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Nettekoven C, Reck N, Pieczewski J, Neuschmelting V, Thiele K, Grefkes C, Goldbrunner R, Lucas CW. P 13 Congruency between speech-related areas investigated by fMRI and three rTMS protocols with different frequencies. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pieczewski J, Nettekoven C, Neuschmelting V, Thiele K, Hoevels M, Reck N, Tittgemeyer M, Grefkes C, Goldbrunner R, Lucas CW. P 12 Integrating nTMS motor mapping of the M1 tongue area into diffusion tractography to reconstruct motor-speech pathways. Clin Neurophysiol 2017. [DOI: 10.1016/j.clinph.2017.06.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lockau H, Neuschmelting V, Ogirala A, Vilaseca A, Grimm J. Dynamic 18F-FDG PET Lymphography for In Vivo Identification of Lymph Node Metastases in Murine Melanoma. J Nucl Med 2017; 59:210-215. [PMID: 28912145 DOI: 10.2967/jnumed.117.196303] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/25/2017] [Indexed: 01/06/2023] Open
Abstract
Positron lymphography using 18F-FDG followed by Cerenkov-guided resection of lymph nodes in healthy mice has previously been introduced by our group. Our aim in this study was to further assess the technique's potential beyond merely localizing sentinel lymph nodes. We now aimed to evaluate the potential of positron lymphography to characterize the nodes with respect to their tumor status in order to identify metastatic lymph nodes. We explored whether metastatic nodes could be distinguished from normal nodes via dynamic 18F-FDG lymphography, to then be resected under Cerenkov imaging guidance. Methods: A murine melanoma cell line highly metastatic to lymph nodes (B16F10) was implanted subcutaneously on the dorsal hind paw of C57 mice while the tumor-free contralateral leg served as an intraindividual control. A model of reactive lymph nodes after concanavalin A challenge served as an additional control to provide nonmalignant inflammatory lymphadenopathy. Dynamic PET/CT imaging was performed immediately after injection of 18F-FDG around the tumor or intracutaneously in the contralateral footpad. Furthermore, PET/CT and Cerenkov studies were performed repeatedly over time to follow the course of metastatic spread. In selected mice, popliteal lymph nodes underwent Cerenkov luminescence imaging. Hematoxylin and eosin staining was done to verify the presence of lymphatic melanoma infiltration. Results: Positron lymphography using 18F-FDG was successfully performed on tumor-bearing and non-tumor-bearing mice, as well as on controls bearing sites of inflammation; the results clearly identified the sentinel lymph node basin and delineated the lymphatic drainage. Significantly prolonged retention of activity was evident in metastatic nodes as compared with controls without tumor. On the basis of these results, the contrast in detection and identification of metastatic lymph nodes was distinct and could be used for guided lymph node resection, such as by using Cerenkov luminescence imaging. However, retention after 18F-FDG lymphography was also seen in acute inflammatory lymphadenopathy. Conclusion: In a tumor model, significantly longer retention of the radiotracer during 18F-FDG lymphography was seen in metastatic than nonmetastatic lymph nodes, allowing for differentiation between the two and for selective resection of tumor-bearing nodes using Cerenkov imaging. Inflammation can be better differentiated in a subacute state.
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Weiss Lucas C, Tursunova I, Neuschmelting V, Nettekoven C, Oros-Peusquens AM, Stoffels G, Faymonville AM, Jon SN, Langen KJ, Lockau H, Goldbrunner R, Grefkes C. Functional MRI vs. navigated TMS to optimize M1 seed volume delineation for DTI tractography. A prospective study in patients with brain tumours adjacent to the corticospinal tract. NEUROIMAGE-CLINICAL 2016; 13:297-309. [PMID: 28050345 PMCID: PMC5192048 DOI: 10.1016/j.nicl.2016.11.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND DTI-based tractography is an increasingly important tool for planning brain surgery in patients suffering from brain tumours. However, there is an ongoing debate which tracking approaches yield the most valid results. Especially the use of functional localizer data such as navigated transcranial magnetic stimulation (nTMS) or functional magnetic resonance imaging (fMRI) seem to improve fibre tracking data in conditions where anatomical landmarks are less informative due to tumour-induced distortions of the gyral anatomy. We here compared which of the two localizer techniques yields more plausible results with respect to mapping different functional portions of the corticospinal tract (CST) in brain tumour patients. METHODS The CSTs of 18 patients with intracranial tumours in the vicinity of the primary motor area (M1) were investigated by means of deterministic DTI. The core zone of the tumour-adjacent hand, foot and/or tongue M1 representation served as cortical regions of interest (ROIs). M1 core zones were defined by both the nTMS hot-spots and the fMRI local activation maxima. In addition, for all patients, a subcortical ROI at the level of the inferior anterior pons was implemented into the tracking algorithm in order to improve the anatomical specificity of CST reconstructions. As intra-individual control, we additionally tracked the CST of the hand motor region of the unaffected, i.e., non-lesional hemisphere, again comparing fMRI and nTMS M1 seeds. The plausibility of the fMRI-ROI- vs. nTMS-ROI-based fibre trajectories was assessed by a-priori defined anatomical criteria. Moreover, the anatomical relationship of different fibre courses was compared regarding their distribution in the anterior-posterior direction as well as their location within the posterior limb of the internal capsule (PLIC). RESULTS Overall, higher plausibility rates were observed for the use of nTMS- as compared to fMRI-defined cortical ROIs (p < 0.05) in tumour vicinity. On the non-lesional hemisphere, however, equally good plausibility rates (100%) were observed for both localizer techniques. fMRI-originated fibres generally followed a more posterior course relative to the nTMS-based tracts (p < 0.01) in both the lesional and non-lesional hemisphere. CONCLUSION NTMS achieved better tracking results than fMRI in conditions when the cortical tract origin (M1) was located in close vicinity to a brain tumour, probably influencing neurovascular coupling. Hence, especially in situations with altered BOLD signal physiology, nTMS seems to be the method of choice in order to identify seed regions for CST mapping in patients.
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Key Words
- APB, Abductor pollicis brevis muscle
- BOLD, Blood-oxygenation-level dependent
- CST
- CST, Corticospinal tract
- DCS, Direct cortical stimulation
- DTI, Diffusion tensor imaging
- Deterministic
- EF, Electric field
- EMG, Electromyography
- FA(T), Fractional anisotropy (threshold)
- FACT, Fibre assignment by continuous tracking
- FOV, Field-of-view
- FWE, Family-wise error
- KPS, Karnofsky performance scale
- LT, Lateral tongue muscle, anterior third
- M1, Primary motor cortex
- MEP, Motor-evoked potential
- MFL, Minimal fibre length
- MPRAGE, Magnetization prepared rapid acquisition gradient echo (T1 MR seq.)
- OR, Odd's ratio
- PLIC, Posterior limb of the internal capsule
- PM, Plantar muscle
- Pyramidal tract
- RMT, Resting motor threshold
- ROI
- ROI, Region-of-interest
- SD, Standard deviation
- SE, Standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- dMRI, Diffusion magnetic resonance imaging (i.e., diffusion-weighted imaging, DWI)
- fMRI
- fMRI, Functional magnetic resonance imaging
- nTMS
- nTMS, Neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test
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Nettekoven C, Neuschmelting V, Faymonville A, Stoffels G, Langen K, Oros-Peusquens AM, Shah N, Goldbrunner R, Grefkes C, Weiss-Lucas C. FV 3. Higher concordance of navigated transcranial magnetic stimulation (nTMS) than of functional MRI with intraoperative direct cortical stimulation (DCS) for delineating the primary motor area. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pieczewski J, Nettekoven C, Neuschmelting V, Thiele K, Grefkes C, Goldbrunner R, Lucas CW. EP 66. Better tolerability and lower mean intensities favour higher-frequent stimulation as compared to 10 Hz online-rTMS for language mapping: A test-retest reliability study in healthy volunteers. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andreou C, Neuschmelting V, Tschaharganeh DF, Huang CH, Oseledchyk A, Iacono P, Karabeber H, Colen RR, Mannelli L, Lowe SW, Kircher MF. Imaging of Liver Tumors Using Surface-Enhanced Raman Scattering Nanoparticles. ACS NANO 2016; 10:5015-26. [PMID: 27078225 PMCID: PMC4884645 DOI: 10.1021/acsnano.5b07200] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Complete surgical resection is the ideal first-line treatment for most liver malignancies. This goal would be facilitated by an intraoperative imaging method that enables more precise visualization of tumor margins and detection of otherwise invisible microscopic lesions. To this end, we synthesized silica-encapsulated surface-enhanced Raman scattering (SERS) nanoparticles (NPs) that act as a molecular imaging agent for liver malignancies. We hypothesized that, after intravenous administration, SERS NPs would avidly home to healthy liver tissue but not to intrahepatic malignancies. We tested these SERS NPs in genetically engineered mouse models of hepatocellular carcinoma and histiocytic sarcoma. After intravenous injection, liver tumors in both models were readily identifiable with Raman imaging. In addition, Raman imaging using SERS NPs enabled detection of microscopic lesions in liver and spleen. We compared the performance of SERS NPs to fluorescence imaging using indocyanine green (ICG). We found that SERS NPs delineate tumors more accurately and are less susceptible to photobleaching. Given the known advantages of SERS imaging, namely, high sensitivity and specific spectroscopic detection, these findings hold promise for improved resection of liver cancer.
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Neuschmelting V, Lockau H, Ntziachristos V, Grimm J, Kircher MF. Lymph Node Micrometastases and In-Transit Metastases from Melanoma: In Vivo Detection with Multispectral Optoacoustic Imaging in a Mouse Model. Radiology 2016; 280:137-50. [PMID: 27144537 DOI: 10.1148/radiol.2016160191] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Purpose To study whether multispectral optoacoustic tomography (MSOT) can serve as a label-free imaging modality for the detection of lymph node micrometastases and in-transit metastases from melanoma on the basis of the intrinsic contrast of melanin in comparison to fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT). Materials and Methods The study was approved by the institutional animal care and use committee. Sequential MSOT was performed in a mouse B16F10 melanoma limb lymph node metastasis model (n = 13) to survey the development of macro-, micro- and in-transit metastases (metastases that are in transit from the primary tumor site to the local nodal basin) in vivo. The in vitro limit of detection was assessed in a B16F10 cell phantom. Signal specificity was determined on the basis of a simultaneous lymphadenitis (n = 4) and 4T1 breast cancer lymph metastasis (n = 2) model. MSOT was compared with intravenous FDG PET/CT. The diagnosis was assessed with histologic examination. Differences in the signal ratio (metastatic node to contralateral limb) between the two modalities were determined with the two-tailed paired t test. Results The mean signal ratios acquired with MSOT in micrometastases (2.5 ± 0.3, n = 6) and in-transit metastases (8.3 ± 5.8, n = 4) were higher than those obtained with FDG PET/CT (1.1 ± 0.5 [P < .01] and 1.3 ± 0.6 [P < .05], respectively). MSOT was able to help differentiate even small melanoma lymph node metastases from the other lymphadenopathies (P < .05 for both) in vivo, whereas FDG PET/CT could not (P > .1 for both). In vitro, the limit of detection was at an approximate cell density of five cells per microliter (P < .01). Conclusion MSOT enabled detection of melanoma lymph node micrometastases and in-transit metastases undetectable with FDG PET/CT and helped differentiate melanoma metastasis from other lymphadenopathies. (©) RSNA, 2016 Online supplemental material is available for this article.
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Neuschmelting V, Burton NC, Lockau H, Urich A, Harmsen S, Ntziachristos V, Kircher MF. Performance of a Multispectral Optoacoustic Tomography (MSOT) System equipped with 2D vs. 3D Handheld Probes for Potential Clinical Translation. PHOTOACOUSTICS 2016; 4:1-10. [PMID: 27069872 PMCID: PMC4811917 DOI: 10.1016/j.pacs.2015.12.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/23/2015] [Accepted: 12/18/2015] [Indexed: 05/04/2023]
Abstract
A handheld approach to optoacoustic imaging is essential for the clinical translation. The first 2- and 3-dimensional handheld multispectral optoacoustic tomography (MSOT) probes featuring real-time unmixing have recently been developed. Imaging performance of both probes was determined in vitro and in a brain melanoma metastasis mouse model in vivo. T1-weighted MR images were acquired for anatomical reference. The limit of detection of melanoma cells in vitro was significantly lower using the 2D than the 3D probe. The signal decrease was more profound in relation to depth with the 3D versus the 2D probe. Both approaches were capable of imaging the melanoma tumors qualitatively at all time points. Quantitatively, the 2D approach enabled closer anatomical resemblance of the tumor compared to the 3D probe, particularly at depths beyond 3 mm. The 3D probe was shown to be superior for rapid 3D imaging and, thus, holds promise for more superficial target structures.
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Neuschmelting V, Weiss Lucas C, Stoffels G, Oros-Peusquens AM, Lockau H, Shah NJ, Langen KJ, Goldbrunner R, Grefkes C. Multimodal Imaging in Malignant Brain Tumors: Enhancing the Preoperative Risk Evaluation for Motor Deficits with a Combined Hybrid MRI-PET and Navigated Transcranial Magnetic Stimulation Approach. AJNR Am J Neuroradiol 2016; 37:266-73. [PMID: 26514607 DOI: 10.3174/ajnr.a4536] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/14/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE Motor deficits in patients with brain tumors are caused mainly by irreversible infiltration of the motor network or by indirect mass effects; these deficits are potentially reversible on tumor removal. Here we used a novel multimodal imaging approach consisting of structural, functional, and metabolic neuroimaging to better distinguish these underlying causes in a preoperative setting and determine the predictive value of this approach. MATERIALS AND METHODS Thirty patients with malignant brain tumors involving the central region underwent a hybrid O-(2-[(18)F]fluoroethyl)-L-tyrosine-PET-MR imaging and motor mapping by neuronavigated transcranial magnetic stimulation. The functional maps served as localizers for DTI tractography of the corticospinal tract. The spatial relationship between functional tissue (motor cortex and corticospinal tract) and lesion volumes as depicted by structural and metabolic imaging was analyzed. RESULTS Motor impairment was found in nearly all patients in whom the contrast-enhanced T1WI or PET lesion overlapped functional tissue. All patients who functionally deteriorated after the operation showed such overlap on presurgical maps, while the absence of overlap predicted a favorable motor outcome. PET was superior to contrast-enhanced T1WI for revealing a motor deficit before the operation. However, the best correlation with clinical impairment was found for T2WI lesion overlap with functional tissue maps, but the prognostic value for motor recovery was not significant. CONCLUSIONS Overlapping contrast-enhanced T1WI or PET-positive signals with motor functional tissue were highly indicative of motor impairment and predictive for surgery-associated functional outcome. Such a multimodal diagnostic approach may contribute to the risk evaluation of operation-associated motor deficits in patients with brain tumors.
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Lucas CW, Neuschmelting V, Nettekoven C, Oros-Peusquens AM, Stoffels G, Grefkes C, Faymonville AM, Goldbrunner R. NIMG-71ROBUSTNESS AND VALIDITY OF M1 DETERMINATION BY NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION (NTMS) AND FUNCTIONAL MRI AS COMPARED TO INTRAOPERATIVE DIRECT CORTICAL STIMULATION (DCS). Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov225.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Tursunova I, Neuschmelting V, Lockau H, Nettekoven C, Oros-Peusquens AM, Stoffels G, Faymonville AM, Grefkes C, Goldbrunner R, Lucas CW. NIMG-72TRACKING THE PYRAMIDAL TRACT IN TUMOUR PATIENTS USING DIFFERENT FUNCTIONAL LOCALIZER METHODS: PLAUSIBILITY OF DTI-TRACTS USING FUNCTIONAL MRI VS. NAVIGATED TRANSCRANIAL MAGNETIC STIMULATION. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov225.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Schröter C, Neuschmelting V, Seiler L, Shah N, Langen K, Nettekoven C, Goldbrunner R, Grefkes C, Weiß Lucas C. P157. Incidence and predictability of motor functioning after resection of pre-centrally located brain tumours. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weiß Lucas C, Tursunova I, Neuschmelting V, Lockau H, Nettekoven C, Oros-Peusquens AM, Stoffels G, Rehme A, Faymonville A, Shah N, Langen K, Goldbrunner R, Grefkes C. P115. The predictive value of FAT and MFL for deterministic, NTMS-based fibre tracking using a multiple-ROI approach. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2015.04.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Weiss C, Tursunova I, Neuschmelting V, Lockau H, Nettekoven C, Oros-Peusquens AM, Stoffels G, Rehme AK, Faymonville AM, Shah NJ, Langen KJ, Goldbrunner R, Grefkes C. Improved nTMS- and DTI-derived CST tractography through anatomical ROI seeding on anterior pontine level compared to internal capsule. NEUROIMAGE-CLINICAL 2015; 7:424-37. [PMID: 25685709 PMCID: PMC4314616 DOI: 10.1016/j.nicl.2015.01.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/07/2015] [Accepted: 01/08/2015] [Indexed: 12/16/2022]
Abstract
Imaging of the course of the corticospinal tract (CST) by diffusion tensor imaging (DTI) is useful for function-preserving tumour surgery. The integration of functional localizer data into tracking algorithms offers to establish a direct structure–function relationship in DTI data. However, alterations of MRI signals in and adjacent to brain tumours often lead to spurious tracking results. We here compared the impact of subcortical seed regions placed at different positions and the influences of the somatotopic location of the cortical seed and clinical co-factors on fibre tracking plausibility in brain tumour patients. The CST of 32 patients with intracranial tumours was investigated by means of deterministic DTI and neuronavigated transcranial magnetic stimulation (nTMS). The cortical seeds were defined by the nTMS hot spots of the primary motor area (M1) of the hand, the foot and the tongue representation. The CST originating from the contralesional M1 hand area was mapped as intra-individual reference. As subcortical region of interests (ROI), we used the posterior limb of the internal capsule (PLIC) and/or the anterior inferior pontine region (aiP). The plausibility of the fibre trajectories was assessed by a-priori defined anatomical criteria. The following potential co-factors were analysed: Karnofsky Performance Scale (KPS), resting motor threshold (RMT), T1-CE tumour volume, T2 oedema volume, presence of oedema within the PLIC, the fractional anisotropy threshold (FAT) to elicit a minimum amount of fibres and the minimal fibre length. The results showed a higher proportion of plausible fibre tracts for the aiP-ROI compared to the PLIC-ROI. Low FAT values and the presence of peritumoural oedema within the PLIC led to less plausible fibre tracking results. Most plausible results were obtained when the FAT ranged above a cut-off of 0.105. In addition, there was a strong effect of somatotopic location of the seed ROI; best plausibility was obtained for the contralateral hand CST (100%), followed by the ipsilesional hand CST (>95%), the ipsilesional foot (>85%) and tongue (>75%) CST. In summary, we found that the aiP-ROI yielded better tracking results compared to the IC-ROI when using deterministic CST tractography in brain tumour patients, especially when the M1 hand area was tracked. In case of FAT values lower than 0.10, the result of the respective CST tractography should be interpreted with caution with respect to spurious tracking results. Moreover, the presence of oedema within the internal capsule should be considered a negative predictor for plausible CST tracking. Somatotopic CST tractography was done in 32 patients with eloquent brain tumours. Seeding ROIs were defined by navigated TMS of the M1 hot spot (hand, foot, tongue). Using the anterior pons as a second ROI yielded more plausible tracts than the PLIC. Low FAT and oedema of the internal capsule were negative predictors.
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Key Words
- ANOVA, analysis of variance
- APB, abductor pollicis brevis muscle
- AUC, area under the curve
- BOLD, blood oxygenation level dependent
- CST
- CST, corticospinal tract
- DTI
- DTI, diffusion tensor imaging
- FA(T), fractional anisotropy (threshold)
- FACT, fibre assignment by continuous tracking
- FMRI, functional magnetic resonance imaging
- FOV, field-of-view
- FWE, family-wise error
- Fractional anisotropy
- KPS, Karnofsky performance scale
- LDA/C, linear discriminant analysis/coefficient
- LT, lateral tongue muscle, anterior third
- M1, primary motor cortex
- MEP, motor evoked potential
- MFL, minimal fibre length
- MPRAGE, magnetization prepared rapid acquisition gradient echo (T1 MR sequence)
- OR, odd's ratio
- PLIC, posterior limb of the internal capsule
- PM, plantar muscle
- RMT, resting motor threshold
- ROI
- ROI, region-of-interest
- SD, standard deviation
- SE, standard error
- Somatotopic
- X-sq, X-squared (Pearson's chi-square test)
- aiP, anterior inferior pons
- nTMS
- nTMS, neuronavigated transcranial magnetic stimulation
- pxsq, p-value according to Pearson's chi-square test.
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Marbacher S, Fathi AR, Muroi C, Coluccia D, Andereggen L, Neuschmelting V, Widmer HR, Jakob SM, Fandino J. The rabbit blood shunt subarachnoid haemorrhage model. ACTA NEUROCHIRURGICA. SUPPLEMENT 2015; 120:337-42. [PMID: 25366648 DOI: 10.1007/978-3-319-04981-6_58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The recently introduced rabbit blood shunt subarachnoid haemorrhage model is based on the two standard procedures of subclavian artery cannulation and transcutaneous cisterna magna puncture. An extracorporeal shunt placed in between the arterial system and the subarachnoid space allows examiner-independent SAH in a closed cranium. Despite its straightforwardness, it is worth examining some specific features and characteristics of the model. We outline technical considerations to successfully perform the model with minimal mortality and morbidity. In addition, we discuss outcome measures, advantages and limitations, and the applicability of the model for the study of early brain injury and delayed cerebral vasospasm after SAH.
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Marbacher S, Neuschmelting V, Andereggen L, Widmer HR, von Gunten M, Takala J, Jakob SM, Fandino J. Early brain injury linearly correlates with reduction in cerebral perfusion pressure during the hyperacute phase of subarachnoid hemorrhage. Intensive Care Med Exp 2014; 2:30. [PMID: 26266927 PMCID: PMC4512974 DOI: 10.1186/s40635-014-0030-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023] Open
Abstract
Background It is unclear how complex pathophysiological mechanisms that result in early brain injury (EBI) after subarachnoid hemorrhage (SAH) are triggered. We investigate how peak intracranial pressure (ICP), amount of subarachnoid blood, and hyperacute depletion of cerebral perfusion pressure (CPP) correlate to the onset of EBI following experimental SAH. Methods An entire spectrum of various degrees of SAH severities measured as peak ICP was generated and controlled using the blood shunt SAH model in rabbits. Standard cardiovascular monitoring, ICP, CPP, and bilateral regional cerebral blood flow (rCBF) were continuously measured. Cells with DNA damage and neurodegeneration were detected using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and Fluoro-jade B (FJB). Results rCBF was significantly correlated to reduction in CPP during the initial 15 min after SAH in a linear regression pattern (r2 = 0.68, p < 0.001). FJB- and TUNEL-labeled cells were linearly correlated to reduction in CPP during the first 3 min of hemorrhage in the hippocampal regions (FJB: r2 = 0.50, p < 0.01; TUNEL: r2 = 0.35, p < 0.05), as well as in the basal cortex (TUNEL: r2 = 0.58, p < 0.01). EBI occurred in animals with severe (relative CPP depletion >0.4) and moderate (relative CPP depletion >0.25 but <0.4) SAH. Neuronal cell death was equally detected in vulnerable and more resistant brain regions. Conclusions The degree of EBI in terms of neuronal cell degeneration in both the hippocampal regions and the basal cortex linearly correlates with reduced CPP during hyperacute SAH. Temporary CPP reduction, however, is not solely responsible for EBI but potentially triggers processes that eventually result in early brain damage. Electronic supplementary material The online version of this article (doi:10.1186/s40635-014-0030-1) contains supplementary material, which is available to authorized users.
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Lockau H, Liebig T, Henning T, Neuschmelting V, Stetefeld H, Kabbasch C, Dorn F. Mechanical thrombectomy in tandem occlusion: procedural considerations and clinical results. Neuroradiology 2014; 57:589-98. [PMID: 25404414 DOI: 10.1007/s00234-014-1465-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 11/04/2014] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute tandem occlusions of the cervical and distal internal carotid artery (ICA) or middle cerebral artery (MCA) are associated with major stroke with intravenous (i.v.) thrombolysis alone in approximately 90 % of patients. The data on endovascular management of tandem occlusions is still limited. The purpose of this study was to review technical aspects and the current state of the literature on acute ICA stenting in combination with stent retriever-based intracranial thrombectomy. METHODS We retrospectively reviewed the data of 37 consecutive patients with tandem occlusions including clinical parameters, angiographic results, procedural aspects, complications, and hemorrhages. RESULTS Median National Institutes of Health Stroke Scale (NIHSS) on admission was 17 (3-30). Intracranial thrombectomy was performed prior to ICA stenting in 25/37 (67.6 %) and after stenting in 12/37 (32.4 %) patients. ICA stenting was successful in all cases, and a thrombolysis in cerebral infarction (TICI) scale 2b/3 result was achieved in 27/37 (73 %) cases. The mean angiography time was significantly shorter in the "thrombectomy first" group (43.1 ± 30.8 vs. 110.8 ± 43.0 min, p < 0.001), and more patients had favorable outcomes after 3 months (13/25 = 52.0 vs. 4/12 = 33.3 %, p = 0.319). In this group, intermediate catheters were used and successfully prevented embolism to unaffected territories in all cases. CONCLUSION Acute stenting of the cervical ICA in combination with intracranial thrombectomy was technically feasible and safe in our series. Thrombectomy prior to proximal stenting was associated with shorter reperfusion times and a tendency towards better clinical outcome leading to a good outcome in about 50 % of the patients. Therefore, we recommend this approach in tandem occlusion requiring stent angioplasty.
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Andereggen L, Neuschmelting V, von Gunten M, Widmer HR, Takala J, Jakob SM, Fandino J, Marbacher S. The rabbit blood-shunt model for the study of acute and late sequelae of subarachnoid hemorrhage: technical aspects. J Vis Exp 2014:e52132. [PMID: 25350004 DOI: 10.3791/52132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Early brain injury and delayed cerebral vasospasm both contribute to unfavorable outcomes after subarachnoid hemorrhage (SAH). Reproducible and controllable animal models that simulate both conditions are presently uncommon. Therefore, new models are needed in order to mimic human pathophysiological conditions resulting from SAH. This report describes the technical nuances of a rabbit blood-shunt SAH model that enables control of intracerebral pressure (ICP). An extracorporeal shunt is placed between the arterial system and the subarachnoid space, which enables examiner-independent SAH in a closed cranium. Step-by-step procedural instructions and necessary equipment are described, as well as technical considerations to produce the model with minimal mortality and morbidity. Important details required for successful surgical creation of this robust, simple and consistent ICP-controlled SAH rabbit model are described.
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Weiss C, Tursunova I, Nettekoven C, Neuschmelting V, Seiler L, Oros-Peusquens A, Stoffels G, Faymonville A, Goldbrunner R, Grefkes C. P182: Perilesional edema of inner capsule deteriorates nTMS-based fiber tracking results. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Erhardt S, Marbacher S, Neuschmelting V, Coluccia D, Remonda L, Fandino J. Comparison between routine cylindrical cerebral aneurysm volume approximation and three-dimensional volume measurements in experimental aneurysms. Neurol Res 2014; 36:739-45. [PMID: 24620978 DOI: 10.1179/1743132813y.0000000316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Aneurysm volume is routinely approximated calculating cylindrical volumes. Exact aneurysm volume assessment is crucial for liquid polymer embolization. The aim of this study was to compare simple cylindrical volume approximations with direct multiplanar reconstruction (MPR) segmentational volumetry in a saccular/complex experimental rabbit bifurcation aneurysm model. METHODS In 12 female New Zealand white rabbits, saccular, broad-based, bilobular, and bisaccular aneurysms (three of each) were created using the rabbit venous pouch bifurcation model. Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed, and maximal intensity projection (MIP) reconstructions as well as an MPR dataset were acquired. Aneurysm width and length were measured in MIP images, and the volume was approximated calculating cylindrical volumes. Three-dimensional (3D) segmentational volumetry using the MPR dataset was performed in a semi-automated manner. RESULTS Maximal intensity projection cylindrical volumes ranged from 53·6 to 503·5 mm(3) (mean 186·5±118 mm(3)). Multiplanar reconstruction segmentation-based volumes ranged from 74·7 to 581·0 mm(3) (mean 202·2±133 mm(3)). The mean relative difference between MIP cylindrical and MPR segmentation volume calculation was 24·7% (range -77·5 to +50·8%). Only 4 of 12 MPR segmentational volumes were within a 10% range of results calculated for MIP cylindrical volume, and 3 of those were in broad-based aneurysms. CONCLUSION This descriptive study demonstrates that estimated MIP cylindrical volumes differ from those measured by MPR segmentation volumetry. With the increasing acquisition of 3D data as 3D-MRA and the increasing need for exact volume determination, studies on the accuracy of computational segmentational volumetry of CE-MRA are necessary.
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Tursunova I, Nettekoven C, Neuschmelting V, Seiler L, Oros-Peusquens A, Stoffels G, Faymonville A, Mehdiani K, Goldbrunner R, Grefkes C, Weiß C. NTMS- und DTI-basierte Pyramidenbahndarstellung bei Hirntumorpatienten. ROI-Platzierung auf pontinem Niveau verbessert Plausibilität. KLIN NEUROPHYSIOL 2014. [DOI: 10.1055/s-0034-1371290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Weiß C, Nettekoven C, Neuschmelting V, Eisenbeis A, Langen K, Goldbrunner R, Grefkes C. P 185. Functional imaging of the M1 representation of the tongue, the hand and the foot in patients with eloquently localized intracerebral tumors. Discripancies and validity of navigated TMS and functional MRI results when compared to direct cortical stimulation. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.04.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Weiß C, Nettekoven C, Neuschmelting V, Eisenbeis A, Langen KJ, Grefkes C, Goldbrunner R. Funktionelle Kartierung der primär-motorischen Repräsentation von Zunge, Hand und Fuß bei Patienten mit eloquent gelegenen, intracerebralen Tumoren – Vergleich von fMRT, nTMS und direkter Cortexstimulation. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Weiß C, Colman J, Neuschmelting V, Eisenbeis A, Nettekoven C, Grefkes C, Goldbrunner R. Bestimmung der Ruhemotorschwelle für das Fußareal durch navigierte TMS: Bessere Abschätzbarkeit mittels Hand-Ruhemotorschwelle und Cortexniveau. KLIN NEUROPHYSIOL 2013. [DOI: 10.1055/s-0033-1337161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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