Child ; Child, Preschool ; Female ; Humans ; Intraoperative Complications/epidemiology ; Laser Therapy/methods ; Length of Stay ; Magnetic Resonance Imaging/methods ; Male ; Neoplasm Recurrence, Local ; Neuroimaging/methods ; Retrospective Studies ; Stereotaxic Techniques ; Surgery, Computer-Assisted/methods ; Treatment Outcome
    Language English
    Publishing date 2021-03-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2021.03.027
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  8. Article ; Online: The role of methylation profiling in histologically diagnosed neurocytoma: a case series.

    Kalawi, Adam Z / Malicki, Denise M / Abdullaev, Zied / Pratt, Drew W / Quezado, Martha / Aldape, Kenneth / Elster, Jennifer D / Paul, Megan R / Khanna, Paritosh C / Levy, Michael L / Crawford, John R

    Journal of neuro-oncology

    2022  Volume 159, Issue 3, Page(s) 725–733

    Abstract: Purpose: To highlight the clinical, neuroradiographic, neuropathologic, and molecular features of histologically identified neurocytoma in a pediatric cohort and highlight the evolving use methylation profiling in providing diagnostic clarity in ... ...

    Abstract Purpose: To highlight the clinical, neuroradiographic, neuropathologic, and molecular features of histologically identified neurocytoma in a pediatric cohort and highlight the evolving use methylation profiling in providing diagnostic clarity in difficult to diagnosis pediatric brain tumors.
    Methods: Five consecutive children (ages 9-13, 2 girls 3 boys) were histologically diagnosed with neurocytoma at Rady Children's Hospital San Diego from 2012 to 2018. Clinical and molecular features were analyzed with regards to treatment course and outcome.
    Results: Presenting symptoms included seizures (n = 2), syncope (n = 1), headache (n = 2), visual disturbances (n = 2) and emesis (n = 2). Tumor location included intraventricular (n = 2), intraventricular with parenchymal spread (n = 1), and extraventricular (n = 2). Magnetic resonance imaging demonstrated reduced diffusivity (2/5), signal abnormality on susceptibility-weighted sequences (3/5), and varying degrees of contrast enhancement (4/5). All patients underwent surgical resection alone. Recurrence occurred in four children that were treated with surgery (4/4), adjuvant radiation (2/4), and chemoradiation (1/4). Neuropathologic features included positivity for GFAP (4/5), synaptophysin (4/5), NSE (2/2), NeuN (4/4), and variable Ki-67 (< 1% to 15%). Next generation sequencing (3/5) and microarray (3/5) collectively were abnormal in four of five tumors. Methylation profiling was successfully performed on four of five samples which led to modification of diagnosis in two patients and the others were either unclassifiable or confirmatory with the histologic diagnosis. Mean time to follow up was 77 months (range 44-112 months). Mean progression free survival and overall survival were 24 months (range 6 to 52 months) and 100% respectively.
    Conclusion: Neurocytomas are a rare clinical entity that warrants further investigation into molecular and pathologic prognosticating features. Methylation profiling may aid in differentiation of neurocytoma from other difficult to diagnose tumors who share similar histologic features.
    MeSH term(s) Brain Neoplasms/diagnostic imaging ; Brain Neoplasms/genetics ; Child ; Female ; Humans ; Ki-67 Antigen ; Magnetic Resonance Imaging ; Male ; Methylation ; Neurocytoma/pathology ; Synaptophysin
    Chemical Substances Ki-67 Antigen ; Synaptophysin
    Language English
    Publishing date 2022-08-22
    Publishing country United States
    Document type Journal Article
    ZDB-ID 604875-4
    ISSN 1573-7373 ; 0167-594X
    ISSN (online) 1573-7373
    ISSN 0167-594X
    DOI 10.1007/s11060-022-04117-1
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  9. Article ; Online: Scurvy Findings in a Child with Jacobsen Syndrome: A Case Report.

    Puddy, Alan C / Hughes, Jessica L / Joffe, Avrum L / Khanna, Paritosh C / Thornburg, Courtney D / Mubarak, Scott J

    JBJS case connector

    2019  Volume 9, Issue 3, Page(s) e0352

    Abstract: ... and patient's medication. Following vitamin C supplementation, signs and symptoms of the patient's ...

    Abstract Case: We describe the first reported case of scurvy developing secondary to behavioral traits of Jacobsen syndrome. The diagnosis of scurvy was significantly delayed because bleeding symptoms were initially attributed to baseline thrombocytopenia and platelet dysfunction associated with Jacobsen syndrome and patient's medication. Following vitamin C supplementation, signs and symptoms of the patient's disease quickly resolved.
    Conclusions: We aim to reinforce the need to consider nutritional deficiencies in patients with complex medical histories and behavioral issues, especially when presenting with new complaints.
    MeSH term(s) Child ; Female ; Humans ; Jacobsen Distal 11q Deletion Syndrome/complications ; Scurvy/diagnostic imaging ; Scurvy/etiology
    Language English
    Publishing date 2019-10-11
    Publishing country United States
    Document type Case Reports ; Journal Article
    ISSN 2160-3251
    ISSN (online) 2160-3251
    DOI 10.2106/JBJS.CC.18.00352
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  10. Article ; Online: Intracranial findings of Hunter syndrome.

    Iyer, Ramesh S / Khanna, Paritosh C

    Pediatric radiology

    2010  Volume 40 Suppl 1, Page(s) S173

    MeSH term(s) Adolescent ; Brain/pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Mucopolysaccharidosis II/pathology ; Nerve Fibers, Myelinated/pathology
    Language English
    Publishing date 2010-12
    Publishing country Germany
    Document type Case Reports ; Journal Article
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-010-1825-1
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