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Nie S, Zhu Y, Yang J, Xin T, Xue S, Zhang X, Sun J, Mu D, Gao Y, Chen Z, Ding X, Yu J, Hu M. Determining optimal clinical target volume margins in high-grade glioma based on microscopic tumor extension and magnetic resonance imaging. Radiat Oncol 2021; 16:97. [PMID: 34098965 PMCID: PMC8186169 DOI: 10.1186/s13014-021-01819-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/10/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction In this study, we performed a consecutive macropathologic analysis to assess microscopic extension (ME) in high-grade glioma (HGG) to determine appropriate clinical target volume (CTV) margins for radiotherapy. Materials and methods The study included HGG patients with tumors located in non-functional areas, and supratotal resection was performed. The ME distance from the edge of the tumor to the microscopic tumor cells surrounding brain tissue was measured. Associations between the extent of ME and clinicopathological characteristics were evaluated by multivariate linear regression (MVLR) analysis. An ME predictive model was developed based on the MVLR model. Results Between June 2017 and July 2019, 652 pathologic slides obtained from 30 HGG patients were analyzed. The mean ME distance was 1.70 cm (range, 0.63 to 2.87 cm). The MVLR analysis identified that pathologic grade, subventricular zone (SVZ) contact and O6-methylguanine-DNA methyltransferase (MGMT) methylation, isocitrate dehydrogenase (IDH) mutation and 1p/19q co-deletion status were independent variables predicting ME (all P < 0.05). A multivariable prediction model was developed as follows: YME = 0.672 + 0.513XGrade + 0.380XSVZ + 0.439XMGMT + 0.320XIDH + 0.333X1p/19q. The R-square value of goodness of fit was 0.780. The receiver operating characteristic curve proved that the area under the curve was 0.964 (P < 0.001). Conclusion ME was heterogeneously distributed across different grades of gliomas according to the tumor location and molecular marker status, which indicated that CTV delineation should be individualized. The model could predict the ME of HGG, which may help clinicians determine the CTV for individual patients. Trial registration The trial was registered with Chinese Clinical Trial Registry (ChiCTR2100046106). Registered 4 May 2021-Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01819-0.
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Affiliation(s)
- Shulun Nie
- Department of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao Road 6699, Jinan, 250117, Shandong, People's Republic of China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China
| | - Yufang Zhu
- Department of Neurosurgery, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Jia Yang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China
| | - Tao Xin
- Department of Neurosurgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, People's Republic of China
| | - Song Xue
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China
| | - Xianbin Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China
| | - Jujie Sun
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Dianbin Mu
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Yongsheng Gao
- Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Zhaoqiu Chen
- Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, People's Republic of China
| | - Xingchen Ding
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao Road 6699, Jinan, 250117, Shandong, People's Republic of China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China.
| | - Man Hu
- Department of Radiation Oncology, Shandong First Medical University and Shandong Academy of Medical Sciences, Qingdao Road 6699, Jinan, 250117, Shandong, People's Republic of China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jiyan Road 440, Jinan, 250117, Shandong, People's Republic of China.
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Di Giorgio E, Cuocolo A, Mansi L, Sicignano M, Squame F, Gaudieri V, Giordano P, Giugliano FM, Mazzaferro MP, Negro A, Villa A, Spadafora M. Assessment of therapy response to Regorafenib by 18F-DOPA-PET/CT in patients with recurrent high-grade gliomas: a case series. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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103
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Ziemys A, Simic V, Milosevic M, Kojic M, Liu YT, Yokoi K. Attenuated Microcirculation in Small Metastatic Tumors in Murine Liver. Pharmaceutics 2021; 13:pharmaceutics13050703. [PMID: 34065867 PMCID: PMC8150276 DOI: 10.3390/pharmaceutics13050703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
Metastatic cancer disease is the major cause of death in cancer patients. Because those small secondary tumors are clinically hardly detectable in their early stages, little is known about drug biodistribution and permeation into those metastatic tumors potentially contributing to insufficient clinical success against metastatic disease. Our recent studies indicated that breast cancer liver metastases may have compromised perfusion of intratumoral capillaries hindering the delivery of therapeutics for yet unknown reasons. To understand the microcirculation of small liver metastases, we have utilized computational simulations to study perfusion and oxygen concentration fields in and around the metastases smaller than 700 µm in size at the locations of portal vessels, central vein, and liver lobule acinus. Despite tumor vascularization, the results show that blood flow in those tumors can be substantially reduced indicating the presence of inadequate blood pressure gradients across tumors. A low blood pressure may contribute to the collapsed intratumoral capillary lumen limiting tumor perfusion that phenomenologically corroborates with our previously published in vivo studies. Tumors that are smaller than the liver lobule size and originating at different lobule locations may possess a different microcirculation environment and tumor perfusion. The acinus and portal vessel locations in the lobule were found to be the most beneficial to tumor growth based on tumor access to blood flow and intratumoral oxygen. These findings suggest that microcirculation states of small metastatic tumors can potentially contribute to physiological barriers preventing efficient delivery of therapeutic substances into small tumors.
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Affiliation(s)
- Arturas Ziemys
- Houston Methodist Research Institute, Houston, TX 77030, USA; (M.K.); (Y.T.L.); (K.Y.)
- Correspondence:
| | - Vladimir Simic
- Bioengineering Research and Development Center BioIRC Kragujevac, 3400 Kragujevac, Serbia; (V.S.); (M.M.)
| | - Miljan Milosevic
- Bioengineering Research and Development Center BioIRC Kragujevac, 3400 Kragujevac, Serbia; (V.S.); (M.M.)
| | - Milos Kojic
- Houston Methodist Research Institute, Houston, TX 77030, USA; (M.K.); (Y.T.L.); (K.Y.)
- Bioengineering Research and Development Center BioIRC Kragujevac, 3400 Kragujevac, Serbia; (V.S.); (M.M.)
| | - Yan Ting Liu
- Houston Methodist Research Institute, Houston, TX 77030, USA; (M.K.); (Y.T.L.); (K.Y.)
| | - Kenji Yokoi
- Houston Methodist Research Institute, Houston, TX 77030, USA; (M.K.); (Y.T.L.); (K.Y.)
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104
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Li C, Li S, Du K, Li P, Qiu B, Ding W. On-Chip Replication of Extremely Early-Stage Tumor Behavior. ACS APPLIED MATERIALS & INTERFACES 2021; 13:19768-19777. [PMID: 33877794 DOI: 10.1021/acsami.1c03740] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cancer is a multistep progressive disease that generally involves tumor growth, invasion, and metastasis. It is crucial to understand tumor progression for tumor diagnosis and therapy. However, tumor progression at an extremely early stage (EES) is barely demonstrated because EES tumors are too small to be detected by imaging. Herein, we, for the first time, replicated tumor progression at the EES on a microfluidic chip and uncovered the tumor behaviors affected by the tumor microenvironment. To mimic the progression of a single solid tumor at the EES, a HeLa cell spheroid was seeded and cultured on the chip, and a microvascular network was developed to integrate the microphysiological contexts around the tumor. We revealed not only the growth patterns and cell behaviors of tumor spheroids of different sizes under angiogenesis and fibroblast conditions but also the effect of tumor progression on peritumoral angiogenesis. We found that smaller tumors were more aggressive and that endotheliocytes and fibroblasts significantly accelerated both the proliferation and migration of tumor cells. In addition, we also first present the dynamic epithelial-mesenchymal transition process of tumor cells and the formation of vasculogenic mimicry at the EES. This work can provide insights for understanding tumor progression at the EES and offer new ideas for tumor therapy.
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Affiliation(s)
- Chengpan Li
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei 230027, China
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Shibo Li
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei 230027, China
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Kun Du
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei 230027, China
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Ping Li
- Chinese Integrative Medicine Oncology Department, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Bensheng Qiu
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei 230027, China
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
| | - Weiping Ding
- Center for Biomedical Engineering, University of Science and Technology of China, Hefei 230027, China
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei 230027, China
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105
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Werner JM, Weller J, Ceccon G, Schaub C, Tscherpel C, Lohmann P, Bauer EK, Schäfer N, Stoffels G, Baues C, Celik E, Marnitz S, Kabbasch C, Gielen GH, Fink GR, Langen KJ, Herrlinger U, Galldiks N. Diagnosis of Pseudoprogression Following Lomustine-Temozolomide Chemoradiation in Newly Diagnosed Glioblastoma Patients Using FET-PET. Clin Cancer Res 2021; 27:3704-3713. [PMID: 33947699 DOI: 10.1158/1078-0432.ccr-21-0471] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/15/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The CeTeG/NOA-09 phase III trial demonstrated a significant survival benefit of lomustine-temozolomide chemoradiation in patients with newly diagnosed glioblastoma with methylated O6-methylguanine-DNA methyltransferase (MGMT) promoter. Following lomustine-temozolomide chemoradiation, late and prolonged pseudoprogression may occur. We here evaluated the value of amino acid PET using O-(2-[18F]fluoroethyl)-l-tyrosine (FET) for differentiating pseudoprogression from tumor progression. EXPERIMENTAL DESIGN We retrospectively identified patients (i) who were treated off-study according to the CeTeG/NOA-09 protocol, (ii) had equivocal MRI findings after radiotherapy, and (iii) underwent additional FET-PET imaging for diagnostic evaluation (number of scans, 1-3). Maximum and mean tumor-to-brain ratios (TBRmax, TBRmean) and dynamic FET uptake parameters (e.g., time-to-peak) were calculated. In patients with more than one FET-PET scan, relative changes of TBR values were evaluated, that is, an increase or decrease of >10% compared with the reference scan was considered as tumor progression or pseudoprogression. Diagnostic performances were evaluated using ROC curve analyses and Fisher exact test. Diagnoses were confirmed histologically or clinicoradiologically. RESULTS We identified 23 patients with 32 FET-PET scans. Within 5-25 weeks after radiotherapy (median time, 9 weeks), pseudoprogression occurred in 11 patients (48%). The parameter TBRmean calculated from the FET-PET performed 10 ± 7 days after the equivocal MRI showed the highest accuracy (87%) to identify pseudoprogression (threshold, <1.95; P = 0.029). The integration of relative changes of TBRmean further improved the accuracy (91%; P < 0.001). Moreover, the combination of static and dynamic parameters increased the specificity to 100% (P = 0.005). CONCLUSIONS The data suggest that FET-PET parameters are of significant clinical value to diagnose pseudoprogression related to lomustine-temozolomide chemoradiation.
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Affiliation(s)
- Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Caroline Tscherpel
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elena K Bauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Eren Celik
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Simone Marnitz
- Department of Radiation Oncology and Cyberknife Center, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Christoph Kabbasch
- Department of Neuroradiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany
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106
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Comparison of diagnostic value of 68 Ga-DOTATOC PET/MRI and standalone MRI for the detection of intracranial meningiomas. Sci Rep 2021; 11:9064. [PMID: 33907204 PMCID: PMC8079685 DOI: 10.1038/s41598-021-87866-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
To evaluate the diagnostic performance of magnetic resonance imaging (MRI) alone in comparison to positron emission tomography/ magnetic resonance imaging (PET/MRI) in patients with meningiomas. 57 patients with a total of 112 meningiomas of the brain were included. PET/MRI, including a fully diagnostic contrast enhanced MRI and PET, were acquired. PET/MRI was used as reference standard. The size and location of meningiomas was recorded. Likelihood-ratio chi-square tests were used to calculate p-values within logistic regression in order to compare different models. A multi-level logistic regression was applied to comply the hierarchical data structure. Multi-level regression adjusts for clustering in data was performed. The majority (n = 103) of meningiomas could be identified based on standard MRI sequences compared to PET/MRI. MRI alone achieved a sensitivity of 95% (95% CI 0.78, 0.99) and specificity of 88% (95% CI 0.58, 0.98). Based on intensity of contrast medium uptake, 97 meningiomas could be diagnosed with intense uptake (93.75%). Sensitivity was lowest with 74% for meningiomas < 0.5 cm3, high with 95% for meningiomas > 2cm3 and highest with 100% for meningiomas 0.5-1.0 cm3. Petroclival meningiomas showed lowest sensitivity with 88% compared to sphenoidal meningiomas with 94% and orbital meningiomas with 100%. Specificity of meningioma diagnostic with MRI was high with 100% for sphenoidal and hemispherical-dural meningiomas and meningiomas with 0.5-1.0 and 1.0-2.0 cm3. Overall MRI enables reliable detection of meningiomas compared to PET/MRI. PET/MRI imaging offers highest sensitivity and specificity for small or difficult located meningiomas.
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107
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Distinct Cerebrovascular Reactivity Patterns for Brain Radiation Necrosis. Cancers (Basel) 2021; 13:cancers13081840. [PMID: 33924308 PMCID: PMC8069508 DOI: 10.3390/cancers13081840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/31/2021] [Accepted: 04/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Current imaging-based discrimination between radiation necrosis versus recurrent glioblastoma contrast-enhancing lesions remains imprecise but is paramount for prognostic and therapeutic evaluation. We examined whether patients with radiation necrosis exhibit distinct patterns of blood oxygenation-level dependent fMRI cerebrovascular reactivity (BOLD-CVR) as the first step to better distinguishing patients with radiation necrosis from recurrent glioblastoma compared with patients with newly diagnosed glioblastoma before surgery and radiotherapy. Methods: Eight consecutive patients with primary and secondary brain tumors and a multidisciplinary clinical and radiological diagnosis of radiation necrosis, and fourteen patients with a first diagnosis of glioblastoma underwent BOLD-CVR mapping. For all these patients, the contrast-enhancing lesion was derived from high-resolution T1-weighted MRI and rendered the volume-of-interest (VOI). From this primary VOI, additional 3 mm concentric expanding VOIs up to 30 mm were created for a detailed perilesional BOLD-CVR tissue analysis between the two groups. Receiver operating characteristic curves assessed the discriminative properties of BOLD-CVR for both groups. Results: Mean intralesional BOLD-CVR values were markedly lower in radiation necrosis than in glioblastoma contrast-enhancing lesions (0.001 ± 0.06 vs. 0.057 ± 0.05; p = 0.04). Perilesionally, a characteristic BOLD-CVR pattern was observed for radiation necrosis and glioblastoma patients, with an improvement of BOLD-CVR values in the radiation necrosis group and persisting lower perilesional BOLD-CVR values in glioblastoma patients. The ROC analysis discriminated against both groups when these two parameters were analyzed together (area under the curve: 0.85, 95% CI: 0.65-1.00). Conclusions: In this preliminary analysis, distinctive intralesional and perilesional BOLD-cerebrovascular reactivity patterns are found for radiation necrosis.
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Physiological Imaging Methods for Evaluating Response to Immunotherapies in Glioblastomas. Int J Mol Sci 2021; 22:ijms22083867. [PMID: 33918043 PMCID: PMC8069140 DOI: 10.3390/ijms22083867] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 12/19/2022] Open
Abstract
Glioblastoma (GBM) is the most malignant brain tumor in adults, with a dismal prognosis despite aggressive multi-modal therapy. Immunotherapy is currently being evaluated as an alternate treatment modality for recurrent GBMs in clinical trials. These immunotherapeutic approaches harness the patient's immune response to fight and eliminate tumor cells. Standard MR imaging is not adequate for response assessment to immunotherapy in GBM patients even after using refined response assessment criteria secondary to amplified immune response. Thus, there is an urgent need for the development of effective and alternative neuroimaging techniques for accurate response assessment. To this end, some groups have reported the potential of diffusion and perfusion MR imaging and amino acid-based positron emission tomography techniques in evaluating treatment response to different immunotherapeutic regimens in GBMs. The main goal of these techniques is to provide definitive metrics of treatment response at earlier time points for making informed decisions on future therapeutic interventions. This review provides an overview of available immunotherapeutic approaches used to treat GBMs. It discusses the limitations of conventional imaging and potential utilities of physiologic imaging techniques in the response assessment to immunotherapies. It also describes challenges associated with these imaging methods and potential solutions to avoid them.
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The role of 11C-methionine PET in patients with negative diffusion-weighted magnetic resonance imaging: correlation with histology and molecular biomarkers in operated gliomas. Nucl Med Commun 2021; 41:696-705. [PMID: 32371671 DOI: 10.1097/mnm.0000000000001202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To compare 11C-methionine (11C-METH) PET with diffusion-weighted MRI (DWI-MRI) diagnostic accuracy and prognostic value in patients with glioma candidate to neurosurgery. METHODS We collected and analyzed data from 124 consecutive patients (n = 124) investigated during preoperative work-up. Both visual and semiquantitative parameters were utilized for image analysis. The reference standard was based on histopathology. The median follow-up was 14.3 months. RESULTS Overall, 47 high-grade gliomas (HGG) and 77 low-grade gliomas (LGG) were diagnosed. On visual assessment, sensitivity and specificity for differentiating HGG from LGG were 80.8 and 59.7% for DWI-MRI, versus 95.7 and 41.5% for 11C-METH PET, respectively. On semiquantitative analysis, the sensitivity, specificity, and area under the curve were 78.7, 71.4, and 80.4% for SUVmax, 78.7, 70.1, and 81.1% for SUVratio, and 74.5, 61, and 76.7% for MTB (metabolic tumor burden), respectively. In patients with negative DWI-MRI and IDH-wild type, SUVmax and SUVratio were higher compared to IDH-mutated (P = 0.025 and P = 0.01, respectively). In LGG, patients with 1p/19q codeletion showed higher SUVmax (P = 0.044). In all patients with negative DWI-MRI, median PFS was longer for SUVmax <3.9 (median not reached vs 34.2 months, P = 0.004), SUVratio <2.3 (median not reached vs 21.5 months, P < 0.001), and MTB <3.1 (median not reached vs 45.7 months, P = 0.05). In LGG patients with negative DWI-MRI, only SUVratio <2.3 and MTB <3.1 were associated with longer PFS (P = 0.016 and P = 0.024, respectively). CONCLUSION C-METH PET was found highly sensitive for glioma differentiation and molecular characterization. In DWI-negative patients, PET parameters correlated with molecular profile were associated with clinical outcome.
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110
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D'Amore F, Grinberg F, Mauler J, Galldiks N, Blazhenets G, Farrher E, Filss C, Stoffels G, Mottaghy FM, Lohmann P, Shah NJ, Langen KJ. Combined 18F-FET PET and diffusion kurtosis MRI in posttreatment glioblastoma: differentiation of true progression from treatment-related changes. Neurooncol Adv 2021; 3:vdab044. [PMID: 34013207 PMCID: PMC8117449 DOI: 10.1093/noajnl/vdab044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Radiological differentiation of tumor progression (TPR) from treatment-related changes (TRC) in pretreated glioblastoma is crucial. This study aimed to explore the diagnostic value of diffusion kurtosis MRI combined with information derived from O-(2-[18F]-fluoroethyl)-l-tyrosine (18F-FET) PET for the differentiation of TPR from TRC in patients with pretreated glioblastoma. Methods Thirty-two patients with histomolecularly defined and pretreated glioblastoma suspected of having TPR were included in this retrospective study. Twenty-one patients were included in the TPR group, and 11 patients in the TRC group, as assessed by neuropathology or clinicoradiological follow-up. Three-dimensional (3D) regions of interest were generated based on increased 18F-FET uptake using a tumor-to-brain ratio of 1.6. Furthermore, diffusion MRI kurtosis maps were obtained from the same regions of interest using co-registered 18F-FET PET images, and advanced histogram analysis of diffusion kurtosis map parameters was applied to generated 3D regions of interest. Diagnostic accuracy was analyzed by receiver operating characteristic curve analysis and combinations of PET and MRI parameters using multivariate logistic regression. Results Parameters derived from diffusion MRI kurtosis maps show high diagnostic accuracy, up to 88%, for differentiating between TPR and TRC. Logistic regression revealed that the highest diagnostic accuracy of 94% (area under the curve, 0.97; sensitivity, 94%; specificity, 91%) was achieved by combining the maximum tumor-to-brain ratio of 18F-FET uptake and diffusion MRI kurtosis metrics. Conclusions The combined use of 18F-FET PET and MRI diffusion kurtosis maps appears to be a promising approach to improve the differentiation of TPR from TRC in pretreated glioblastoma and warrants further investigation.
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Affiliation(s)
- Francesco D'Amore
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Department of Neuroradiology, Circolo Hospital and Macchi Foundation, Varese, Italy
| | - Farida Grinberg
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - Jörg Mauler
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Ganna Blazhenets
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Department of Nuclear Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ezequiel Farrher
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - Christian Filss
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - Felix M Mottaghy
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany.,Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadim Jon Shah
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany.,Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany.,Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany
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111
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Castellano A, Bailo M, Cicone F, Carideo L, Quartuccio N, Mortini P, Falini A, Cascini GL, Minniti G. Advanced Imaging Techniques for Radiotherapy Planning of Gliomas. Cancers (Basel) 2021; 13:cancers13051063. [PMID: 33802292 PMCID: PMC7959155 DOI: 10.3390/cancers13051063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0-961-369-4155
| | - Luciano Carideo
- National Cancer Institute, G. Pascale Foundation, 80131 Naples, Italy;
| | - Natale Quartuccio
- A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90144 Palermo, Italy;
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Andrea Falini
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Giuseppe Lucio Cascini
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
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112
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Borja AJ, Hancin EC, Raynor WY, Ayubcha C, Detchou DK, Werner TJ, Revheim ME, Alavi A. A Critical Review of PET Tracers Used for Brain Tumor Imaging. PET Clin 2021; 16:219-231. [PMID: 33589386 DOI: 10.1016/j.cpet.2020.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The brain is a common site for metastases as well as primary tumors. Although evaluation of these malignancies with contrast-enhanced MR imaging defines current clinical practice, 18F-fluorodeoxyglucose (FDG)-PET has shown considerable utility in this area. In addition, many other tracers targeting various aspects of tumor biology have been developed and tested. This article discusses recent developments in PET imaging and the anticipated role of FDG and other tracers in the assessment of brain tumors.
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Affiliation(s)
- Austin J Borja
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Emily C Hancin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Lewis Katz School of Medicine at Temple University, 3500 North Broad Street, Philadelphia, PA 19140, USA
| | - William Y Raynor
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Drexel University College of Medicine, 2900 West Queen Lane, Philadelphia, PA 19129, USA
| | - Cyrus Ayubcha
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Donald K Detchou
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Mona-Elisabeth Revheim
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo 0372, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, Oslo 0315, Norway
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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113
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Razansky D, Klohs J, Ni R. Multi-scale optoacoustic molecular imaging of brain diseases. Eur J Nucl Med Mol Imaging 2021; 48:4152-4170. [PMID: 33594473 PMCID: PMC8566397 DOI: 10.1007/s00259-021-05207-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/17/2021] [Indexed: 02/07/2023]
Abstract
The ability to non-invasively visualize endogenous chromophores and exogenous probes and sensors across the entire rodent brain with the high spatial and temporal resolution has empowered optoacoustic imaging modalities with unprecedented capacities for interrogating the brain under physiological and diseased conditions. This has rapidly transformed optoacoustic microscopy (OAM) and multi-spectral optoacoustic tomography (MSOT) into emerging research tools to study animal models of brain diseases. In this review, we describe the principles of optoacoustic imaging and showcase recent technical advances that enable high-resolution real-time brain observations in preclinical models. In addition, advanced molecular probe designs allow for efficient visualization of pathophysiological processes playing a central role in a variety of neurodegenerative diseases, brain tumors, and stroke. We describe outstanding challenges in optoacoustic imaging methodologies and propose a future outlook.
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Affiliation(s)
- Daniel Razansky
- Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Wolfgang-Pauli-Strasse 27, HIT E42.1, 8093, Zurich, Switzerland
- Zurich Neuroscience Center (ZNZ), Zurich, Switzerland
- Faculty of Medicine and Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
| | - Jan Klohs
- Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Wolfgang-Pauli-Strasse 27, HIT E42.1, 8093, Zurich, Switzerland
- Zurich Neuroscience Center (ZNZ), Zurich, Switzerland
| | - Ruiqing Ni
- Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Wolfgang-Pauli-Strasse 27, HIT E42.1, 8093, Zurich, Switzerland.
- Zurich Neuroscience Center (ZNZ), Zurich, Switzerland.
- Institute for Regenerative Medicine, Uiversity of Zurich, Zurich, Switzerland.
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114
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Galldiks N, Kocher M, Ceccon G, Werner JM, Brunn A, Deckert M, Pope WB, Soffietti R, Le Rhun E, Weller M, Tonn JC, Fink GR, Langen KJ. Imaging challenges of immunotherapy and targeted therapy in patients with brain metastases: response, progression, and pseudoprogression. Neuro Oncol 2021; 22:17-30. [PMID: 31437274 DOI: 10.1093/neuonc/noz147] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The advent of immunotherapy using immune checkpoint inhibitors (ICIs) and targeted therapy (TT) has dramatically improved the prognosis of various cancer types. However, following ICI therapy or TT-either alone (especially ICI) or in combination with radiotherapy-imaging findings on anatomical contrast-enhanced MRI can be unpredictable and highly variable, and are often difficult to interpret regarding treatment response and outcome. This review aims at summarizing the imaging challenges related to TT and ICI monotherapy as well as combined with radiotherapy in patients with brain metastases, and to give an overview on advanced imaging techniques which potentially overcome some of these imaging challenges. Currently, major evidence suggests that imaging parameters especially derived from amino acid PET, perfusion-/diffusion-weighted MRI, or MR spectroscopy may provide valuable additional information for the differentiation of treatment-induced changes from brain metastases recurrence and the evaluation of treatment response.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Düsseldorf, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martina Deckert
- Institute of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Emilie Le Rhun
- Neuro-Oncology, General and Stereotaxic Neurosurgery Service, University Hospital Lille, Lille, France.,Breast Cancer Department, Oscar Lambret Center, Lille, France.,Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig Maximilians University of Munich, Munich, Germany.,German Cancer Consortium, partner site Munich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
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115
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Gutsche R, Scheins J, Kocher M, Bousabarah K, Fink GR, Shah NJ, Langen KJ, Galldiks N, Lohmann P. Evaluation of FET PET Radiomics Feature Repeatability in Glioma Patients. Cancers (Basel) 2021; 13:cancers13040647. [PMID: 33562803 PMCID: PMC7915742 DOI: 10.3390/cancers13040647] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Initial studies suggested the additional diagnostic value of amino acid positron emission tomography (PET) radiomics using the tracer O-(2-[18F]fluoroethyl)-L-tyrosine (FET) in brain tumor patient management. However, to ensure the reliable performance of the generated FET PET radiomics models for clinical diagnostics, repeatability of radiomics features is essential. Hence, we assessed the impact of brain tumor volumes and key molecular alterations such as an isocitrate dehydrogenase (IDH) mutation on the repeatability of FET PET radiomics features in 50 newly diagnosed glioma patients. In a test–retest approach based on routinely acquired FET PET scans, we identified 297 repeatable features. The IDH genotype did not affect feature repeatability. Moreover, these robust features were able to differentiate patients with IDH-wildtype glioma from those with an IDH mutation. Our results suggest that robust radiomics features can be obtained from routinely acquired FET PET scans, which are valuable for further standardization of radiomics analyses in neurooncology. Abstract Amino acid PET using the tracer O-(2-[18F]fluoroethyl)-L-tyrosine (FET) has attracted considerable interest in neurooncology. Furthermore, initial studies suggested the additional diagnostic value of FET PET radiomics in brain tumor patient management. However, the conclusiveness of radiomics models strongly depends on feature generalizability. We here evaluated the repeatability of feature-based FET PET radiomics. A test–retest analysis based on equivalent but statistically independent subsamples of FET PET images was performed in 50 newly diagnosed and histomolecularly characterized glioma patients. A total of 1,302 radiomics features were calculated from semi-automatically segmented tumor volumes-of-interest (VOIs). Furthermore, to investigate the influence of the spatial resolution of PET on repeatability, spherical VOIs of different sizes were positioned in the tumor and healthy brain tissue. Feature repeatability was assessed by calculating the intraclass correlation coefficient (ICC). To further investigate the influence of the isocitrate dehydrogenase (IDH) genotype on feature repeatability, a hierarchical cluster analysis was performed. For tumor VOIs, 73% of first-order features and 71% of features extracted from the gray level co-occurrence matrix showed high repeatability (ICC 95% confidence interval, 0.91–1.00). In the largest spherical tumor VOIs, 67% of features showed high repeatability, significantly decreasing towards smaller VOIs. The IDH genotype did not affect feature repeatability. Based on 297 repeatable features, two clusters were identified separating patients with IDH-wildtype glioma from those with an IDH mutation. Our results suggest that robust features can be obtained from routinely acquired FET PET scans, which are valuable for further standardization of radiomics analyses in neurooncology.
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Affiliation(s)
- Robin Gutsche
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- RWTH Aachen University, 52062 Aachen, Germany
| | - Jürgen Scheins
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
| | - Martin Kocher
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Center for Integrated Oncology (CIO), Universities Aachen, Bonn, Duesseldorf and Cologne, 50937 Cologne, Germany
| | - Khaled Bousabarah
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
| | - Gereon R. Fink
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Nadim J. Shah
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Neurology, University Hospital RWTH Aachen, 52074 Aachen, Germany
- JARA-BRAIN-Translational Medicine, 52074 Aachen, Germany
| | - Karl-Josef Langen
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Universities Aachen, Bonn, Duesseldorf and Cologne, 52074 Aachen, Germany
| | - Norbert Galldiks
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Center for Integrated Oncology (CIO), Universities Aachen, Bonn, Duesseldorf and Cologne, 50937 Cologne, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Philipp Lohmann
- Research Center Juelich, Institute of Neuroscience and Medicine (INM-3, -4, -11), 52425 Juelich, Germany; (R.G.); (J.S.); (M.K.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany;
- Correspondence:
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116
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Imaging of Response to Radiosurgery and Immunotherapy in Brain Metastases: Quo Vadis? Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose of Review
This review presents an overview of how advanced imaging techniques may help to overcome shortcomings of anatomical MRI for response assessment in patients with brain metastases who are undergoing stereotactic radiosurgery, immunotherapy, or combinations thereof.
Recent Findings
Study results suggest that parameters derived from amino acid PET, diffusion- and perfusion-weighted MRI, MR spectroscopy, and newer MRI methods are particularly helpful for the evaluation of the response to radiosurgery or checkpoint inhibitor immunotherapy and provide valuable information for the differentiation of radiotherapy-induced changes such as radiation necrosis from brain metastases. The evaluation of these imaging modalities is also of great interest in the light of emerging high-throughput analysis methods such as radiomics, which allow the acquisition of additional data at a low cost.
Summary
Preliminary results are promising and should be further evaluated. Shortcomings are different levels of PET and MRI standardization, the number of patients enrolled in studies, and the monocentric and retrospective character of most studies.
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117
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Orevi M, Shamni O, Zalcman N, Chicheportiche A, Mordechai A, Moscovici S, Shoshan Y, Shahar T, Charbit H, Gutreiman M, Paldor I, Mishani E, Lossos A, Lavon I. [ 18F]-FDHT PET/CT as a tool for imaging androgen receptor expression in high-grade glioma. Neurooncol Adv 2021; 3:vdab019. [PMID: 33738450 PMCID: PMC7954111 DOI: 10.1093/noajnl/vdab019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background G lioblastoma (GBM) is associated with poor overall survival. Recently, we showed that androgen receptor (AR) protein is overexpressed in 56% of GBM specimens and AR antagonists induced dose-dependent death in several GBM cell lines and significantly reduced tumor growth and prolonged the lifespan of mice implanted with human GBM. 16β-18F-fluoro-5α-dihydrotestosterone ([18F]-FDHT) is a positron emission tomography (PET) tracer used to detect AR expression in prostate and breast cancers. This study was aimed at exploring the ability of [18F]-FDHT-PET to detect AR expression in high-grade gliomas. Methods Twelve patients with suspected high-grade glioma underwent a regular workup and additional dynamic and static [18F]-FDHT-PET/CT. Visual and quantitative analyses of [18 F]-FDHT kinetics in the tumor and normal brain were performed. Mean and maximum (max) standardized uptake values (SUVs) were determined in selected volumes of interest. The patients had surgery or biopsy after PET/CT. AR protein was analyzed in the tumor samples by western blot. Fold change in AR expression was calculated by densitometry analysis. Correlation between imaging and AR protein samples was determined. Results In six of the 12 patients, [18 F]-FDHT uptake was significantly higher in the tumor than in the normal brain. These patients also had increased AR protein expression within the tumor. Pearson correlation coefficient analysis for the tumor-to-control normal brain uptake ratio in terms of SUVmean versus AR protein expression was positive and significant (R = 0.84; P = .002). Conclusion [18 F]-FDHT-PET/CT could identify increased AR expression in high-grade glioma.
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Affiliation(s)
- Marina Orevi
- Department of Nuclear Medicine and Biophysics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ofer Shamni
- Cyclotron/Radiochemistry Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nomi Zalcman
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alexandre Chicheportiche
- Department of Nuclear Medicine and Biophysics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Anat Mordechai
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Samuel Moscovici
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yigal Shoshan
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Shahar
- The Laboratory for Molecular Neuro-Oncology, Department of Neurosurgery, Shaare Zedek-Hebrew University Medical Center, Jerusalem, Israel
| | - Hanna Charbit
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mijal Gutreiman
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Iddo Paldor
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eyal Mishani
- Cyclotron/Radiochemistry Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alexander Lossos
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Department of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Iris Lavon
- Leslie and Michael Gaffin Center for Neuro-Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Agnes Ginges Center for Human Neurogenetics, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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118
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Lohmann P, Meißner AK, Kocher M, Bauer EK, Werner JM, Fink GR, Shah NJ, Langen KJ, Galldiks N. Feature-based PET/MRI radiomics in patients with brain tumors. Neurooncol Adv 2021; 2:iv15-iv21. [PMID: 33521637 PMCID: PMC7829472 DOI: 10.1093/noajnl/vdaa118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Radiomics allows the extraction of quantitative features from medical images such as CT, MRI, or PET, thereby providing additional, potentially relevant diagnostic information for clinical decision-making. Because the computation of these features is performed highly automated on medical images acquired during routine follow-up, radiomics offers this information at low cost. Further, the radiomics features can be used alone or combined with other clinical or histomolecular parameters to generate predictive or prognostic mathematical models. These models can then be applied for various important diagnostic indications in neuro-oncology, for example, to noninvasively predict relevant biomarkers in glioma patients, to differentiate between treatment-related changes and local brain tumor relapse, or to predict treatment response. In recent years, amino acid PET has become an important diagnostic tool in patients with brain tumors. Therefore, the number of studies in patients with brain tumors investigating the potential of PET radiomics or combined PET/MRI radiomics is steadily increasing. This review summarizes current research regarding feature-based PET as well as combined PET/MRI radiomics in neuro-oncology.
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Affiliation(s)
- Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna-Katharina Meißner
- Department of Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Elena K Bauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Juelich, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Juelich, Germany.,JARA - BRAIN - Translational Medicine, Aachen, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany.,JARA - BRAIN - Translational Medicine, Aachen, Germany.,Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Aachen, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Germany.,Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Shymanskaya A, Worthoff WA, Stoffels G, Lindemeyer J, Neumaier B, Lohmann P, Galldiks N, Langen KJ, Shah NJ. Comparison of [ 18F]Fluoroethyltyrosine PET and Sodium MRI in Cerebral Gliomas: a Pilot Study. Mol Imaging Biol 2021; 22:198-207. [PMID: 30989437 DOI: 10.1007/s11307-019-01349-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Positron emission tomography (PET) using O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) improves the diagnostics of cerebral gliomas compared with conventional magnetic resonance imaging (MRI). Sodium MRI is an evolving method to assess tumor metabolism. In this pilot study, we explored the relationship of [18F]FET-PET and sodium MRI in patients with cerebral gliomas in relation to the mutational status of the enzyme isocitrate dehydrogenase (IDH). PROCEDURES Ten patients with untreated cerebral gliomas and one patient with a recurrent glioblastoma (GBM) were investigated by dynamic [18F]FET-PET and sodium MRI using an enhanced simultaneous single-quantum- and triple-quantum-filtered imaging of 23Na (SISTINA) sequence to estimate total (NaT), weighted non-restricted (NaNR, mainly extracellular), and restricted (NaR, mainly intracellular) sodium in tumors and normal brain tissue. [18F]FET uptake and sodium parameters in tumors with a different IDH mutational status were compared. After biopsy or resection, histology and the IDH mutational status were determined neuropathologically. RESULTS NaT (p = 0.05), tumor-to-brain ratios (TBR) of NaT (p = 0.02), NaNR (p = 0.003), and the ratio of NaT/NaR (p < 0.001) were significantly higher in IDH-mutated than in IDH-wild-type gliomas (n = 5 patients each) while NaR was significantly lower in IDH-mutated gliomas (p = 0.01). [18F]FET parameters (TBR, time-to-peak) were not predictive of IDH status in this small cohort of patients. There was no obvious relationship between sodium distribution and [18F]FET uptake. The patient with a recurrent GBM exhibited an additional radiation injury with strong abnormalities in sodium MRI. CONCLUSIONS Sodium MRI appears to be more strongly related to the IDH mutational status than are [18F]FET-PET parameters. A further evaluation of the combination of the two methods in a larger group of high- and low-grade gliomas seems promising.
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Affiliation(s)
- Aliaksandra Shymanskaya
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany.
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Johannes Lindemeyer
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Bernd Neumaier
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany.,Department of Neurology, University of Cologne, Cologne, Germany.,Center of Integrated Oncology (CIO), Universities of Bonn and Cologne, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany.,Department of Nuclear Medicine, RWTH Aachen University, Aachen, Germany.,Jülich-Aachen Research Alliance (JARA) - Section JARA-Brain, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (3, 4, 5, 11), Forschungszentrum Jülich GmbH, 52425, Jülich, Germany.,Jülich-Aachen Research Alliance (JARA) - Section JARA-Brain, Aachen, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany
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[ 18F]FET PET Uptake Indicates High Tumor and Low Necrosis Content in Brain Metastasis. Cancers (Basel) 2021; 13:cancers13020355. [PMID: 33478030 PMCID: PMC7835779 DOI: 10.3390/cancers13020355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Various types of cancers can lead to brain metastasis. Treatment strategies have improved substantially in the past decade, leading to longer survival in many cases, but also to new diagnostic challenges. Being able to locate those parts of a lesion suspicious for brain metastasis that contain the highest concentrations of viable tumor cells can be crucial, e.g., to obtain a precise diagnosis via targeted biopsies or to differentiate recurring tumor from dead tissue after treatment. Positron emission tomography (PET) imaging has the potential to provide this kind of information. However, studies relating PET findings to actual tissue properties are sparse. The aim of this study was to investigate the association of PET imaging with microscopic tissue properties in samples obtained neurosurgically from brain metastases. Our findings can improve the planning and yield of biopsies from brain metastases, and they may inform future studies aimed at improving the discrimination of recurring from dead tumor in treated brain metastases using PET. Abstract Amino acid positron emission tomography (PET) has been employed in the management of brain metastases. Yet, histopathological correlates of PET findings remain poorly understood. We investigated the relationship of O-(2-[18F]Fluoroethyl)-L-tyrosine ([18F]FET) PET, magnetic resonance imaging (MRI), and histology in brain metastases. Fifteen patients undergoing brain metastasis resection were included prospectively. Using intraoperative navigation, 39 targeted biopsies were obtained from parts of the metastases that were either PET-positive or negative and MRI-positive or negative. Tumor and necrosis content, proliferation index, lymphocyte infiltration, and vascularization were determined histopathologically. [18F]FET PET had higher specificity than MRI (66% vs. 56%) and increased sensitivity for tumor from 73% to 93% when combined with MRI. Tumor content per sample increased with PET uptake (rs = 0.3, p = 0.045), whereas necrosis content decreased (rs = −0.4, p = 0.014). PET-positive samples had more tumor (median: 75%; interquartile range: 10–97%; p = 0.016) than PET-negative samples. The other investigated histological properties were not correlated with [18F]FET PET intensity. Tumors were heterogeneous at the levels of imaging and histology. [18F]FET PET can be a valuable tool in the management of brain metastases. In biopsies, one should aim for PET hotspots to increase the chance for retrieval of samples with high tumor cell concentrations. Multiple biopsies should be performed to account for intra-tumor heterogeneity. PET could be useful for differentiating treatment-related changes (e.g., radiation necrosis) from tumor recurrence.
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Verburg N, Koopman T, Yaqub MM, Hoekstra OS, Lammertsma AA, Barkhof F, Pouwels PJW, Reijneveld JC, Heimans JJ, Rozemuller AJM, Bruynzeel AME, Lagerwaard F, Vandertop WP, Boellaard R, Wesseling P, de Witt Hamer PC. Improved detection of diffuse glioma infiltration with imaging combinations: a diagnostic accuracy study. Neuro Oncol 2021; 22:412-422. [PMID: 31550353 PMCID: PMC7058442 DOI: 10.1093/neuonc/noz180] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background Surgical resection and irradiation of diffuse glioma are guided by standard MRI: T2/fluid attenuated inversion recovery (FLAIR)–weighted MRI for non-enhancing and T1-weighted gadolinium-enhanced (T1G) MRI for enhancing gliomas. Amino acid PET has been suggested as the new standard. Imaging combinations may improve standard MRI and amino acid PET. The aim of the study was to determine the accuracy of imaging combinations to detect glioma infiltration. Methods We included 20 consecutive adults with newly diagnosed non-enhancing glioma (7 diffuse astrocytomas, isocitrate dehydrogenase [IDH] mutant; 1 oligodendroglioma, IDH mutant and 1p/19q codeleted; 1 glioblastoma IDH wildtype) or enhancing glioma (glioblastoma, 9 IDH wildtype and 2 IDH mutant). Standardized preoperative imaging (T1-, T2-, FLAIR-weighted, and T1G MRI, perfusion and diffusion MRI, MR spectroscopy and O-(2-[18F]-fluoroethyl)-L-tyrosine ([18F]FET) PET) was co-localized with multiregion stereotactic biopsies preceding resection. Tumor presence in the biopsies was assessed by 2 neuropathologists. Diagnostic accuracy was determined using receiver operating characteristic analysis. Results A total of 174 biopsies were obtained (63 from 9 non-enhancing and 111 from 11 enhancing gliomas), of which 129 contained tumor (50 from non-enhancing and 79 from enhancing gliomas). In enhancing gliomas, the combination of apparent diffusion coefficient (ADC) with [18F]FET PET (area under the curve [AUC], 95% CI: 0.89, 0.79‒0.99) detected tumor better than T1G MRI (0.56, 0.39‒0.72; P < 0.001) and [18F]FET PET (0.76, 0.66‒0.86; P = 0.001). In non-enhancing gliomas, no imaging combination detected tumor significantly better than standard MRI. FLAIR-weighted MRI had an AUC of 0.81 (0.65–0.98) compared with 0.69 (0.56–0.81; P = 0.019) for [18F]FET PET. Conclusion Combining ADC and [18F]FET PET detects glioma infiltration better than standard MRI and [18F]FET PET in enhancing gliomas, potentially enabling better guidance of local therapy.
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Affiliation(s)
- Niels Verburg
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Thomas Koopman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Maqsood M Yaqub
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands.,University College London Institute of Neurology and Healthcare Engineering, London, UK
| | - Petra J W Pouwels
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Jaap C Reijneveld
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Department of Neurology, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | - Jan J Heimans
- Department of Neurology, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | | | | | - Frank Lagerwaard
- Department of Radiotherapy, Amsterdam UMC, VUmc, Amsterdam, Netherlands
| | - William P Vandertop
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Free University Medical Center (VUmc), Amsterdam, Netherlands
| | - Pieter Wesseling
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Pathology, Amsterdam UMC, VUmc, Amsterdam, Netherlands.,Princess Máxima Center for Pediatric Oncology and Department of Pathology, UMC Utrecht, Utrecht, Netherlands
| | - Philip C de Witt Hamer
- Brain Tumor Center Amsterdam, Amsterdam University Medical Center (UMC), Amsterdam, Netherlands.,Neurosurgical Center Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
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Su Y, Miao Y, Zhu Y, Zou W, Yu B, Shen Y, Cong H. A design strategy for D–A conjugated polymers for NIR-II fluorescence imaging. Polym Chem 2021. [DOI: 10.1039/d1py00470k] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The development of bioimaging technology in recent years has shown that second near-infrared (NIR-II) fluorescence imaging (FI) is gradually replacing the traditional visible light and first near-infrared (NIR-I) FI.
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Affiliation(s)
- Yingbin Su
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
| | - Yawei Miao
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
| | - Yaowei Zhu
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
| | - Wentao Zou
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
| | - Bing Yu
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Chemistry and Chemical Engineering, Qingdao University, Qingdao 266071, China
| | - Youqing Shen
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
- Center for Bionanoengineering and Key Laboratory of Biomass Chemical Engineering of Ministry of Education, College of Chemical and Biological Engineering, Zhejiang University, China
| | - Hailin Cong
- Institute of Biomedical Materials and Engineering, College of Materials Science and Engineering, Qingdao University, Qingdao 266071, China
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Chemistry and Chemical Engineering, Qingdao University, Qingdao 266071, China
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Stegmayr C, Stoffels G, Filß C, Heinzel A, Lohmann P, Willuweit A, Ermert J, Coenen HH, Mottaghy FM, Galldiks N, Langen KJ. Current trends in the use of O-(2-[ 18F]fluoroethyl)-L-tyrosine ([ 18F]FET) in neurooncology. Nucl Med Biol 2021; 92:78-84. [PMID: 32113820 DOI: 10.1016/j.nucmedbio.2020.02.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/16/2020] [Indexed: 12/14/2022]
Abstract
The diagnostic potential of PET using the amino acid analogue O-(2-[18F]fluoroethyl)-L-tyrosine ([18F]FET) in brain tumor diagnostics has been proven in many studies during the last two decades and is still the subject of multiple studies every year. In addition to standard magnetic resonance imaging (MRI), positron emission tomography (PET) using [18F]FET provides important diagnostic data concerning brain tumor delineation, therapy planning, treatment monitoring, and improved differentiation between treatment-related changes and tumor recurrence. The pharmacokinetics, uptake mechanisms and metabolism have been well described in various preclinical studies. The accumulation of [18F]FET in most benign lesions and healthy brain tissue has been shown to be low, thus providing a high contrast between tumor tissue and benign tissue alterations. Based on logistic advantages of F-18 labelling and convincing clinical results, [18F]FET has widely replaced short lived amino acid tracers such as L-[11C]methyl-methionine ([11C]MET) in many centers across Western Europe. This review summarizes the basic knowledge on [18F]FET and its contribution to the care of patients with brain tumors. In particular, recent studies about specificity, possible pitfalls, and the utility of [18F]FET PET in tumor grading and prognostication regarding the revised WHO classification of brain tumors are addressed.
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Affiliation(s)
- Carina Stegmayr
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany
| | - Christian Filß
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany; Dept. of Nuclear Medicine, RWTH University Hospital, Aachen, Germany
| | - Alexander Heinzel
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany; Dept. of Nuclear Medicine, RWTH University Hospital, Aachen, Germany; Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany
| | - Antje Willuweit
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany
| | - Johannes Ermert
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany
| | - Heinz H Coenen
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany
| | - Felix M Mottaghy
- Dept. of Nuclear Medicine, RWTH University Hospital, Aachen, Germany; Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain, Germany; Center of Integrated Oncology (CIO), University of Aachen, Bonn, Cologne and Duesseldorf, Germany; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany; Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO), University of Aachen, Bonn, Cologne and Duesseldorf, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-5), Forschungszentrum Juelich, Juelich, Germany; Dept. of Nuclear Medicine, RWTH University Hospital, Aachen, Germany; Juelich-Aachen Research Alliance (JARA) - Section JARA-Brain, Germany; Center of Integrated Oncology (CIO), University of Aachen, Bonn, Cologne and Duesseldorf, Germany.
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Aasen SN, Espedal H, Keunen O, Adamsen TCH, Bjerkvig R, Thorsen F. Current landscape and future perspectives in preclinical MR and PET imaging of brain metastasis. Neurooncol Adv 2021; 3:vdab151. [PMID: 34988446 PMCID: PMC8704384 DOI: 10.1093/noajnl/vdab151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Brain metastasis (BM) is a major cause of cancer patient morbidity. Clinical magnetic resonance imaging (MRI) and positron emission tomography (PET) represent important resources to assess tumor progression and treatment responses. In preclinical research, anatomical MRI and to some extent functional MRI have frequently been used to assess tumor progression. In contrast, PET has only to a limited extent been used in animal BM research. A considerable culprit is that results from most preclinical studies have shown little impact on the implementation of new treatment strategies in the clinic. This emphasizes the need for the development of robust, high-quality preclinical imaging strategies with potential for clinical translation. This review focuses on advanced preclinical MRI and PET imaging methods for BM, describing their applications in the context of what has been done in the clinic. The strengths and shortcomings of each technology are presented, and recommendations for future directions in the development of the individual imaging modalities are suggested. Finally, we highlight recent developments in quantitative MRI and PET, the use of radiomics and multimodal imaging, and the need for a standardization of imaging technologies and protocols between preclinical centers.
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Affiliation(s)
- Synnøve Nymark Aasen
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Heidi Espedal
- The Molecular Imaging Center, Department of Biomedicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olivier Keunen
- Translational Radiomics, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Tom Christian Holm Adamsen
- Centre for Nuclear Medicine, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- 180 °N – Bergen Tracer Development Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - Rolf Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Frits Thorsen
- Department of Biomedicine, University of Bergen, Bergen, Norway
- The Molecular Imaging Center, Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Qilu Hospital of Shandong University and Brain Science Research Institute, Shandong University, Key Laboratory of Brain Functional Remodeling, Shandong, Jinan, P.R. China
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Karimzadeh M, Tabibzadeh A, Moghoofei M, Abbasi S, Sadri Nahand J, Sadeghii F, Karbalaie Niya MH, Keyvani H, Bokharaei-Salim F, Esghaei M, Esghaei M. As Evidence-Based Tumorigenic Role of Epstein-Barr Virus miR-BART1-3p in Neurological Tumors. Asian Pac J Cancer Prev 2021; 22:257-266. [PMID: 33507707 PMCID: PMC8184183 DOI: 10.31557/apjcp.2021.22.1.257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Central nervous system tumors are a diverse group of tumors that account for 2% of all adult cancers and 17% of childhood malignancies. Several internal and external risk factors are involved in the development of this cancer such as viral infections. The aim of this study was to the determination of the EBV infection frequency and the expression level of miR-122 and miR-BART in CNS tumors samples. METHODS One hundred and thirty-eight fresh tissue sample (106 case and 32 control) was collected from CNS specimens. The presence of Epstein-Barr virus (EBV) DNA was examined by PCR assay and the expression level of miR-122 and miR-BART were evaluated by using real-time PCR assay in CNS tissue samples. RESULTS EBV DNA was detected in 17% (18 of 106) of tumors tissue samples and 6.4% (2 of 32) of control samples. according to results, there was a significant relationship between the presence of EBV-DNA with CNS tumors. Additionally, the expression level of miR-122 was significantly downregulated in the EBV-positive sample compared to that of the EBV-negative sample. Also, the level of EBV-BART1-3p expression was significantly higher in EBV-positive tumors samples than EBV-positive normal samples. CONCLUSION The results of this study suggest that the EBV could change the condition of cancer cells by altering the expression of miR-122 and EBV-BART1-3p and maybe contribute to the development of cancer cells. However, the role of viral infections in CNS cancer requires further studies. <br />.
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Affiliation(s)
- Mohammad Karimzadeh
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Tabibzadeh
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Moghoofei
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Department of Microbiology, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Saeedeh Abbasi
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Javid Sadri Nahand
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farzin Sadeghii
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Hossin Keyvani
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farah Bokharaei-Salim
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Laboratory of National Center, Vice Chancellor for Health, Iran University of Medical Sciences, Tehran, Iran
| | - Moein Esghaei
- Cognitive Neuroscience Laboratory, German Primate Center - Leibniz Institute for Primate Research, Göttingen, Germany
| | - Maryam Esghaei
- Department of Virology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Lohmann P, Elahmadawy MA, Gutsche R, Werner JM, Bauer EK, Ceccon G, Kocher M, Lerche CW, Rapp M, Fink GR, Shah NJ, Langen KJ, Galldiks N. FET PET Radiomics for Differentiating Pseudoprogression from Early Tumor Progression in Glioma Patients Post-Chemoradiation. Cancers (Basel) 2020; 12:cancers12123835. [PMID: 33353180 PMCID: PMC7766151 DOI: 10.3390/cancers12123835] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/11/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Following chemoradiation with alkylating agents in glioma patients, structural magnetic resonance imaging (MRI) may suggest tumor progression which subsequently improves during the course of the disease without any treatment change. This phenomenon has been termed pseudoprogression. Despite advances in medical imaging, a reliable diagnosis of pseudoprogression remains a challenging task. Radiomics is a subdiscipline of artificial intelligence and allows the identification and extraction of imaging features from various routine imaging modalities. These features can be used for the generation of mathematical models to improve diagnostics in patients with brain tumors. The present study highlights the potential of radiomics obtained from amino acid positron emission tomography (PET) for the diagnosis of pseudoprogression. In 34 patients with suspicious MRI early after chemoradiation completion, our radiomics model correctly identified all patients with pseudoprogression. Abstract Currently, a reliable diagnostic test for differentiating pseudoprogression from early tumor progression is lacking. We explored the potential of O-(2-[18F]fluoroethyl)-L-tyrosine (FET) positron emission tomography (PET) radiomics for this clinically important task. Thirty-four patients (isocitrate dehydrogenase (IDH)-wildtype glioblastoma, 94%) with progressive magnetic resonance imaging (MRI) changes according to the Response Assessment in Neuro-Oncology (RANO) criteria within the first 12 weeks after completing temozolomide chemoradiation underwent a dynamic FET PET scan. Static and dynamic FET PET parameters were calculated. For radiomics analysis, the number of datasets was increased to 102 using data augmentation. After randomly assigning patients to a training and test dataset, 944 features were calculated on unfiltered and filtered images. The number of features for model generation was limited to four to avoid data overfitting. Eighteen patients were diagnosed with early tumor progression, and 16 patients had pseudoprogression. The FET PET radiomics model correctly diagnosed pseudoprogression in all test cohort patients (sensitivity, 100%; negative predictive value, 100%). In contrast, the diagnostic performance of the best FET PET parameter (TBRmax) was lower (sensitivity, 81%; negative predictive value, 80%). The results suggest that FET PET radiomics helps diagnose patients with pseudoprogression with a high diagnostic performance. Given the clinical significance, further studies are warranted.
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Affiliation(s)
- Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Correspondence:
| | - Mai A. Elahmadawy
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Nuclear Medicine, National Cancer Institute (NCI), Cairo University, 11796 Cairo, Egypt
| | - Robin Gutsche
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- RWTH Aachen University, 52062 Aachen, Germany
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.-M.W.); (E.K.B.); (G.C.)
| | - Elena K. Bauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.-M.W.); (E.K.B.); (G.C.)
| | - Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.-M.W.); (E.K.B.); (G.C.)
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
- Center for Integrated Oncology (CIO), Universities Aachen, Bonn, Duesseldorf and Cologne, 50937 Cologne, Germany
| | - Christoph W. Lerche
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
| | - Marion Rapp
- Department of Neurosurgery, University of Duesseldorf, 40255 Duesseldorf, Germany;
| | - Gereon R. Fink
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.-M.W.); (E.K.B.); (G.C.)
| | - Nadim J. Shah
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Neurology, University Hospital RWTH Aachen, 52074 Aachen, Germany
- JARA-BRAIN-Translational Medicine, 52074 Aachen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Nuclear Medicine, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Center for Integrated Oncology (CIO), Universities Aachen, Bonn, Duesseldorf and Cologne, 52074 Aachen, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, 52425 Juelich, Germany; (M.A.E.); (R.G.); (M.K.); (C.W.L.); (G.R.F.); (N.J.S.); (K.-J.L.); (N.G.)
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (J.-M.W.); (E.K.B.); (G.C.)
- Center for Integrated Oncology (CIO), Universities Aachen, Bonn, Duesseldorf and Cologne, 50937 Cologne, Germany
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Miyake K, Suzuki K, Ogawa T, Ogawa D, Hatakeyama T, Shinomiya A, Kudomi N, Yamamoto Y, Nishiyama Y, Tamiya T. Multiple positron emission tomography tracers for use in the classification of gliomas according to the 2016 World Health Organization criteria. Neurooncol Adv 2020; 3:vdaa172. [PMID: 33681765 PMCID: PMC7920529 DOI: 10.1093/noajnl/vdaa172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The molecular diagnosis of gliomas such as isocitrate dehydrogenase (IDH) status (wild-type [wt] or mutation [mut]) is especially important in the 2016 World Health Organization (WHO) classification. Positron emission tomography (PET) has afforded molecular and metabolic diagnostic imaging. The present study aimed to define the interrelationship between the 2016 WHO classification of gliomas and the integrated data from PET images using multiple tracers, including 18F-fluorodeoxyglucose (18F-FDG), 11C-methionine (11C-MET), 18F-fluorothymidine (18F-FLT), and 18F-fluoromisonidazole (18F-FMISO). Methods This retrospective, single-center study comprised 113 patients with newly diagnosed glioma based on the 2016 WHO criteria. Patients were divided into 4 glioma subtypes (Mut, Codel, Wt, and glioblastoma multiforme [GBM]). Tumor standardized uptake value (SUV) divided by mean normal cortical SUV (tumor–normal tissue ratio [TNR]) was calculated for 18F-FDG, 11C-MET, and 18F-FLT. Tumor–blood SUV ratio (TBR) was calculated for 18F-FMISO. To assess the diagnostic accuracy of PET tracers in distinguishing glioma subtypes, a comparative analysis of TNRs and TBR as well as the metabolic tumor volume (MTV) were calculated by Scheffe's multiple comparison procedure for each PET tracer following the Kruskal–Wallis test. Results The differences in mean 18F-FLT TNR and 18F-FMISO TBR were significant between GBM and other glioma subtypes (P < .001). Regarding the comparison between Gd-T1WI volumes and 18F-FLT MTVs or 18F-FMISO MTVs, we identified significant differences between Wt and Mut or Codel (P < .01). Conclusion Combined administration of 4 PET tracers might aid in the preoperative differential diagnosis of gliomas according to the 2016 WHO criteria.
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Affiliation(s)
- Keisuke Miyake
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Kenta Suzuki
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Tomoya Ogawa
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Daisuke Ogawa
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Tetsuhiro Hatakeyama
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Aya Shinomiya
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Nobuyuki Kudomi
- Department of Medical Physics, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Yuka Yamamoto
- Department of Radiology, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
| | - Takashi Tamiya
- Department of Neurological Surgery, Kagawa University, Faculty of Medicine, Ikenobe, Miki-Cho, Kita-gun, Kagawa, Japan
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128
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Sequential implementation of DSC-MR perfusion and dynamic [ 18F]FET PET allows efficient differentiation of glioma progression from treatment-related changes. Eur J Nucl Med Mol Imaging 2020; 48:1956-1965. [PMID: 33241456 PMCID: PMC8113145 DOI: 10.1007/s00259-020-05114-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/08/2020] [Indexed: 11/21/2022]
Abstract
Purpose Perfusion-weighted MRI (PWI) and O-(2-[18F]fluoroethyl-)-l-tyrosine ([18F]FET) PET are both applied to discriminate tumor progression (TP) from treatment-related changes (TRC) in patients with suspected recurrent glioma. While the combination of both methods has been reported to improve the diagnostic accuracy, the performance of a sequential implementation has not been further investigated. Therefore, we retrospectively analyzed the diagnostic value of consecutive PWI and [18F]FET PET. Methods We evaluated 104 patients with WHO grade II–IV glioma and suspected TP on conventional MRI using PWI and dynamic [18F]FET PET. Leakage corrected maximum relative cerebral blood volumes (rCBVmax) were obtained from dynamic susceptibility contrast PWI. Furthermore, we calculated static (i.e., maximum tumor to brain ratios; TBRmax) and dynamic [18F]FET PET parameters (i.e., Slope). Definitive diagnoses were based on histopathology (n = 42) or clinico-radiological follow-up (n = 62). The diagnostic performance of PWI and [18F]FET PET parameters to differentiate TP from TRC was evaluated by analyzing receiver operating characteristic and area under the curve (AUC). Results Across all patients, the differentiation of TP from TRC using rCBVmax or [18F]FET PET parameters was moderate (AUC = 0.69–0.75; p < 0.01). A rCBVmax cutoff > 2.85 had a positive predictive value for TP of 100%, enabling a correct TP diagnosis in 44 patients. In the remaining 60 patients, combined static and dynamic [18F]FET PET parameters (TBRmax, Slope) correctly discriminated TP and TRC in a significant 78% of patients, increasing the overall accuracy to 87%. A subgroup analysis of isocitrate dehydrogenase (IDH) mutant tumors indicated a superior performance of PWI to [18F]FET PET (AUC = 0.8/< 0.62, p < 0.01/≥ 0.3). Conclusion While marked hyperperfusion on PWI indicated TP, [18F]FET PET proved beneficial to discriminate TP from TRC when PWI remained inconclusive. Thus, our results highlight the clinical value of sequential use of PWI and [18F]FET PET, allowing an economical use of diagnostic methods. The impact of an IDH mutation needs further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05114-0.
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129
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Winter SF, Loebel F, Loeffler J, Batchelor TT, Martinez-Lage M, Vajkoczy P, Dietrich J. Treatment-induced brain tissue necrosis: a clinical challenge in neuro-oncology. Neuro Oncol 2020; 21:1118-1130. [PMID: 30828724 DOI: 10.1093/neuonc/noz048] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/04/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Cancer therapy-induced adverse effects on the brain are a major challenge in neuro-oncology. Brain tissue necrosis (treatment necrosis [TN]) as a consequence of brain directed cancer therapy remains an insufficiently characterized condition with diagnostic and therapeutic difficulties and is frequently associated with significant patient morbidity. A better understanding of the underlying mechanisms, improvement of diagnostic tools, development of preventive strategies, and implementation of evidence-based therapeutic practices are pivotal to improve patient management. In this comprehensive review, we address existing challenges associated with current TN-related clinical and research practices and highlight unanswered questions and areas in need of further research with the ultimate goal to improve management of patients affected by this important neuro-oncological condition.
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Affiliation(s)
- Sebastian F Winter
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jay Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- C S Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorg Dietrich
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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130
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Shankar A, Bomanji J, Hyare H. Hybrid PET-MRI Imaging in Paediatric and TYA Brain Tumours: Clinical Applications and Challenges. J Pers Med 2020; 10:jpm10040218. [PMID: 33182433 PMCID: PMC7711629 DOI: 10.3390/jpm10040218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/29/2020] [Accepted: 11/03/2020] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Standard magnetic resonance imaging (MRI) remains the gold standard for brain tumour imaging in paediatric and teenage and young adult (TYA) patients. Combining positron emission tomography (PET) with MRI offers an opportunity to improve diagnostic accuracy. (2) Method: Our single-centre experience of 18F-fluorocholine (FCho) and 18fluoro-L-phenylalanine (FDOPA) PET–MRI in paediatric/TYA neuro-oncology patients is presented. (3) Results: Hybrid PET–MRI shows promise in the evaluation of gliomas and germ cell tumours in (i) assessing early treatment response and (ii) discriminating tumour from treatment-related changes. (4) Conclusions: Combined PET–MRI shows promise for improved diagnostic and therapeutic assessment in paediatric and TYA brain tumours.
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Affiliation(s)
- Ananth Shankar
- Children and Young People’s Cancer Services, University College London hospitals NHS Foundation Trust, London NW1 2PG, UK
- Correspondence: ; Tel.: +44-20-3447-9950
| | - Jamshed Bomanji
- Department of Nuclear Medicine, University College London hospitals NHS Foundation Trust, London NW1 2PG, UK;
| | - Harpreet Hyare
- Department of Radiology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK;
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London WC1N 3BG, UK
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131
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Nenning KH, Furtner J, Kiesel B, Schwartz E, Roetzer T, Fortelny N, Bock C, Grisold A, Marko M, Leutmezer F, Liu H, Golland P, Stoecklein S, Hainfellner JA, Kasprian G, Prayer D, Marosi C, Widhalm G, Woehrer A, Langs G. Distributed changes of the functional connectome in patients with glioblastoma. Sci Rep 2020; 10:18312. [PMID: 33110138 PMCID: PMC7591862 DOI: 10.1038/s41598-020-74726-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022] Open
Abstract
Glioblastoma might have widespread effects on the neural organization and cognitive function, and even focal lesions may be associated with distributed functional alterations. However, functional changes do not necessarily follow obvious anatomical patterns and the current understanding of this interrelation is limited. In this study, we used resting-state functional magnetic resonance imaging to evaluate changes in global functional connectivity patterns in 15 patients with glioblastoma. For six patients we followed longitudinal trajectories of their functional connectome and structural tumour evolution using bi-monthly follow-up scans throughout treatment and disease progression. In all patients, unilateral tumour lesions were associated with inter-hemispherically symmetric network alterations, and functional proximity of tumour location was stronger linked to distributed network deterioration than anatomical distance. In the longitudinal subcohort of six patients, we observed patterns of network alterations with initial transient deterioration followed by recovery at first follow-up, and local network deterioration to precede structural tumour recurrence by two months. In summary, the impact of focal glioblastoma lesions on the functional connectome is global and linked to functional proximity rather than anatomical distance to tumour regions. Our findings further suggest a relevance for functional network trajectories as a possible means supporting early detection of tumour recurrence.
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Affiliation(s)
- Karl-Heinz Nenning
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
| | - Julia Furtner
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Ernst Schwartz
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Fortelny
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria
| | - Christoph Bock
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Vienna, Austria.,Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Martha Marko
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Hesheng Liu
- A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Cambridge, USA
| | - Polina Golland
- Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA
| | - Sophia Stoecklein
- Department of Radiology, Ludwig-Maximilians-University, Munich, Germany
| | - Johannes A Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Division for Neuro- and Musculo-Skeletal Radiology, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Georg Langs
- Computational Imaging Research Lab, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria. .,Computer Science and Artificial Intelligence Lab, Massachusetts Institute of Technology, Cambridge, USA.
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Wykes V, Zisakis A, Irimia M, Ughratdar I, Sawlani V, Watts C. Importance and Evidence of Extent of Resection in Glioblastoma. J Neurol Surg A Cent Eur Neurosurg 2020; 82:75-86. [PMID: 33049795 DOI: 10.1055/s-0040-1701635] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Maximal safe resection is an essential part of the multidisciplinary care of patients with glioblastoma. A growing body of data shows that gross total resection is an independent prognostic factor associated with improved clinical outcome. The relationship between extent of glioblastoma (GB) resection and clinical benefit depends critically on the balance between cytoreduction and avoiding neurologic morbidity. The definition of the extent of tumor resection, how this is best measured pre- and postoperatively, and its relation to volume of residual tumor is still discussed. We review the literature supporting extent of resection in GB, highlighting the importance of a standardized definition and measurement of extent of resection to allow greater collaboration in research projects and trials. Recent developments in neurosurgical techniques and technologies focused on maximizing extent of resection and safety are discussed.
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Affiliation(s)
- Victoria Wykes
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom of Great Britain and Northern Ireland.,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Athanasios Zisakis
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Mihaela Irimia
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Ismail Ughratdar
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Vijay Sawlani
- Department of Radiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Colin Watts
- Institute of Cancer and Genomic Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, United Kingdom of Great Britain and Northern Ireland.,Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom of Great Britain and Northern Ireland
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133
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Predicting Survival in Glioblastoma Patients Using Diffusion MR Imaging Metrics-A Systematic Review. Cancers (Basel) 2020; 12:cancers12102858. [PMID: 33020420 PMCID: PMC7600641 DOI: 10.3390/cancers12102858] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 12/20/2022] Open
Abstract
Simple Summary An accurate survival analysis is crucial for disease management in glioblastoma (GBM) patients. Due to the ability of the diffusion MRI techniques of providing a quantitative assessment of GBM tumours, an ever-growing number of studies aimed at investigating the role of diffusion MRI metrics in survival prediction of GBM patients. Since the role of diffusion MRI in prediction and evaluation of survival outcomes has not been fully addressed and results are often controversial or unsatisfactory, we performed this systematic review in order to collect, summarize and evaluate all studies evaluating the role of diffusion MRI metrics in predicting survival in GBM patients. We found that quantitative diffusion MRI metrics provide useful information for predicting survival outcomes in GBM patients, mainly in combination with other clinical and multimodality imaging parameters. Abstract Despite advances in surgical and medical treatment of glioblastoma (GBM), the medium survival is about 15 months and varies significantly, with occasional longer survivors and individuals whose tumours show a significant response to therapy with respect to others. Diffusion MRI can provide a quantitative assessment of the intratumoral heterogeneity of GBM infiltration, which is of clinical significance for targeted surgery and therapy, and aimed at improving GBM patient survival. So, the aim of this systematic review is to assess the role of diffusion MRI metrics in predicting survival of patients with GBM. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic literature search was performed to identify original articles since 2010 that evaluated the association of diffusion MRI metrics with overall survival (OS) and progression-free survival (PFS). The quality of the included studies was evaluated using the QUIPS tool. A total of 52 articles were selected. The most examined metrics were associated with the standard Diffusion Weighted Imaging (DWI) (34 studies) and Diffusion Tensor Imaging (DTI) models (17 studies). Our findings showed that quantitative diffusion MRI metrics provide useful information for predicting survival outcomes in GBM patients, mainly in combination with other clinical and multimodality imaging parameters.
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134
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Worthoff WA, Shymanskaya A, Lindemeyer J, Langen KJ, Shah NJ. Relaxometry and quantification in sodium MRI of cerebral gliomas: A FET-PET and MRI small-scale study. NMR IN BIOMEDICINE 2020; 33:e4361. [PMID: 32696547 DOI: 10.1002/nbm.4361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Sodium MRI is a promising method for assessing the metabolic properties of brain tumours. In a recent study, a strong relationship between semi-quantitative abnormalities in sodium MRI and the mutational status of the isocitrate dehydrogenase enzyme (IDH) with untreated cerebral gliomas was observed. Here, sodium relaxometry in brain tumour tissue was investigated in relation to molecular markers in order to reveal quantitative sodium tissue parameters and the differences between healthy tissue and brain tumour. The previous semi-quantitative approach is extended by use of suitable relaxometry methods accompanied by numerical simulation to achieve detailed quantitative analysis of intra- and extracellular sodium concentration using an enhanced SISTINA sequence at 4 T. Using optimised techniques, biexponential sodium relaxation times in tumour (T*2f , T*2s ) and in healthy contralateral brain tissue (T*2f,CL , T*2s,CL ) were estimated in 10 patients, along with intracellular sodium molar fractions (χ, χCL ), volume fractions (η, ηCL ) and concentrations (ρin , ρin,CL ). The total sodium tissue concentrations (ρT , ρT,CL ) were also estimated. The ratios T*2f /T*2f,CL (P = .05), η/ηCL (P = .02) and χ/χCL (P = .02) were significantly lower in IDH mutated than in IDH wildtype gliomas (n = 4 and n = 5 patients, respectively). The Wilcoxon rank-sum test was used to compare sodium MRI parameters in patients with and without IDH mutation. Thus, quantitative analysis of relaxation rates, intra- and extracellular sodium concentrations, intracellular molar and volume fractions based on enhanced SISTINA confirmed a relationship between abnormalities in sodium parameters and the IDH mutational status in cerebral gliomas, hence catering for the potential to provide further insights into the status of the disease.
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Affiliation(s)
- Wieland A Worthoff
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
| | | | - Johannes Lindemeyer
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
- Department of Nuclear Medicine, RWTH Aachen University, JARA, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
- Institute of Neuroscience and Medicine - 11, Forschungszentrum Jülich, Jülich, Germany
- Department of Neurology, RWTH Aachen University, JARA, Aachen, Germany
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135
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Edelman R, Leloudas N, Pang J, Bailes J, Merrell R, Koktzoglou I. Twofold improved tumor-to-brain contrast using a novel T1 relaxation-enhanced steady-state (T 1RESS) MRI technique. SCIENCE ADVANCES 2020; 6:6/44/eabd1635. [PMID: 33115747 PMCID: PMC7608787 DOI: 10.1126/sciadv.abd1635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
A technique that provides more accurate cancer detection would be of great value. Toward this end, we developed T1 relaxation-enhanced steady-state (T1RESS), a novel magnetic resonance imaging (MRI) pulse sequence that enables the flexible modulation of T1 weighting and provides the unique feature that intravascular signals can be toggled on and off in contrast-enhanced scans. T1RESS makes it possible to effectively use an MRI technique with improved signal-to-noise ratio efficiency for cancer imaging. In a proof-of-concept study, "dark blood" unbalanced T1RESS provided a twofold improvement in tumor-to-brain contrast compared with standard techniques, whereas balanced T1RESS greatly enhanced vascular detail. In conclusion, T1RESS represents a new MRI technique with substantial potential value for cancer imaging, along with a broad range of other clinical applications.
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Affiliation(s)
- R Edelman
- Radiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA.
- Northwestern Medicine, 251 E. Huron St., Chicago, IL 60611, USA
| | - N Leloudas
- Radiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
| | - J Pang
- Siemens Medical Solutions USA Inc., 737 N. Michigan Ave., Chicago, IL 60611, USA
| | - J Bailes
- University of Chicago Pritzker School of Medicine, 924 E. 57th St., Chicago, IL 60637, USA
- Neurosurgery, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
| | - R Merrell
- University of Chicago Pritzker School of Medicine, 924 E. 57th St., Chicago, IL 60637, USA
- Neurology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
| | - I Koktzoglou
- Radiology, NorthShore University HealthSystem, 2650 Ridge Ave., Evanston, IL 60201, USA
- University of Chicago Pritzker School of Medicine, 924 E. 57th St., Chicago, IL 60637, USA
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136
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Galldiks N, Abdulla DSY, Scheffler M, Wolpert F, Werner JM, Hüllner M, Stoffels G, Schweinsberg V, Schlaak M, Kreuzberg N, Landsberg J, Lohmann P, Ceccon G, Baues C, Trommer M, Celik E, Ruge MI, Kocher M, Marnitz S, Fink GR, Tonn JC, Weller M, Langen KJ, Wolf J, Mauch C. Treatment Monitoring of Immunotherapy and Targeted Therapy Using 18F-FET PET in Patients with Melanoma and Lung Cancer Brain Metastases: Initial Experiences. J Nucl Med 2020; 62:464-470. [PMID: 32887757 DOI: 10.2967/jnumed.120.248278] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022] Open
Abstract
We investigated the value of O-(2-18F-fluoroethyl)-l-tyrosine (18F-FET) PET for treatment monitoring of immune checkpoint inhibition (ICI) or targeted therapy (TT) alone or in combination with radiotherapy in patients with brain metastasis (BM) since contrast-enhanced MRI often remains inconclusive. Methods: We retrospectively identified 40 patients with 107 BMs secondary to melanoma (n = 29 with 75 BMs) or non-small cell lung cancer (n = 11 with 32 BMs) treated with ICI or TT who had 18F-FET PET (n = 60 scans) for treatment monitoring from 2015 to 2019. Most patients (n = 37; 92.5%) had radiotherapy during the course of the disease. In 27 patients, 18F-FET PET was used to differentiate treatment-related changes from BM relapse after ICI or TT. In 13 patients, 18F-FET PET was performed for response assessment to ICI or TT using baseline and follow-up scans (median time between scans, 4.2 mo). In all lesions, static and dynamic 18F-FET PET parameters were obtained (i.e., mean tumor-to-brain ratios [TBR], time-to-peak values). Diagnostic accuracies of PET parameters were evaluated by receiver-operating-characteristic analyses using the clinical follow-up or neuropathologic findings as a reference. Results: A TBR threshold of 1.95 differentiated BM relapse from treatment-related changes with an accuracy of 85% (P = 0.003). Metabolic responders to ICI or TT on 18F-FET PET had a significantly longer stable follow-up (threshold of TBR reduction relative to baseline, ≥10%; accuracy, 82%; P = 0.004). Furthermore, at follow-up, time to peak in metabolic responders increased significantly (P = 0.019). Conclusion: 18F-FET PET may add valuable information for treatment monitoring in BM patients treated with ICI or TT.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany .,Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Diana S Y Abdulla
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Scheffler
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Fabian Wolpert
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jan-Michael Werner
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hüllner
- Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Viola Schweinsberg
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Max Schlaak
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Kreuzberg
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jennifer Landsberg
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Dermatology, University Hospital Bonn, Bonn, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Garry Ceccon
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Baues
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maike Trommer
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eren Celik
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian I Ruge
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Stereotaxy and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simone Marnitz
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Radiation Oncology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, University Hospital LMU Munich, Munich, Germany; and
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, RWTH University Hospital Aachen, Aachen, Germany
| | - Jürgen Wolf
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Lung Cancer Group, Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Cornelia Mauch
- Center of Integrated Oncology, Universities of Aachen, Bonn, Cologne, and Duesseldorf, Germany.,Department of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Grant R, Dowswell T, Tomlinson E, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Bulbeck H, Kernohan A, Robinson T, Lawrie TA. Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev 2020; 9:CD013564. [PMID: 32901926 PMCID: PMC8082957 DOI: 10.1002/14651858.cd013564.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.
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Affiliation(s)
- Robin Grant
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Therese Dowswell
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Eve Tomlinson
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, 1st Floor Education Centre, Royal United Hospital, Bath, UK
| | - Paul M Brennan
- Translational Neurosurgery Department, Western General Hospital, Edinburgh, UK
| | - Fiona M Walter
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David William Hunt
- Foundation School/Dept of Clinical and Experimental Medicine, Royal Surrey County Hospital/University of Surrey, Guildford, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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Zlatopolskiy BD, Endepols H, Krasikova RN, Fedorova OS, Ermert J, Neumaier B. 11C- and 18F-labelled tryptophans as PET-tracers for imaging of altered tryptophan metabolism in age-associated disorders. RUSSIAN CHEMICAL REVIEWS 2020. [DOI: 10.1070/rcr4954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ageing of the world’s population is the result of increased life expectancy observed in almost all countries throughout the world. Consequently, a rising tide of ageing-associated disorders, like cancer and neurodegenerative diseases, represents one of the main global challenges of the 21st century. The ability of mankind to overcome these challenges is directly dependent on the capability to develop novel methods for therapy and diagnosis of age-associated diseases. One hallmark of age-related pathologies is an altered tryptophan metabolism. Numerous pathological processes including neurodegenerative and neurological diseases like epilepsy, Parkinson’s and Alzheimer’s diseases, cancer and diabetes exhibit marked changes in tryptophan metabolism. Visualization of key processes of tryptophan metabolic pathways, especially using positron emission tomography (PET) and related hybrid methods like PET/CT and PET/MRI, can be exploited to early detect the aforementioned disorders with considerable accuracy, allowing appropriate and timely treatment of patients. Here we review the published 11C- and 18F-labelled tryptophans with respect to the production and also preclinical and clinical evaluation as PET-tracers for visualization of different branches of tryptophan metabolism.
The bibliography includes 159 references.
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139
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Zhou L, Zhang M, Li R, Xue J, Lu Y. Pseudoprogression and hyperprogression in lung cancer: a comprehensive review of literature. J Cancer Res Clin Oncol 2020; 146:3269-3279. [PMID: 32857178 DOI: 10.1007/s00432-020-03360-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/18/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Immune checkpoint inhibitors are associated with clinical benefit in lung cancer. However, response patterns to immunotherapy, including pseudoprogression and hyperprogression, are difficult to diagnose, and their mechanisms remain unclear. This review aimed to describe two response patterns observed in lung cancer, namely pseudoprogression and hyperprogression, including their epidemiology, diagnostic characteristics, and plausible mechanisms. METHODS We performed a comprehensive literature search in the PubMed database, using keywords "pseudoprogression", "hyperprogression", and "lung cancer", among others. The literature was examined for pseudoprogression and hyperprogression characteristics and plausible mechanisms. RESULTS Pseudoprogression manifests in multiple forms; however, the immune system-related response criteria and biopsy data are helpful to make accurate diagnosis. Serological biomarkers, such as neutrophil-to-lymphocyte ratio (NLR) and circulating tumor DNA (ctDNA), might help distinguish pseudoprogression from true progression. The incidence of hyperprogression ranges within 5-19.2%, depending on definition. The unique response pattern of rapid progression is observed not only with immunotherapy, but also with other treatment regimens. Molecular mutations and amplifications may result in hyperprogression; however, the exact mechanism remains unclear. CONCLUSION Atypical response patterns, such as pseudoprogression and hyperprogression, are increasingly common in clinical practice. Immune-related response criteria can help diagnose pseudoprogression. Molecular mechanisms of hyperprogression remain unclear. Biomarkers for pseudoprogression and hyperprogression are required.
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Affiliation(s)
- Laiyan Zhou
- Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, China
| | - Mai Zhang
- Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, China
| | - Rui Li
- Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, China
| | - Jianxin Xue
- Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, China.
| | - You Lu
- Department of Thoracic Cancer, Cancer Center, West China Hospital, West China School of Clinical Medicine, Sichuan University, Chengdu, 610041, China.
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140
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Galldiks N, Langen KJ, Albert NL, Chamberlain M, Soffietti R, Kim MM, Law I, Le Rhun E, Chang S, Schwarting J, Combs SE, Preusser M, Forsyth P, Pope W, Weller M, Tonn JC. PET imaging in patients with brain metastasis-report of the RANO/PET group. Neuro Oncol 2020; 21:585-595. [PMID: 30615138 DOI: 10.1093/neuonc/noz003] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/11/2018] [Accepted: 01/03/2019] [Indexed: 12/23/2022] Open
Abstract
Brain metastases (BM) from extracranial cancer are associated with significant morbidity and mortality. Effective local treatment options are stereotactic radiotherapy, including radiosurgery or fractionated external beam radiotherapy, and surgical resection. The use of systemic treatment for intracranial disease control also is improving. BM diagnosis, treatment planning, and follow-up is most often based on contrast-enhanced magnetic resonance imaging (MRI). However, anatomic imaging modalities including standard MRI have limitations in accurately characterizing posttherapeutic reactive changes and treatment response. Molecular imaging techniques such as positron emission tomography (PET) characterize specific metabolic and cellular features of metastases, potentially providing clinically relevant information supplementing anatomic MRI. Here, the Response Assessment in Neuro-Oncology working group provides recommendations for the use of PET imaging in the clinical management of patients with BM based on evidence from studies validated by histology and/or clinical outcome.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine 3, 4, Research Center Juelich, Juelich, Germany.,Center of Integrated Oncology, Universities of Cologne and Bonn, Cologne, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine 3, 4, Research Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Marc Chamberlain
- Departments of Neurology and Neurological Surgery, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Michelle M Kim
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Emilie Le Rhun
- Department of Neurosurgery, University Hospital Lille, Lille, France
| | - Susan Chang
- Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Julian Schwarting
- Department of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany.,German Cancer Consortium, Partner Site Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University Munich, Munich, Germany
| | - Matthias Preusser
- Department of Medicine I and Comprehensive Cancer Centre CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | - Peter Forsyth
- Moffitt Cancer Center, University of South Florida, Tampa, Florida, USA
| | - Whitney Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California , USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig Maximilians-University of Munich, Munich, Germany.,German Cancer Consortium, Partner Site Munich, Germany
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Lee D, Riestenberg RA, Haskell-Mendoza A, Bloch O. Brain Metastasis Recurrence Versus Radiation Necrosis: Evaluation and Treatment. Neurosurg Clin N Am 2020; 31:575-587. [PMID: 32921353 DOI: 10.1016/j.nec.2020.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Radiation necrosis (RN) occurs in 5% to 25% of patients with brain metastases treated with stereotactic radiosurgery. RN must be distinguished from recurrent tumor to determine appropriate treatment. Stereotactic biopsy remains the gold standard for identifying RN. Initial treatment of RN often involves management of edema using corticosteroids, antiangiogenic therapies, and hyperbaric oxygen therapy. For refractory symptoms, surgical resection can be considered. Minimally invasive stereotactic laser ablation has the benefit of providing tissue diagnosis and treating RN or recurrent tumor with similar efficacy. Laser ablation should be considered for lesions in need of intervention where the diagnosis requires tissue confirmation.
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Affiliation(s)
- Dennis Lee
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Robert A Riestenberg
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Aden Haskell-Mendoza
- Department of Neurological Surgery, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California, Davis School of Medicine, University of California Davis, 4860 Y Street, Suite 3740, Sacramento, CA 95817, USA.
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142
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Galldiks N, Unterrainer M, Judov N, Stoffels G, Rapp M, Lohmann P, Vettermann F, Dunkl V, Suchorska B, Tonn JC, Kreth FW, Fink GR, Bartenstein P, Langen KJ, Albert NL. Photopenic defects on O-(2-[18F]-fluoroethyl)-L-tyrosine PET: clinical relevance in glioma patients. Neuro Oncol 2020; 21:1331-1338. [PMID: 31077276 DOI: 10.1093/neuonc/noz083] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET has a sensitivity of more than 90% to detect gliomas. In the remaining small fraction of gliomas without increased tracer uptake, some tumors even show photopenic defects whose clinical significance is unclear. METHODS Glioma patients with a negative FET PET scan prior to neuropathological confirmation were identified retrospectively. Gliomas were rated visually as (i) having indifferent FET uptake or (ii) photopenic, if FET uptake was below background activity. FET uptake in the area of signal hyperintensity on the T2/fluid attenuated inversion recovery-weighted MRI was evaluated by mean standardized uptake value (SUV) and mean tumor-to-brain ratio (TBR). The progression-free survival (PFS) of photopenic gliomas was compared with that of gliomas with indifferent FET uptake. RESULTS Of 100 FET-negative gliomas, 40 cases with photopenic defects were identified. Fifteen of these 40 cases (38%) had World Health Organization (WHO) grades III and IV gliomas. FET uptake in photopenic gliomas was significantly decreased compared with both the healthy-appearing brain tissue (SUV, 0.89 ± 0.26 vs 1.08 ± 0.23; P < 0.001) and gliomas with indifferent FET uptake (TBR, 0.82 ± 0.09 vs 0.96 ± 0.13; P < 0.001). Irrespective of the applied treatment, isocitrate dehydrogenase (IDH)-mutated WHO grade II diffuse astrocytoma patients with indifferent FET uptake (n = 25) had a significantly longer PFS than patients with IDH-mutated diffuse astrocytomas (WHO grade II) with photopenic defects (n = 11) (51 vs 24 mo; P = 0.027). The multivariate survival analysis indicated that photopenic defects predict an unfavorable PFS (P = 0.009). CONCLUSION Photopenic gliomas in negative FET PET scans should be managed more actively, as they seem to have a higher risk of harboring a higher-grade glioma and an unfavorable outcome.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3/-4), Reseach Center Juelich, Juelich, Germany.,Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne, and Düsseldorf, Germany
| | - Marcus Unterrainer
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Natalie Judov
- Institute of Neuroscience and Medicine (INM-3/-4), Reseach Center Juelich, Juelich, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3/-4), Reseach Center Juelich, Juelich, Germany
| | - Marion Rapp
- Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3/-4), Reseach Center Juelich, Juelich, Germany
| | - Franziska Vettermann
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Veronika Dunkl
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany
| | | | - Jörg C Tonn
- Department of Neurosurgery, LMU, Munich, Germany
| | | | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3/-4), Reseach Center Juelich, Juelich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3/-4), Reseach Center Juelich, Juelich, Germany.,Department of Nuclear Medicine, University of Aachen, Aachen, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich (LMU), Munich, Germany
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143
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Kim D, Ko HY, Lee S, Lee YH, Ryu S, Kim SY, Chung JI, Lee M, Moon JH, Chang JH, Yun M. Glucose Loading Enhances the Value of 18F-FDG PET/CT for the Characterization and Delineation of Cerebral Gliomas. Cancers (Basel) 2020; 12:cancers12071977. [PMID: 32698507 PMCID: PMC7409292 DOI: 10.3390/cancers12071977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022] Open
Abstract
This study aimed to assess how to enhance the value of 18F-Fluorodeoxyglucose (FDG) PET/CTs for glioma grading and better delineation of the tumor boundary by glucose loading. In mouse models of brain tumor using U87MG cells, 18F-FDG-PET images were obtained after fasting and after glucose loading. There was a significant difference in the tumor-to-normal cortex-uptake ratio (TNR) between the fasting and glucose-loading scans. 14C-2-Deoxy-D-glucose (14C-DG) uptake was measured in vitro using U87MG, U373MG and primary neurons cultured with different concentrations of glucose. The tumor-to-neuron ratio of 14C-DG uptake increased with up to 10 mM of glucose. Finally, 10 low-grade and 17 high-grade glioma patients underwent fasting and glucose loading 18F-FDG PET/CT and the TNR was compared between scans. The effect of glucose loading was significant in high-grade but not in low-grade gliomas. The receiver operating characteristic curve analyses with a cut-off TNR of 0.81 showed a higher area under the curve after glucose loading than fasting for differentiating low-grade versus high-grade gliomas. In addition, the glucose loading PET/CT was more useful than the fasting PET/CT for the discrimination of oligodendrogliomas from IDH-wildtype glioblastomas. Glucose loading resulted in a greater reduction in 18F-FDG uptake in the normal cortex than in tumors, which increases the usefulness of 18F-FDG PET/CT for grading.
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Affiliation(s)
- Dongwoo Kim
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.K.); (H.Y.K.); (S.L.); (S.Y.K.); (J.-i.C.)
| | - Hae Young Ko
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.K.); (H.Y.K.); (S.L.); (S.Y.K.); (J.-i.C.)
| | - Sangwon Lee
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.K.); (H.Y.K.); (S.L.); (S.Y.K.); (J.-i.C.)
| | - Yong-ho Lee
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Sujin Ryu
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul 03722, Korea;
| | - Seon Yoo Kim
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.K.); (H.Y.K.); (S.L.); (S.Y.K.); (J.-i.C.)
| | - Jee-in Chung
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.K.); (H.Y.K.); (S.L.); (S.Y.K.); (J.-i.C.)
| | - Misu Lee
- Division of Life Sciences, College of Life Science and Bioengineering, Incheon National University, Incheon 22012, Korea;
| | - Ju Hyung Moon
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.M.); (J.H.C.)
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (J.H.M.); (J.H.C.)
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea; (D.K.); (H.Y.K.); (S.L.); (S.Y.K.); (J.-i.C.)
- Correspondence: ; Tel.: +82-2-2228-6068
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144
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Pigeon H, Pérès EA, Truillet C, Jego B, Boumezbeur F, Caillé F, Zinnhardt B, Jacobs AH, Le Bihan D, Winkeler A. TSPO-PET and diffusion-weighted MRI for imaging a mouse model of infiltrative human glioma. Neuro Oncol 2020; 21:755-764. [PMID: 30721979 DOI: 10.1093/neuonc/noz029] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most devastating brain tumor. Despite the use of multimodal treatments, most patients relapse, often due to the highly invasive nature of gliomas. However, the detection of glioma infiltration remains challenging. The aim of this study was to assess advanced PET and MRI techniques for visualizing biological activity and infiltration of the tumor. METHODS Using multimodality imaging, we investigated [18F]DPA-714, a radiotracer targeting the 18 kDa translocator protein (TSPO), [18F]FET PET, non-Gaussian diffusion MRI (apparent diffusion coefficient, kurtosis), and the S-index, a composite diffusion metric, to detect tumor infiltration in a human invasive glioma model. In vivo imaging findings were confirmed by autoradiography and immunofluorescence. RESULTS Increased tumor-to-contralateral [18F]DPA-714 uptake ratios (1.49 ± 0.11) were found starting 7 weeks after glioma cell implantation. TSPO-PET allowed visualization of glioma infiltration into the contralateral hemisphere 2 weeks earlier compared with the clinically relevant biomarker for biological glioma activity [18F]FET. Diffusion-weighted imaging (DWI), in particular kurtosis, was more sensitive than standard T2-weighted MRI to detect differences between the glioma-bearing and the contralateral hemisphere at 5 weeks. Immunofluorescence data reflect in vivo findings. Interestingly, labeling for tumoral and stromal TSPO indicates a predominant expression of TSPO by tumor cells. CONCLUSION These results suggest that advanced PET and MRI methods, such as [18F]DPA-714 and DWI, may be superior to standard imaging methods to visualize glioma growth and infiltration at an early stage.
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Affiliation(s)
- Hayet Pigeon
- UMR 1023, IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
| | - Elodie A Pérès
- UMR 1023, IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France.,NeuroSpin, CEA/Université Paris-Saclay, Gif sur Yvette, France.,Normandie Université, UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, Caen, France
| | - Charles Truillet
- UMR 1023, IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
| | - Benoit Jego
- UMR 1023, IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
| | | | - Fabien Caillé
- UMR 1023, IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
| | - Bastian Zinnhardt
- EIMI and Department of Nuclear Medicine, University Hospital Münster, Westfälische Wilhelms University Münster, Münster, Germany
| | - Andreas H Jacobs
- EIMI and Department of Nuclear Medicine, University Hospital Münster, Westfälische Wilhelms University Münster, Münster, Germany.,Department of Geriatrics, Johanniter Hospital, Evangelische Kliniken, Bonn, Germany
| | - Denis Le Bihan
- NeuroSpin, CEA/Université Paris-Saclay, Gif sur Yvette, France
| | - Alexandra Winkeler
- UMR 1023, IMIV, Service Hospitalier Frédéric Joliot, CEA, Inserm, Université Paris Sud, CNRS, Université Paris-Saclay, Orsay, France
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145
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Verburg N, de Witt Hamer PC. State-of-the-art imaging for glioma surgery. Neurosurg Rev 2020; 44:1331-1343. [PMID: 32607869 PMCID: PMC8121714 DOI: 10.1007/s10143-020-01337-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
Diffuse gliomas are infiltrative primary brain tumors with a poor prognosis despite multimodal treatment. Maximum safe resection is recommended whenever feasible. The extent of resection (EOR) is positively correlated with survival. Identification of glioma tissue during surgery is difficult due to its diffuse nature. Therefore, glioma resection is imaging-guided, making the choice for imaging technique an important aspect of glioma surgery. The current standard for resection guidance in non-enhancing gliomas is T2 weighted or T2w-fluid attenuation inversion recovery magnetic resonance imaging (MRI), and in enhancing gliomas T1-weighted MRI with a gadolinium-based contrast agent. Other MRI sequences, like magnetic resonance spectroscopy, imaging modalities, such as positron emission tomography, as well as intraoperative imaging techniques, including the use of fluorescence, are also available for the guidance of glioma resection. The neurosurgeon’s goal is to find the balance between maximizing the EOR and preserving brain functions since surgery-induced neurological deficits result in lower quality of life and shortened survival. This requires localization of important brain functions and white matter tracts to aid the pre-operative planning and surgical decision-making. Visualization of brain functions and white matter tracts is possible with functional MRI, diffusion tensor imaging, magnetoencephalography, and navigated transcranial magnetic stimulation. In this review, we discuss the current available imaging techniques for the guidance of glioma resection and the localization of brain functions and white matter tracts.
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Affiliation(s)
- Niels Verburg
- Department of Neurosurgery and Cancer Center Amsterdam, Amsterdam UMC location VU University Medical Center, Amsterdam, The Netherlands. .,Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Brain Tumor Imaging Laboratory, University of Cambridge, Addenbrooke's Hospital, Hill Rd, Cambridge, CB2 0QQ, UK.
| | - Philip C de Witt Hamer
- Department of Neurosurgery and Cancer Center Amsterdam, Amsterdam UMC location VU University Medical Center, Amsterdam, The Netherlands
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146
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Galldiks N, Lohmann P, Langen KJ. Imaging challenges following newer treatment options: are companion diagnostics required in neurooncology? Expert Rev Mol Diagn 2020; 20:651-652. [PMID: 32552245 DOI: 10.1080/14737159.2020.1782191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne, Germany.,Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich , Juelich, Germany.,Center of Integrated Oncology (CIO, Universities of Aachen, Bonn, Cologne, and Duesseldorf , Cologne, Germany
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich , Juelich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4), Research Center Juelich , Juelich, Germany.,Center of Integrated Oncology (CIO, Universities of Aachen, Bonn, Cologne, and Duesseldorf , Cologne, Germany.,Department of Nuclear Medicine, University Hospital RWTH Aachen , Aachen, Germany
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147
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Lohmann P, Galldiks N, Kocher M, Heinzel A, Filss CP, Stegmayr C, Mottaghy FM, Fink GR, Jon Shah N, Langen KJ. Radiomics in neuro-oncology: Basics, workflow, and applications. Methods 2020; 188:112-121. [PMID: 32522530 DOI: 10.1016/j.ymeth.2020.06.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023] Open
Abstract
Over the last years, the amount, variety, and complexity of neuroimaging data acquired in patients with brain tumors for routine clinical purposes and the resulting number of imaging parameters have substantially increased. Consequently, a timely and cost-effective evaluation of imaging data is hardly feasible without the support of methods from the field of artificial intelligence (AI). AI can facilitate and shorten various time-consuming steps in the image processing workflow, e.g., tumor segmentation, thereby optimizing productivity. Besides, the automated and computer-based analysis of imaging data may help to increase data comparability as it is independent of the experience level of the evaluating clinician. Importantly, AI offers the potential to extract new features from the routinely acquired neuroimages of brain tumor patients. In combination with patient data such as survival, molecular markers, or genomics, mathematical models can be generated that allow, for example, the prediction of treatment response or prognosis, as well as the noninvasive assessment of molecular markers. The subdiscipline of AI dealing with the computation, identification, and extraction of image features, as well as the generation of prognostic or predictive mathematical models, is termed radiomics. This review article summarizes the basics, the current workflow, and methods used in radiomics with a focus on feature-based radiomics in neuro-oncology and provides selected examples of its clinical application.
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Affiliation(s)
- Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Kerpener Str. 62, 50937 Cologne, Germany
| | - Martin Kocher
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Kerpener Str. 62, 50937 Cologne, Germany
| | - Alexander Heinzel
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Christian P Filss
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Carina Stegmayr
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany
| | - Felix M Mottaghy
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Kerpener Str. 62, 50937 Cologne, Germany; Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), P.Debeylaan 25, 6229 HX Maastricht, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands
| | - Gereon R Fink
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; JARA - BRAIN - Translational Medicine, Aachen, Germany; Department of Neurology, RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, -4, -11), Research Center Juelich, Wilhelm-Johnen-Str., 52428 Juelich, Germany; Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, Kerpener Str. 62, 50937 Cologne, Germany; Department of Nuclear Medicine and Comprehensive Diagnostic Center Aachen (CDCA), RWTH Aachen University, Pauwelsstr. 30, 52074 Aachen, Germany; JARA - BRAIN - Translational Medicine, Aachen, Germany
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148
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Guerrero I, Correa A. Site‐Selective Trifluoromethylation Reactions of Oligopeptides. ASIAN J ORG CHEM 2020. [DOI: 10.1002/ajoc.202000170] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Itziar Guerrero
- Department of Organic Chemistry IUniversity of the Basque Country (UPV/EHU) Joxe Mari Korta R&D Center, Avda. Tolosa 72 20018 Donostia-San Sebastián Spain
| | - Arkaitz Correa
- Department of Organic Chemistry IUniversity of the Basque Country (UPV/EHU) Joxe Mari Korta R&D Center, Avda. Tolosa 72 20018 Donostia-San Sebastián Spain
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Applications of radiomics and machine learning for radiotherapy of malignant brain tumors. Strahlenther Onkol 2020; 196:856-867. [PMID: 32394100 PMCID: PMC7498494 DOI: 10.1007/s00066-020-01626-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 04/22/2020] [Indexed: 12/12/2022]
Abstract
Background Magnetic resonance imaging (MRI) and amino acid positron-emission tomography (PET) of the brain contain a vast amount of structural and functional information that can be analyzed by machine learning algorithms and radiomics for the use of radiotherapy in patients with malignant brain tumors. Methods This study is based on comprehensive literature research on machine learning and radiomics analyses in neuroimaging and their potential application for radiotherapy in patients with malignant glioma or brain metastases. Results Feature-based radiomics and deep learning-based machine learning methods can be used to improve brain tumor diagnostics and automate various steps of radiotherapy planning. In glioma patients, important applications are the determination of WHO grade and molecular markers for integrated diagnosis in patients not eligible for biopsy or resection, automatic image segmentation for target volume planning, prediction of the location of tumor recurrence, and differentiation of pseudoprogression from actual tumor progression. In patients with brain metastases, radiomics is applied for additional detection of smaller brain metastases, accurate segmentation of multiple larger metastases, prediction of local response after radiosurgery, and differentiation of radiation injury from local brain metastasis relapse. Importantly, high diagnostic accuracies of 80–90% can be achieved by most approaches, despite a large variety in terms of applied imaging techniques and computational methods. Conclusion Clinical application of automated image analyses based on radiomics and artificial intelligence has a great potential for improving radiotherapy in patients with malignant brain tumors. However, a common problem associated with these techniques is the large variability and the lack of standardization of the methods applied.
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150
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Optimization of time frame binning for FDOPA uptake quantification in glioma. PLoS One 2020; 15:e0232141. [PMID: 32320440 PMCID: PMC7176128 DOI: 10.1371/journal.pone.0232141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction 3,4-dihydroxy-6-[18F]fluoro-L-phenylalanine (FDOPA) uptake quantification in glioma assessment can be distorted using a non-optimal time frame binning of time-activity curves (TAC). Under-sampling or over-sampling dynamic PET images induces significant variations on kinetic parameters quantification. We aimed to optimize temporal time frame binning for dynamic FDOPA PET imaging. Methods Fourteen patients with 33 tumoral TAC with biopsy-proven gliomas were analysed. The mean SUVmax tumor-to-brain ratio (TBRmax) were compared at 20 min and 35 min post-injection (p.i). Five different time frame samplings within 20 min were compared: 11x10sec-6x15sec-5x20sec-3x300sec; 8x15sec– 2x30sec– 2x60sec– 3x300sec; 6x20sec– 8x60sec– 2x300sec; 10x30sec– 3x300sec and 4x45sec– 3x90sec– 5x150sec. The reversible single-tissue compartment model with blood volume parameter (VB) was selected using the Akaike information criterion. K1 values extracted from 1024 noisy simulated TAC using Monte Carlo method from the 5 different time samplings were compared to a target K1 value as the objective, which is the average of the K1 values extracted from the 33 lesions using an imaging-derived input function for each patient. Results The mean TBRmax was significantly higher at 20 min p.i. than at 35 min p.i (respectively 1.4 +/- 0.8 and 1.2 +/- 0.6; p <0.001). The target K1 value was 0.161 mL/ccm/min. The 8x15sec– 2x30sec– 2x60sec– 3x300sec time sampling was the optimal time frame binning. K1 values extracted using this optimal time frame binning were significantly different with K1 values extracted from the other time frame samplings, except with K1 values obtained using the 11x10sec– 6x15sec –5x20sec-3x300sec time frame binning. Conclusions This optimal sampling schedule design (8x15sec– 2x30sec– 2x60sec– 3x300sec) could be used to minimize bias in quantification of FDOPA uptake in glioma using kinetic analysis.
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