Evidence map›Paper›PMID 40913628›Full record

ArticleClinical & experimental metastasis2025

FLAIR extending beyond a quadrant (FEQ) of the cerebrum as a qualitative imaging biomarker: a conceptual proposition and proof-of-principle.

Ali A Alattar, Jiri Bartek, Carlin Chuck, Giovanni Kozel, Elaina J Wang, Hsien-Chung Chen, Parag Sanghvi, Eric T Wong, Sasmit Sarangi, Heinrich Elinzano and 2 more

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Article in Clinical & experimental metastasis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Ali A Alattar *Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Jiri Bartek *Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
Carlin Chuck *Department of Neurosurgery, Warren Alpert Medical School of Brown University, 593 Eddy Street - APC 6, Providence, RI, 02903, USA.
Giovanni KozelWarren Alpert Medical School of Brown University, Providence, USA.
Elaina J WangDepartment of Neurosurgery, Warren Alpert Medical School of Brown University, 593 Eddy Street - APC 6, Providence, RI, 02903, USA.
Hsien-Chung ChenDepartment of Neurosurgery, Warren Alpert Medical School of Brown University, 593 Eddy Street - APC 6, Providence, RI, 02903, USA.
Parag SanghviDepartment of Radiation Oncology, University of California San Diego School of Medicine, San Diego, CA, USA.
Eric T WongDepartment of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Sasmit SarangiDepartment of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Heinrich ElinzanoDepartment of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Sharonda Ben-HaimDepartment of Neurosurgery, School of Medicine, University of California San Diego, San Diego, CA, USA.
Clark C ChenDepartment of Neurosurgery, Warren Alpert Medical School of Brown University, 593 Eddy Street - APC 6, Providence, RI, 02903, USA. clark_chen@brown.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Significant variability exists in the use of corticosteroids for treating adverse radiation effects (ARE) after stereotactic radiosurgery (SRS) of brain metastasis (BM). Here, we determine the diagnostic utility of a quadrant-based, visual assessment of magnetic resonance (MR) FLAIR as an imaging biomarker for steroid-dependent ARE. FLAIR was assessed at four axial levels along the rostral-caudal axis of the cerebrum, defined by standard landmarks of superior temporal line, third ventricle, temporal horn, and fourth ventricle. Each axial level was divided into four quadrants, defined by 12, 3, 6, and 9 on a clock face. New, post-SRS FLAIR hyperintensity extending beyond any quadrant was defined as FEQ+. FEQ+ was then correlated with corticosteroid treatment instituted within a month of the MRI. To establish intra- and inter-rater reliability of FEQ, MR images from 20 patients (10 FEQ+ and 10 FEQ-) were assessed by three clinicians (a radiation oncologist and two neurosurgeons) for FEQ positivity. These results showed an > 85% intra- and inter-rater reliability (Cohen's Kappa and Fleiss' Kappa of 0.970 and 0.785, respectively, both p < 0.001). We tested the hypothesis that FEQ+ is associated with corticosteroid use post-SRS in an initial cohort of 40 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of FEQ for corticosteroid treatment were 75.0%, 96.4%, 75.0%, and 90.0%, respectively. To validate these findings, we examined the association of FEQ and corticosteroid use in an independent cohort of 214 SRS-treated BM patients. The sensitivity, specificity, positive predictive value, and negative predictive value of FEQ for corticosteroid treatment in this validation cohort were 94.6%, 74.0%, 43.2%, and 98.5%, respectively. We conclude that FEQ is an imaging marker with high intra- and inter-rater reliability, with a high negative predictive value (90.0-98.5%) for steroid treatment in SRS-treated BM patients. These results lay the foundation for future studies of FEQ for research and clinical applications.

Indexed as

Brain NeoplasmsCerebrumMagnetic Resonance ImagingRadiosurgeryAdrenal Cortex HormonesAdultAgedBiomarkersFemaleHumansMaleMiddle AgedAdrenal Cortex HormonesBiomarkersAcute radiation effectsBrain metastasisCorticosteroidStereotactic radiosurgery

Identifiers

PMID40913628

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.