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Cagol A, Tsagkas C, Granziera C. Advanced Brain Imaging in Central Nervous System Demyelinating Diseases. Neuroimaging Clin N Am 2024; 34:335-357. [PMID: 38942520 DOI: 10.1016/j.nic.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
In recent decades, advances in neuroimaging have profoundly transformed our comprehension of central nervous system demyelinating diseases. Remarkable technological progress has enabled the integration of cutting-edge acquisition and postprocessing techniques, proving instrumental in characterizing subtle focal changes, diffuse microstructural alterations, and macroscopic pathologic processes. This review delves into state-of-the-art modalities applied to multiple sclerosis, neuromyelitis optica spectrum disorders, and myelin oligodendrocyte glycoprotein antibody-associated disease. Furthermore, it explores how this dynamic landscape holds significant promise for the development of effective and personalized clinical management strategies, encompassing support for differential diagnosis, prognosis, monitoring treatment response, and patient stratification.
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Affiliation(s)
- Alessandro Cagol
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland; Department of Neurology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Spitalstrasse 2, 4031 Basel, Switzerland; Department of Health Sciences, University of Genova, Via A. Pastore, 1 16132 Genova, Italy. https://twitter.com/CagolAlessandr0
| | - Charidimos Tsagkas
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland; Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health (NIH), 10 Center Drive, Bethesda, MD 20892, USA
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINk) Basel, Department of Biomedical Engineering, University Hospital Basel and University of Basel, Hegenheimermattweg 167b, 4123 Allschwil, Switzerland; Department of Neurology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Spitalstrasse 2, 4031 Basel, Switzerland.
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Girdhar S, Nair SS, Thomas B, Kesavadas C. Non-contrast magnetic resonance evaluation of active multiple sclerosis lesions: Emerging role of quantitative synthetic magnetic resonance imaging. Neuroradiol J 2024:19714009241269541. [PMID: 39075947 DOI: 10.1177/19714009241269541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
PURPOSE The current study aims to explore the utility of novel synthetic MRI-derived quantitative parameters including myelin-correlated volume (MyC) in identifying active MS lesions without injecting gadolinium contrast. METHODS 43 MS patients underwent institutional MS protocol including 3D FLAIR and post-contrast 3D T1VIBE sequence on a 1.5 T MR Scanner in addition to synthetic MRI sequence. MS plaques were categorised into enhancing (C) and non-enhancing (N) lesions. They were also sub-categorised based on location into periventricular WM lesions (P), deep WM lesions (D), infratentorial lesions (I) and cortical-juxtacortical (C) lesions. ROIs were placed on Synthetic FLAIR images in MS lesions and quantitative parameters of R1, R2, PD and myelin-correlated volume (MyC) obtained. Sensitivity and specificity for various cut-off values to differentiate enhancing from non-enhancing multiple sclerosis lesions were calculated by performing ROC curve analysis and logistic regression analysis. RESULTS Contrast enhancing lesions demonstrated significantly higher mean R1, R2 values and lower mean PD values in comparison to non-enhancing lesions (p < 0.05) but with limited specificity. Region-wise analysis revealed high AUC values for mean R1 and R2 at cortical-juxtacortical lesions (p < 0.001) followed by periventricular lesions (p < 0.003) for differentiating enhancing from non-enhancing lesions with no significant contribution from MyC and PD values. CONCLUSION Synthetic MRI-derived quantitative parameters of mean R1, R2, MyC and PD hold value in differentiating contrast enhancing and non-enhancing MS lesions without administering gadolinium-based contrast agent. However, the current study did not achieve significant specificity for establishing the same.
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Affiliation(s)
| | | | - Bejoy Thomas
- Department of Imaging Sciences & Interventional Radiology, SCTIMST, Trivandrum, India
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Herthum H, Hetzer S. Tensor denoising of quantitative multi-parameter mapping. Magn Reson Med 2024; 92:145-157. [PMID: 38368616 DOI: 10.1002/mrm.30050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE Quantitative multi-parameter mapping (MPM) provides maps of physical quantities representing physiologically meaningful tissue characteristics, which allows to investigate microstructure-function relationships reflecting normal or pathologic processes in the brain. However, the achievable spatial resolution and stability of MPM for basic research or clinical applications is severely constrained by SNR limits of the MR acquisition process, resulting in relatively long acquisition times. To increase SNR, we denoise MPM acquisitions using principal component analysis along tensors exploiting the Marchenko-Pastur law (tMPPCA). METHODS tMPPCA denoising was applied to three sets of MPM raw data before the quantification of maps of proton density, magnetization transfer saturation, R1, and R2*. The regional SNR gain for high-resolution MPM was investigated as well as reproducibility gains for clinically optimized protocols with moderate and high acceleration factors at different image resolutions. RESULTS Substantial noise reduction in raw data was achieved, resulting in reduced noise for quantitative mapping up to sixfold without introducing bias of mean values (below 1%). Scan-rescan fluctuations were reduced up to threefold. Denoising allowed to decrease the voxel volume fourfold at the same scan time or reduce the scan time twofold at same voxel volume without loss of sensitivity. CONCLUSIONS tMPPCA denoising can (a) improve of fine spatial and temporal patterns, (b) considerably reduce scan time for clinical applications, or (c) increase resolution to potentially push cutting-edge MPM protocols from the upper to the lower limit of the mesoscopic scale.
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Affiliation(s)
- Helge Herthum
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Liu J, Li S, Cao Q, Zhang Y, Nickel MD, Wu Y, Zhu J, Cheng J. Risk factors for the recurrence of cervical cancer using MR-based T1 mapping: A pilot study. Front Oncol 2023; 13:1133709. [PMID: 37007135 PMCID: PMC10061013 DOI: 10.3389/fonc.2023.1133709] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectivesThis study aimed to identify risk factors for recurrence in patients with cervical cancer (CC) through quantitative T1 mapping.MethodsA cohort of 107 patients histopathologically diagnosed with CC at our institution between May 2018 and April 2021 was categorized into surgical and non-surgical groups. Patients in each group were further divided into recurrence and non-recurrence subgroups depending on whether they showed recurrence or metastasis within 3 years of treatment. The longitudinal relaxation time (native T1) and apparent diffusion coefficient (ADC) value of the tumor were calculated. The differences between native T1 and ADC values of the recurrence and non-recurrence subgroups were analyzed, and receiver operating characteristic (ROC) curves were drawn for parameters with statistical differences. Logistic regression was performed for analysis of significant factors affecting CC recurrence. Recurrence-free survival rates were estimated by Kaplan–Meier analysis and compared using the log-rank test.ResultsThirteen and 10 patients in the surgical and non-surgical groups, respectively, showed recurrence after treatment. There were significant differences in native T1 values between the recurrence and non-recurrence subgroups in the surgical and non-surgical groups (P<0.05); however, there was no difference in ADC values (P>0.05). The areas under the ROC curve of native T1 values for discriminating recurrence of CC after surgical and non-surgical treatment were 0.742 and 0.780, respectively. Logistic regression analysis indicated that native T1 values were risk factors for tumor recurrence in the surgical and non-surgical groups (P=0.004 and 0.040, respectively). Compared with cut-offs, recurrence-free survival curves of patients with higher native T1 values of the two groups were significantly different from those with lower ones (P=0.000 and 0.016, respectively).ConclusionQuantitative T1 mapping could help identify CC patients with a high risk of recurrence, supplementing information on tumor prognosis other than clinicopathological features and providing the basis for individualized treatment and follow-up schemes.
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Affiliation(s)
- Jie Liu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Jie Liu,
| | - Shujian Li
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qinchen Cao
- Department of Radiotreatment, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Marcel Dominik Nickel
- Magnetic Resonance (MR) Application Predevelopment, Siemens Healthcare Gesellschaft mit beschrankter Haftung (GmbH), Erlangen, Germany
| | - Yanglei Wu
- Magnetic Resonance (MR) Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Jinxia Zhu
- Magnetic Resonance (MR) Collaboration, Siemens Healthineers Ltd., Beijing, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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York EN, Thrippleton MJ, Meijboom R, Hunt DPJ, Waldman AD. Quantitative magnetization transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis. Brain Commun 2022; 4:fcac088. [PMID: 35652121 PMCID: PMC9149789 DOI: 10.1093/braincomms/fcac088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
Myelin-sensitive MRI such as magnetization transfer imaging has been widely used in multiple sclerosis. The influence of methodology and differences in disease subtype on imaging findings is, however, not well established. Here, we systematically review magnetization transfer brain imaging findings in relapsing-remitting multiple sclerosis. We examine how methodological differences, disease effects and their interaction influence magnetization transfer imaging measures. Articles published before 06/01/2021 were retrieved from online databases (PubMed, EMBASE and Web of Science) with search terms including 'magnetization transfer' and 'brain' for systematic review, according to a pre-defined protocol. Only studies that used human in vivo quantitative magnetization transfer imaging in adults with relapsing-remitting multiple sclerosis (with or without healthy controls) were included. Additional data from relapsing-remitting multiple sclerosis subjects acquired in other studies comprising mixed disease subtypes were included in meta-analyses. Data including sample size, MRI acquisition protocol parameters, treatments and clinical findings were extracted and qualitatively synthesized. Where possible, effect sizes were calculated for meta-analyses to determine magnetization transfer (i) differences between patients and healthy controls; (ii) longitudinal change and (iii) relationships with clinical disability in relapsing-remitting multiple sclerosis. Eighty-six studies met inclusion criteria. MRI acquisition parameters varied widely, and were also underreported. The majority of studies examined the magnetization transfer ratio in white matter, but magnetization transfer metrics, brain regions examined and results were heterogeneous. The analysis demonstrated a risk of bias due to selective reporting and small sample sizes. The pooled random-effects meta-analysis across all brain compartments revealed magnetization transfer ratio was 1.17 per cent units (95% CI -1.42 to -0.91) lower in relapsing-remitting multiple sclerosis than healthy controls (z-value: -8.99, P < 0.001, 46 studies). Linear mixed-model analysis did not show a significant longitudinal change in magnetization transfer ratio across all brain regions [β = 0.12 (-0.56 to 0.80), t-value = 0.35, P = 0.724, 14 studies] or normal-appearing white matter alone [β = 0.037 (-0.14 to 0.22), t-value = 0.41, P = 0.68, eight studies]. There was a significant negative association between the magnetization transfer ratio and clinical disability, as assessed by the Expanded Disability Status Scale [r = -0.32 (95% CI -0.46 to -0.17); z-value = -4.33, P < 0.001, 13 studies]. Evidence suggests that magnetization transfer imaging metrics are sensitive to pathological brain changes in relapsing-remitting multiple sclerosis, although effect sizes were small in comparison to inter-study variability. Recommendations include: better harmonized magnetization transfer acquisition protocols with detailed methodological reporting standards; larger, well-phenotyped cohorts, including healthy controls; and, further exploration of techniques such as magnetization transfer saturation or inhomogeneous magnetization transfer ratio.
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Affiliation(s)
- Elizabeth N. York
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | | | - Rozanna Meijboom
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
| | - David P. J. Hunt
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic,
University of Edinburgh, Edinburgh, UK
| | - Adam D. Waldman
- Centre for Clinical Brain Sciences, University of
Edinburgh, Edinburgh, UK
- UK Dementia Research Institute, University of
Edinburgh, Edinburgh, UK
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6
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Ge X, Wang M, Ma H, Zhu K, Wei X, Li M, Zhai X, Shen Y, Huang X, Hou M, Liu W, Wang M, Wang X. Investigated diagnostic value of synthetic relaxometry, three-dimensional pseudo-continuous arterial spin labelling and diffusion-weighted imaging in the grading of glioma. Magn Reson Imaging 2021; 86:20-27. [PMID: 34808303 DOI: 10.1016/j.mri.2021.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/27/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the performance of synthetic relaxometry, three-dimensional pseudo-continuous arterial spin labelling (pCASL) and diffusion-weighted imaging (DWI) in differentiating high-grade gliomas (HGGs) from low-grade gliomas (LGGs) and to compare with the conventional MRI. METHODS Seventy-two patients with gliomas (including 27 LGGs and 45 HGGs) were studied using synthetic magnetic resonance imaging (sy-MRI), pCASL, and DWI with a 3.0 T MR scanner. T1 relaxometry (T1), T2 relaxometry (T2), as well as proton density (PD) from sy-MRI, cerebral blood flow (CBF) from pCASL, apparent diffusion coefficient (ADC) from DWI and enhancement quality (EQ), proportion enhancing (PE) from conventional contrast enhanced image based Visually-Accessible-Rembrandt-Images (VASARI) scoring system, were all analyzed by two radiologists. The Student's t-test, Mann-Whitney U test or Fisher's exact test was used to compare the parameters between LGGs and HGGs. The diagnostic performance of each parameter and their combination for glioma grading were analyzed. RESULTS Significant statistical differences in T1, PD, CBF, ADC, EQ and PE are observed between LGGs and HGGs (all P < 0.001). The ADC values have higher discrimination abilities compared with other univariable parameters, with the AUC of 0.905. AUC values for conventional contrast-enhanced method, EQ and PE from VASARI, and conventional contrast-free method, CBF + ADC, are 0.873 and 0.912 respectively. The combined T1, PD, CBF and ADC model had the best performance for differentiating LGGs and HGGs with AUC, sensitivity and specificity of 0.993, 95.5%, 100%, respectively. CONCLUSIONS Relaxometry parameters derived from synthetic MRI contributed to the discrimination of low-grade gliomas from high-grade gliomas. Proposed contrast-free approach combining T1, PD, CBF and ADC showed a strong discriminative power, and outperformed conventional approaches.
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Affiliation(s)
- Xin Ge
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Minglei Wang
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Hui Ma
- Department of Neurosurgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Kai Zhu
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | | | - Min Li
- GE Healthcare, MR Enhancement Application, Beijing, China
| | - Xuefeng Zhai
- Department of Pathology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ying Shen
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Xueying Huang
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Mingli Hou
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Wenxiao Liu
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Minxing Wang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Xiaodong Wang
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, China.
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7
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Klietz M, Elaman MH, Mahmoudi N, Nösel P, Ahlswede M, Wegner F, Höglinger GU, Lanfermann H, Ding XQ. Cerebral Microstructural Alterations in Patients With Early Parkinson's Disease Detected With Quantitative Magnetic Resonance Measurements. Front Aging Neurosci 2021; 13:763331. [PMID: 34790113 PMCID: PMC8591214 DOI: 10.3389/fnagi.2021.763331] [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: 08/23/2021] [Accepted: 10/11/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: Parkinson’s disease (PD) is the second most common neurodegenerative disease in the elderly. In early stages of PD, patients typically display normal brain magnet resonance imaging (MRI) in routine screening. Advanced imaging approaches are necessary to discriminate early PD patients from healthy controls. In this study, microstructural changes in relevant brain regions of early PD patients were investigated by using quantitative MRI methods. Methods: Cerebral MRI at 3T was performed on 20 PD patients in early stages and 20 age and sex matched healthy controls. Brain relative proton density, T1, T2, and T2′ relaxation times were measured in 14 regions of interest (ROIs) in each hemisphere and compared between patients and controls to estimate PD related alterations. Results: In comparison to matched healthy controls, the PD patients revealed decreased relative proton density in contralateral prefrontal subcortical area, upper and lower pons, in ipsilateral globus pallidus, and bilaterally in splenium corporis callosi, caudate nucleus, putamen, thalamus, and mesencephalon. The T1 relaxation time was increased in contralateral prefrontal subcortical area and centrum semiovale, putamen, nucleus caudatus and mesencephalon, whereas T2 relaxation time was elevated in upper pons bilaterally and in centrum semiovale ipsilaterally. T2′ relaxation time did not show significant changes. Conclusion: Early Parkinson’s disease is associated with a distinct profile of brain microstructural changes which may relate to clinical symptoms. The quantitative MR method used in this study may be useful in early diagnosis of Parkinson’s disease. Limitations of this study include a small sample size and manual selection of the ROIs. Atlas-based or statistical mapping methods would be an alternative for an objective evaluation. More studies are necessary to validate the measurement methods for clinical use in diagnostics of early Parkinson’s disease.
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Affiliation(s)
- Martin Klietz
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - M Handan Elaman
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Nima Mahmoudi
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Patrick Nösel
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Mareike Ahlswede
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Florian Wegner
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | | | - Heinrich Lanfermann
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
| | - Xiao-Qi Ding
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hanover, Germany
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Hajjo R, Sabbah DA, Bardaweel SK, Tropsha A. Identification of Tumor-Specific MRI Biomarkers Using Machine Learning (ML). Diagnostics (Basel) 2021; 11:742. [PMID: 33919342 PMCID: PMC8143297 DOI: 10.3390/diagnostics11050742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 02/06/2023] Open
Abstract
The identification of reliable and non-invasive oncology biomarkers remains a main priority in healthcare. There are only a few biomarkers that have been approved as diagnostic for cancer. The most frequently used cancer biomarkers are derived from either biological materials or imaging data. Most cancer biomarkers suffer from a lack of high specificity. However, the latest advancements in machine learning (ML) and artificial intelligence (AI) have enabled the identification of highly predictive, disease-specific biomarkers. Such biomarkers can be used to diagnose cancer patients, to predict cancer prognosis, or even to predict treatment efficacy. Herein, we provide a summary of the current status of developing and applying Magnetic resonance imaging (MRI) biomarkers in cancer care. We focus on all aspects of MRI biomarkers, starting from MRI data collection, preprocessing and machine learning methods, and ending with summarizing the types of existing biomarkers and their clinical applications in different cancer types.
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Affiliation(s)
- Rima Hajjo
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, The University of North Carlina at Chapel Hill, Chapel Hill, NC 27599, USA;
- National Center for Epidemics and Communicable Disease Control, Amman 11118, Jordan
| | - Dima A. Sabbah
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130, Amman 11733, Jordan;
| | - Sanaa K. Bardaweel
- Department of Pharmaceutical Sciences, School of Pharmacy, University of Jordan, Amman 11942, Jordan;
| | - Alexander Tropsha
- Laboratory for Molecular Modeling, Division of Chemical Biology and Medicinal Chemistry, Eshelman School of Pharmacy, The University of North Carlina at Chapel Hill, Chapel Hill, NC 27599, USA;
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Cooper G, Hirsch S, Scheel M, Brandt AU, Paul F, Finke C, Boehm-Sturm P, Hetzer S. Quantitative Multi-Parameter Mapping Optimized for the Clinical Routine. Front Neurosci 2020; 14:611194. [PMID: 33364921 PMCID: PMC7750476 DOI: 10.3389/fnins.2020.611194] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 12/12/2022] Open
Abstract
Using quantitative multi-parameter mapping (MPM), studies can investigate clinically relevant microstructural changes with high reliability over time and across subjects and sites. However, long acquisition times (20 min for the standard 1-mm isotropic protocol) limit its translational potential. This study aimed to evaluate the sensitivity gain of a fast 1.6-mm isotropic MPM protocol including post-processing optimized for longitudinal clinical studies. 6 healthy volunteers (35±7 years old; 3 female) were scanned at 3T to acquire the following whole-brain MPM maps with 1.6 mm isotropic resolution: proton density (PD), magnetization transfer saturation (MT), longitudinal relaxation rate (R1), and transverse relaxation rate (R2*). MPM maps were generated using two RF transmit field (B1+) correction methods: (1) using an acquired B1+ map and (2) using a data-driven approach. Maps were generated with and without Gibb's ringing correction. The intra-/inter-subject coefficient of variation (CoV) of all maps in the gray and white matter, as well as in all anatomical regions of a fine-grained brain atlas, were compared between the different post-processing methods using Student's t-test. The intra-subject stability of the 1.6-mm MPM protocol is 2–3 times higher than for the standard 1-mm sequence and can be achieved in less than half the scan duration. Intra-subject variability for all four maps in white matter ranged from 1.2–5.3% and in gray matter from 1.8 to 9.2%. Bias-field correction using an acquired B1+ map significantly improved intra-subject variability of PD and R1 in the gray (42%) and white matter (54%) and correcting the raw images for the effect of Gibb's ringing further improved intra-subject variability in all maps in the gray (11%) and white matter (10%). Combining Gibb's ringing correction and bias field correction using acquired B1+ maps provides excellent stability of the 7-min MPM sequence with 1.6 mm resolution suitable for the clinical routine.
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Affiliation(s)
- Graham Cooper
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology and Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Hirsch
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany
| | - Carsten Finke
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Boehm-Sturm
- Department of Experimental Neurology and Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany
| | - Stefan Hetzer
- Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health Berlin, Berlin, Germany.,Bernstein Center for Computational Neuroscience, Humboldt-Universität zu Berlin, Berlin, Germany
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10
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Seiler A, Schöngrundner S, Stock B, Nöth U, Hattingen E, Steinmetz H, Klein JC, Baudrexel S, Wagner M, Deichmann R, Gracien RM. Cortical aging - new insights with multiparametric quantitative MRI. Aging (Albany NY) 2020; 12:16195-16210. [PMID: 32852283 PMCID: PMC7485732 DOI: 10.18632/aging.103629] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Understanding the microstructural changes related to physiological aging of the cerebral cortex is pivotal to differentiate healthy aging from neurodegenerative processes. The aim of this study was to investigate the age-related global changes of cortical microstructure and regional patterns using multiparametric quantitative MRI (qMRI) in healthy subjects with a wide age range. 40 healthy participants (age range: 2nd to 8th decade) underwent high-resolution qMRI including T1, PD as well as T2, T2* and T2′ mapping at 3 Tesla. Cortical reconstruction was performed with the FreeSurfer toolbox, followed by tests for correlations between qMRI parameters and age. Cortical T1 values were negatively correlated with age (p=0.007) and there was a widespread age-related decrease of cortical T1 involving the frontal and the parietotemporal cortex, while T2 was correlated positively with age, both in frontoparietal areas and globally (p=0.004). Cortical T2′ values showed the most widespread associations across the cortex and strongest correlation with age (r= -0.724, p=0.0001). PD and T2* did not correlate with age. Multiparametric qMRI allows to characterize cortical aging, unveiling parameter-specific patterns. Quantitative T2′ mapping seems to be a promising imaging biomarker of cortical age-related changes, suggesting that global cortical iron deposition is a prominent process in healthy aging.
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Affiliation(s)
- Alexander Seiler
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Sophie Schöngrundner
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Benjamin Stock
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | - Helmuth Steinmetz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
| | - Johannes C Klein
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon Baudrexel
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt am Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
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11
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Kirov II, Tal A. Potential clinical impact of multiparametric quantitative MR spectroscopy in neurological disorders: A review and analysis. Magn Reson Med 2020; 83:22-44. [PMID: 31393032 PMCID: PMC6814297 DOI: 10.1002/mrm.27912] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/06/2019] [Accepted: 06/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Unlike conventional MR spectroscopy (MRS), which only measures metabolite concentrations, multiparametric MRS also quantifies their longitudinal (T1 ) and transverse (T2 ) relaxation times, as well as the radiofrequency transmitter inhomogeneity (B1+ ). To test whether knowledge of these additional parameters can improve the clinical utility of brain MRS, we compare the conventional and multiparametric approaches in terms of expected classification accuracy in differentiating controls from patients with neurological disorders. THEORY AND METHODS A literature review was conducted to compile metabolic concentrations and relaxation times in a wide range of neuropathologies and regions of interest. Simulations were performed to construct receiver operating characteristic curves and compute the associated areas (area under the curve) to examine the sensitivity and specificity of MRS for detecting each pathology in each region. Classification accuracy was assessed using metabolite concentrations corrected using population-averages for T1 , T2 , and B1+ (conventional MRS); using metabolite concentrations corrected using per-subject values (multiparametric MRS); and using an optimal linear multiparametric estimator comprised of the metabolites' concentrations and relaxation constants (multiparametric MRS). Additional simulations were conducted to find the minimal intra-subject precision needed for each parameter. RESULTS Compared with conventional MRS, multiparametric approaches yielded area under the curve improvements for almost all neuropathologies and regions of interest. The median area under the curve increased by 0.14 over the entire dataset, and by 0.24 over the 10 instances with the largest individual increases. CONCLUSIONS Multiparametric MRS can substantially improve the clinical utility of MRS in diagnosing and assessing brain pathology, motivating the design and use of novel multiparametric sequences.
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Affiliation(s)
- Ivan I. Kirov
- Center for Advanced Imaging Innovation and Research (CAIR), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, 660 1 Avenue, New York, NY 10016, United States of America
| | - Assaf Tal
- Department of Chemical and Biological Physics, Weizmann Institute of Science, 234 Herzel St., Rehovot 7610001, Israel
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12
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Swanberg KM, Landheer K, Pitt D, Juchem C. Quantifying the Metabolic Signature of Multiple Sclerosis by in vivo Proton Magnetic Resonance Spectroscopy: Current Challenges and Future Outlook in the Translation From Proton Signal to Diagnostic Biomarker. Front Neurol 2019; 10:1173. [PMID: 31803127 PMCID: PMC6876616 DOI: 10.3389/fneur.2019.01173] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/21/2019] [Indexed: 01/03/2023] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) offers a growing variety of methods for querying potential diagnostic biomarkers of multiple sclerosis in living central nervous system tissue. For the past three decades, 1H-MRS has enabled the acquisition of a rich dataset suggestive of numerous metabolic alterations in lesions, normal-appearing white matter, gray matter, and spinal cord of individuals with multiple sclerosis, but this body of information is not free of seeming internal contradiction. The use of 1H-MRS signals as diagnostic biomarkers depends on reproducible and generalizable sensitivity and specificity to disease state that can be confounded by a multitude of influences, including experiment group classification and demographics; acquisition sequence; spectral quality and quantifiability; the contribution of macromolecules and lipids to the spectroscopic baseline; spectral quantification pipeline; voxel tissue and lesion composition; T1 and T2 relaxation; B1 field characteristics; and other features of study design, spectral acquisition and processing, and metabolite quantification about which the experimenter may possess imperfect or incomplete information. The direct comparison of 1H-MRS data from individuals with and without multiple sclerosis poses a special challenge in this regard, as several lines of evidence suggest that experimental cohorts may differ significantly in some of these parameters. We review the existing findings of in vivo1H-MRS on central nervous system metabolic abnormalities in multiple sclerosis and its subtypes within the context of study design, spectral acquisition and processing, and metabolite quantification and offer an outlook on technical considerations, including the growing use of machine learning, by future investigations into diagnostic biomarkers of multiple sclerosis measurable by 1H-MRS.
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Affiliation(s)
- Kelley M Swanberg
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - Karl Landheer
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States
| | - David Pitt
- Department of Neurology, Yale University School of Medicine, New Haven, CT, United States
| | - Christoph Juchem
- Department of Biomedical Engineering, Columbia University Fu Foundation School of Engineering and Applied Science, New York, NY, United States.,Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY, United States
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13
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Wang KY, Carlton J, Guffey D, Hutton GJ, Moron FE. Histogram analysis of apparent diffusion coefficient and fluid-attenuated inversion recovery in discriminating between enhancing and nonenhancing lesions in multiple sclerosis. Clin Imaging 2019; 59:13-20. [PMID: 31715512 DOI: 10.1016/j.clinimag.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/19/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE This study evaluates the diagnostic performance of apparent diffusion coefficient (ADC) and T2 fluid-attenuation inversion recovery (T2 FLAIR) in discriminating between new white matter (WM) enhancing lesions (ELs) and non-enhancing lesions (NELs) in multiple sclerosis (MS) patients. METHODS Thirty MS patients with a new solitary WM lesion on brain MRI were analyzed. A region-of-interest was drawn on all lesions and the contralateral normal-appearing WM (NAWM) on T2 FLAIR and ADC maps. Normalized ratios of T2 FLAIR and ADC were calculated by dividing lesion value by the contralateral NAWM. Histogram analysis was performed on the T2 FLAIR, ADC values, and their normalized ratios. Mann-Whitney U test was used to compare histogram parameters and receiver operating characteristic (ROC) analysis determined the area under the curve (AUC). RESULTS T2 FLAIR histogram parameters were not significantly different between ELs and NELs. Several EL ADC histogram parameters, including maximum and mean, were significantly higher than NELs (p = 0.006 to p = 0.031). There was a trend toward significantly higher maximum ADC in ELs after adjusting for multiple comparisons (p = 0.054). The standard deviation of T2 FLAIR (AUC 0.70), maximum ADC (AUC 0.79), and normalized maximum ADC ratio (AUC 0.75) were among histogram parameters with the highest diagnostic performance. A maximum ADC cutoff of 1274 × 10-6 mm2/s provided a 0.86 sensitivity and 0.75 specificity. CONCLUSION In patients with contraindications to gadolinium or concerns with gadolinium brain deposition, consideration may be given to ADC and T2 FLAIR as potential noncontrast methods for the evaluation of active MS lesions.
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Affiliation(s)
- Kevin Yuqi Wang
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.
| | - Joshua Carlton
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - George J Hutton
- Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Fanny E Moron
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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14
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deSouza NM, Achten E, Alberich-Bayarri A, Bamberg F, Boellaard R, Clément O, Fournier L, Gallagher F, Golay X, Heussel CP, Jackson EF, Manniesing R, Mayerhofer ME, Neri E, O'Connor J, Oguz KK, Persson A, Smits M, van Beek EJR, Zech CJ. Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR). Insights Imaging 2019; 10:87. [PMID: 31468205 PMCID: PMC6715762 DOI: 10.1186/s13244-019-0764-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
Observer-driven pattern recognition is the standard for interpretation of medical images. To achieve global parity in interpretation, semi-quantitative scoring systems have been developed based on observer assessments; these are widely used in scoring coronary artery disease, the arthritides and neurological conditions and for indicating the likelihood of malignancy. However, in an era of machine learning and artificial intelligence, it is increasingly desirable that we extract quantitative biomarkers from medical images that inform on disease detection, characterisation, monitoring and assessment of response to treatment. Quantitation has the potential to provide objective decision-support tools in the management pathway of patients. Despite this, the quantitative potential of imaging remains under-exploited because of variability of the measurement, lack of harmonised systems for data acquisition and analysis, and crucially, a paucity of evidence on how such quantitation potentially affects clinical decision-making and patient outcome. This article reviews the current evidence for the use of semi-quantitative and quantitative biomarkers in clinical settings at various stages of the disease pathway including diagnosis, staging and prognosis, as well as predicting and detecting treatment response. It critically appraises current practice and sets out recommendations for using imaging objectively to drive patient management decisions.
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Affiliation(s)
- Nandita M deSouza
- Cancer Research UK Imaging Centre, The Institute of Cancer Research and The Royal Marsden Hospital, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | | | | | - Fabian Bamberg
- Department of Radiology, University of Freiburg, Freiburg im Breisgau, Germany
| | | | | | | | | | | | - Claus Peter Heussel
- Universitätsklinik Heidelberg, Translational Lung Research Center (TLRC), German Center for Lung Research (DZL), University of Heidelberg, Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
| | - Edward F Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Geert Grooteplein 10, 6525, GA, Nijmegen, The Netherlands
| | | | - Emanuele Neri
- Department of Translational Research, University of Pisa, Pisa, Italy
| | - James O'Connor
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | | | | | - Marion Smits
- Department of Radiology and Nuclear Medicine (Ne-515), Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, Edinburgh Bioquarter, 47 Little France Crescent, Edinburgh, UK
| | - Christoph J Zech
- University Hospital Basel, Radiology and Nuclear Medicine, University of Basel, Petersgraben 4, CH-4031, Basel, Switzerland
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15
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Falk Delgado A, Van Westen D, Nilsson M, Knutsson L, Sundgren PC, Larsson EM, Falk Delgado A. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10:84. [PMID: 31444580 PMCID: PMC6708018 DOI: 10.1186/s13244-019-0771-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017. This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging. Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke. In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.
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Affiliation(s)
- Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
| | - Danielle Van Westen
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Pia C Sundgren
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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16
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Rüber T, David B, Lüchters G, Nass RD, Friedman A, Surges R, Stöcker T, Weber B, Deichmann R, Schlaug G, Hattingen E, Elger CE. Evidence for peri-ictal blood-brain barrier dysfunction in patients with epilepsy. Brain 2019; 141:2952-2965. [PMID: 30239618 DOI: 10.1093/brain/awy242] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/08/2018] [Indexed: 12/11/2022] Open
Abstract
Epilepsy has been associated with a dysfunction of the blood-brain barrier. While there is ample evidence that a dysfunction of the blood-brain barrier contributes to epileptogenesis, blood-brain barrier dysfunction as a consequence of single epileptic seizures has not been systematically investigated. We hypothesized that blood-brain barrier dysfunction is temporally and anatomically associated with epileptic seizures in patients and used a newly-established quantitative MRI protocol to test our hypothesis. Twenty-three patients with epilepsy undergoing inpatient monitoring as part of their presurgical evaluation were included in this study (10 females, mean age ± standard deviation: 28.78 ± 8.45). For each patient, we acquired quantitative T1 relaxation time maps (qT1) after both ictal and interictal injection of gadolinium-based contrast agent. The postictal enhancement of contrast agent was quantified by subtracting postictal qT1 from interictal qT1 and the resulting ΔqT1 was used as a surrogate imaging marker of peri-ictal blood-brain barrier dysfunction. Additionally, the serum concentrations of MMP9 and S100, both considered biomarkers of blood-brain barrier dysfunction, were assessed in serum samples obtained prior to and after the index seizure. Fifteen patients exhibited secondarily generalized tonic-clonic seizures and eight patients exhibited focal seizures at ictal injection of contrast agent. By comparing ΔqT1 of the generalized tonic-clonic seizures and focal seizures groups, the anatomical association between ictal epileptic activity and postictal enhancement of contrast agent could be probed. The generalized tonic-clonic seizures group showed significantly higher ΔqT1 in the whole brain as compared to the focal seizures group. Specific analysis of scans acquired later than 3 h after the onset of the seizure revealed higher ΔqT1 in the generalized tonic-clonic seizures group as compared to the focal seizures group, which was strictly lateralized to the hemisphere of seizure onset. Both MMP9 and S100 showed a significantly increased postictal concentration. The current study provides evidence for the occurrence of a blood-brain barrier dysfunction, which is temporally and anatomically associated with epileptic seizures. qT1 after ictal contrast agent injection is rendered as valuable imaging marker of seizure-associated blood-brain barrier dysfunction and may be measured hours after the seizure. The observation of the strong anatomical association of peri-ictal blood-brain barrier dysfunction may spark the development of new functional imaging modalities for the post hoc visualization of brain areas affected by the seizure.
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Affiliation(s)
- Theodor Rüber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Bastian David
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Guido Lüchters
- Center for Development Research, University of Bonn, Bonn, Germany
| | - Robert D Nass
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, Canada.,Departments of Physiology and Cell Biology, Cognitive and Brain Sciences, Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Rainer Surges
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany.,Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Tony Stöcker
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Bernd Weber
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Gottfried Schlaug
- Stroke Recovery Laboratory, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Elke Hattingen
- Department of Radiology, University of Bonn Medical Center, Bonn, Germany
| | - Christian E Elger
- Department of Epileptology, University of Bonn Medical Center, Bonn, Germany
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17
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Lorio S, Tierney TM, McDowell A, Arthurs OJ, Lutti A, Weiskopf N, Carmichael DW. Flexible proton density (PD) mapping using multi-contrast variable flip angle (VFA) data. Neuroimage 2018; 186:464-475. [PMID: 30465865 DOI: 10.1016/j.neuroimage.2018.11.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Quantitative proton density (PD) maps measure the amount of free water, which is important for non-invasive tissue characterization in pathology and across lifespan. PD mapping requires the estimation and subsequent removal of factors influencing the signal intensity other than PD. These factors include the T1, T2* relaxation effects, transmit field inhomogeneities, receiver coil sensitivity profile (RP) and the spatially invariant factor that is required to scale the data. While the transmit field can be reliably measured, the RP estimation is usually based on image post-processing techniques due to limitations of its measurement at magnetic fields higher than 1.5 T. The post-processing methods are based on unified bias-field/tissue segmentation, fitting the sensitivity profile from images obtained with different coils, or on the linear relationship between T1 and PD. The scaling factor is derived from the signal within a specific tissue compartment or reference object. However, these approaches for calculating the RP and scaling factor have limitations particularly in severe pathology or over a wide age range, restricting their application. We propose a new approach for PD mapping based on a multi-contrast variable flip angle acquisition protocol and a data-driven estimation method for the RP correction and map scaling. By combining all the multi-contrast data acquired at different echo times, we are able to fully correct the MRI signal for T2* relaxation effects and to decrease the variance and the entropy of PD values within tissue class of the final map. The RP is determined from the corrected data applying a non-parametric bias estimation, and the scaling factor is based on the median intensity of an external calibration object. Finally, we compare the signal intensity and homogeneity of the multi-contrast PD map with the well-established effective PD (PD*) mapping, for which the RP is based on concurrent bias field estimation and tissue classification, and the scaling factor is estimated from the mean white matter signal. The multi-contrast PD values homogeneity and accuracy within the cerebrospinal fluid (CSF) and deep brain structures are increased beyond that obtained using PD* maps. We demonstrate that the multi-contrast RP approach is insensitive to anatomical or a priori tissue information by applying it in a patient with extensive brain abnormalities and for whole body PD mapping in post-mortem foetal imaging.
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Affiliation(s)
- Sara Lorio
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Tim M Tierney
- Wellcome Centre for Human Neuroimaging, UCL Institute of Neurology, University College London, London, UK
| | - Amy McDowell
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Owen J Arthurs
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Department of Radiology, Great Ormond Street Hospital for Children, London, UK
| | - Antoine Lutti
- Laboratory for Research in Neuroimaging, Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nikolaus Weiskopf
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - David W Carmichael
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK; EPSRC / Wellcome Centre for Medical Engineering, Biomedical Engineering, King's College, London, UK
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18
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Thaler C, Faizy TD, Sedlacik J, Bester M, Stellmann JP, Heesen C, Fiehler J, Siemonsen S. The use of multiparametric quantitative magnetic resonance imaging for evaluating visually assigned lesion groups in patients with multiple sclerosis. J Neurol 2017; 265:127-133. [PMID: 29159467 DOI: 10.1007/s00415-017-8683-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/13/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
In multiple sclerosis (MS), inflammatory lesions present a broad spectrum of histopathologic processes. For a better discrimination, lesions are visually defined into different lesion groups according to their appearance on conventional magnetic resonance imaging (MRI). The aim of this study was to investigate the properties of different MS lesion groups using multiparametric quantitative MRI. 35 patients diagnosed with relapsing-remitting MS received 3 Tesla MRI including magnetization-prepared 2 rapid acquisition gradient echo, diffusion tensor imaging and magnetization transfer imaging. Lesion segmentation was performed for T2 lesions, black holes and contrast-enhancing lesions. A subtraction mask was created including only T2 lesions that did not correspond to a black hole or contrast-enhancing lesion. T1 relaxation time (T1-RT), magnetization transfer ratio (MTR), mean diffusivity (MD) and fractional anisotropy (FA) were determined for every lesion and in normal-appearing white matter. Only MD differed significantly between all lesion groups and NAWM (p < 0.05), while FA differed between all lesion groups but not NAWM. T1-RT and MTR were not useful imaging biomarkers to distinguish between lesion groups. A lack of sensitivity and specificity and unproportional alterations of quantitative MRI measures, due to heterogenous histopathologic processes within lesions, may be a possible explanation for missing discrimination. Thus, not only interpretation of visually defined MS lesion but also interpretation of quantitative MRI measures remains challenging and should be conducted carefully.
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Affiliation(s)
- Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Tobias D Faizy
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jan Sedlacik
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Maxim Bester
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Neuroimmunology and Clinical MS Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Susanne Siemonsen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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19
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Alves GS, de Carvalho LDA, Sudo FK, Briand L, Laks J, Engelhardt E. A panel of clinical and neuropathological features of cerebrovascular disease through the novel neuroimaging methods. Dement Neuropsychol 2017; 11:343-355. [PMID: 29354214 PMCID: PMC5769992 DOI: 10.1590/1980-57642016dn11-040003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The last decade has witnessed substantial progress in acquiring diagnostic biomarkers for the diagnostic workup of cerebrovascular disease (CVD). Advanced neuroimaging methods not only provide a strategic contribution for the differential diagnosis of vascular dementia (VaD) and vascular cognitive impairment (VCI), but also help elucidate the pathophysiological mechanisms ultimately leading to small vessel disease (SVD) throughout its course. OBJECTIVE In this review, the novel imaging methods, both structural and metabolic, were summarized and their impact on the diagnostic workup of age-related CVD was analysed. Methods: An electronic search between January 2010 and 2017 was carried out on PubMed/MEDLINE, Institute for Scientific Information Web of Knowledge and EMBASE. RESULTS The use of full functional multimodality in simultaneous Magnetic Resonance (MR)/Positron emission tomography (PET) may potentially improve the clinical characterization of VCI-VaD; for structural imaging, MRI at 3.0 T enables higher-resolution scanning with greater imaging matrices, thinner slices and more detail on the anatomical structure of vascular lesions. CONCLUSION Although the importance of most of these techniques in the clinical setting has yet to be recognized, there is great expectancy in achieving earlier and more refined therapeutic interventions for the effective management of VCI-VaD.
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Affiliation(s)
| | | | - Felipe Kenji Sudo
- Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, RJ, Brazil
- Instituto D'Or de Ensino e Pesquisa, Rio de Janeiro, RJ, Brazil
| | - Lucas Briand
- Departamento de Medicina Interna, Universidade Federal do Ceará, CE, Brazil
| | - Jerson Laks
- Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro, RJ, Brazil
- Programa de Pós-Graduação em Biomedicina Translacional (BIOTRANS), Unigranrio, Duque de Caxias, RJ, Brazil
| | - Eliasz Engelhardt
- Setor de Neurologia Cognitiva e do Comportamento, Instituto de Neurologia Deolindo Couto (INDC-CDA/IPUB), Rio de Janeiro, RJ, Brazil
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20
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Nantes JC, Proulx S, Zhong J, Holmes SA, Narayanan S, Brown RA, Hoge RD, Koski L. GABA and glutamate levels correlate with MTR and clinical disability: Insights from multiple sclerosis. Neuroimage 2017; 157:705-715. [DOI: 10.1016/j.neuroimage.2017.01.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 01/04/2023] Open
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21
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Cordes D, Yang Z, Zhuang X, Sreenivasan K, Mishra V, Hua LH. A new algebraic method for quantitative proton density mapping using multi-channel coil data. Med Image Anal 2017; 40:154-171. [PMID: 28668358 DOI: 10.1016/j.media.2017.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/06/2017] [Accepted: 06/15/2017] [Indexed: 11/30/2022]
Abstract
A difficult problem in quantitative MRI is the accurate determination of the proton density, which is an important quantity in measuring brain tissue organization. Recent progress in estimating proton density in vivo has been based on using the inverse linear relationship between the longitudinal relaxation rate T1 and proton density. In this study, the same type of relationship is being used, however, in a more general framework by constructing 3D basis functions to model the receiver bias field. The novelty of this method is that the basis functions developed are suitable to cover an entire range of inverse linearities between T1 and proton density. The method is applied by parcellating the human brain into small cubes with size 30mm x 30mm x 30mm. In each cube the optimal set of basis functions is determined to model the receiver coil sensitivities using multi-channel (32 element) coil data. For validation, we use arbitrary data from a numerical phantom where the data satisfy the conventional MR signal equations. Using added noise of different magnitude and realizations, we show that the proton densities obtained have a bias close to zero and also low noise sensitivity. The obtained root-mean-square-error rate is less than 0.2% for the estimated proton density in a realistic 3D simulation. As an application, the method is used in a small cohort of MS patients, and proton density values for specific brain structures are determined.
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Affiliation(s)
- Dietmar Cordes
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888W. Bonneville Ave, Las Vegas, NV 89106, USA; University of Colorado, Boulder, CO, USA.
| | - Zhengshi Yang
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888W. Bonneville Ave, Las Vegas, NV 89106, USA
| | - Xiaowei Zhuang
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888W. Bonneville Ave, Las Vegas, NV 89106, USA
| | - Karthik Sreenivasan
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888W. Bonneville Ave, Las Vegas, NV 89106, USA
| | - Virendra Mishra
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888W. Bonneville Ave, Las Vegas, NV 89106, USA
| | - Le H Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888W. Bonneville Ave, Las Vegas, NV 89106, USA
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22
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Value of quantitative magnetic resonance imaging T1-relaxometry in predicting contrast-enhancement in glioblastoma patients. Oncotarget 2017; 8:53542-53551. [PMID: 28881830 PMCID: PMC5581129 DOI: 10.18632/oncotarget.18612] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
SUMMARIZING THE IMPORTANCE OF THE STUDY The repetitive usage of gadolinium-based contrast agents (GBCA) is critical for magnetic resonance imaging (MRI) evaluation of tumor burden in glioblastoma patients. It is also a crucial tool for determination of radiographical response to treatment. GBCA injection, however, comes with a 2.4% rate of adverse events including life-threatening conditions such as nephrogenic systemic fibrosis (NSF). Moreover, GBCA have been shown to be deposited in brain tissue of patients even with an intact blood-brain barrier (BBB). The present study explores quantitative T1 relaxometry as an alternative non-invasive imaging technique detection of tumor burden and determination of radiographical response. This technique exploits specific properties of brain tissue with impaired BBB. With a sensitivity and specificity as high as 86% and 80%, respectively, quantitative T1-relaxometry allows for detecting contrast-enhancing areas without the use of GBCA. This method could make it unnecessary to subject patients to the risk of adverse events associated with the use of GBCA. Nonetheless, a large-scale analysis is needed to confirm our findings. Background Gadolinium-based contrast agents (GBCA) are crucial for magnetic resonance imaging (MRI)-based evaluation of tumor burden in glioblastoma (GBM). Serious adverse events of GBCA, even though uncommon, and gadolinium deposition in brain tissue could be avoided by novel imaging techniques not requiring GBCA. Altered tissue composition in areas with impaired blood-brain-barrier also alters the quantified T1 relaxation time (qT1), so that qT1 analysis could replace GBCA-based MRI for the analysis of tumor burden and response. Methods As a part of a prospective pilot MRI-relaxometry trial, patients with newly-diagnosed GBM who relapsed under standard radiochemotherapy were selected for this study. At recurrence, subtraction of qT1 maps pre and post-GBCA application (ΔqT1 maps) was used to determine areas of contrast-enhancement. With the contrast-enhancement on ΔqT1 maps as reference, ROC analysis served to detect an optimal qT1 cut-off on qT1 maps prior to GBCA to distinguish between contrast-enhancing tissue and its surroundings. Results Ten patients were included. A qT1 value >2051ms predicted contrast-enhancing tumor tissue with a sensitivity of 86% and specificity of 80% (AUC, 0.92; p<0.0001). Interestingly, qT1 prolongation >2051 ms that did not overlap with contrast-enhancing area transformed into contrast-enhancement later on (n=4). Conclusion T1-relaxometry may be a useful technique to assess tissue properties equivalent to contrast-enhancement without the need for GBCA application. It may also provide information on sites with future tumor progression. Nonetheless, large-scale studies are needed to confirm these findings.
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23
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Gupta A, Al-Dasuqi K, Xia F, Askin G, Zhao Y, Delgado D, Wang Y. The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:1317-1322. [PMID: 28522663 DOI: 10.3174/ajnr.a5209] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Concerns have arisen about the long-term health effects of repeat gadolinium injections in patients with multiple sclerosis and the incomplete characterization of MS lesion pathophysiology that results from relying on enhancement characteristics alone. PURPOSE Our aim was to perform a systematic review and meta-analysis analyzing whether noncontrast MR imaging biomarkers can distinguish enhancing and nonenhancing brain MS lesions. DATA SOURCES Our sources were Ovid MEDLINE, Ovid Embase, and the Cochrane data base from inception to August 2016. STUDY SELECTION We included 37 journal articles on 985 patients with MS who had MR imaging in which T1-weighted postcontrast sequences were compared with noncontrast sequences obtained during the same MR imaging examination by using ROI analysis of individual MS lesions. DATA ANALYSIS We performed random-effects meta-analyses comparing the standard mean difference of each MR imaging metric taken from enhancing-versus-nonenhancing lesions. DATA SYNTHESIS DTI-based fractional anisotropy values are significantly different between enhancing and nonenhancing lesions (P = .02), with enhancing lesions showing decreased fractional anisotropy compared with nonenhancing lesions. Of the other most frequently studied MR imaging biomarkers (mean diffusivity, magnetization transfer ratio, or ADC), none were significantly different (P values of 0.30, 0.47, and 0.19. respectively) between enhancing and nonenhancing lesions. Of the limited studies providing diagnostic accuracy measures, gradient-echo-based quantitative susceptibility mapping had the best performance in discriminating enhancing and nonenhancing MS lesions. LIMITATIONS MR imaging techniques and patient characteristics were variable across studies. Most studies did not provide diagnostic accuracy measures. All imaging metrics were not studied in all 37 studies. CONCLUSIONS Noncontrast MR imaging techniques, such as DTI-based FA, can assess MS lesion acuity without gadolinium.
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Affiliation(s)
- A Gupta
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.) .,Clinical and Translational Neuroscience Unit (A.G.), Feil Family Brain and Mind Research Institute
| | - K Al-Dasuqi
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.)
| | - F Xia
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.).,Department of Biomedical Engineering (F.X., Y.W.), Cornell University, Ithaca, New York
| | - G Askin
- Department of Healthcare Policy and Research (G.A., Y.Z.)
| | - Y Zhao
- Department of Healthcare Policy and Research (G.A., Y.Z.)
| | - D Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Weill Cornell Medicine, New York, New York
| | - Y Wang
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.).,Department of Biomedical Engineering (F.X., Y.W.), Cornell University, Ithaca, New York
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24
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Müller A, Jurcoane A, Kebir S, Ditter P, Schrader F, Herrlinger U, Tzaridis T, Mädler B, Schild HH, Glas M, Hattingen E. Quantitative T1-mapping detects cloudy-enhancing tumor compartments predicting outcome of patients with glioblastoma. Cancer Med 2016; 6:89-99. [PMID: 27891815 PMCID: PMC5269700 DOI: 10.1002/cam4.966] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/11/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
Contrast enhancement of glioblastomas (GBM) is caused by the decrease in relaxation time, T1. Here, we demonstrate that the quantitative measurement of T1 (qT1) discovers a subtle enhancement in GBM patients that is invisible in standard MRI. We assessed the volume change of this “cloudy” enhancement during radio‐chemotherapy and its impact on patients’ progression‐free survival (PFS). We enrolled 18 GBM patients in this observational, prospective cohort study and measured 3T‐MRI pre‐ and post contrast agent with standard T1‐weighted (T1w) and with sequences to quantify T1 before radiation, and at 6‐week intervals during radio‐chemotherapy. We measured contrast enhancement by subtracting pre from post contrast contrast images, yielding relative signal increase ∆T1w and relative T1 shortening ∆qT1. On ∆qT1, we identified a solid and a cloudy‐enhancing compartment and evaluated the impact of their therapy‐related volume change upon PFS. In ∆qT1 maps cloudy‐enhancing compartments were found in all but two patients at baseline and in all patients during therapy. The qT1 decrease in the cloudy‐enhancing compartment post contrast was 21.64% versus 1.96% in the contralateral control tissue (P < 0.001). It was located at the margin of solid enhancement which was also seen on T1w. In contrast, the cloudy‐enhancing compartment was visually undetectable on ∆T1w. A volume decrease of more than 21.4% of the cloudy‐enhancing compartment at first follow‐up predicted longer PFS (P = 0.038). Cloudy‐enhancing compartment outside the solid contrast‐enhancing area of GBM is a new observation which is only visually detectable with qT1‐mapping and may represent tumor infiltration. Its early volume decrease predicts a longer PFS in GBM patients during standard radio‐chemotherapy.
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Affiliation(s)
- Andreas Müller
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Alina Jurcoane
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Philip Ditter
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Felix Schrader
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Burkhard Mädler
- Philips GmbH, UB Healthcare, Lübeckertordamm 5, Hamburg, 20099, Germany
| | - Hans H Schild
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany.,Division of Experimental and Translational Neurooncology, Department of Neurology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany.,Clinical Cooperation Unit Neurooncology, MediClin Robert Janker Clinic & University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
| | - Elke Hattingen
- Neuroradiology, Department of Radiology, University Hospital Bonn, Sigmund Freud Str. 25, Bonn, 53127, Germany
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25
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Gracien RM, Reitz SC, Wagner M, Mayer C, Volz S, Hof SM, Fleischer V, Droby A, Steinmetz H, Groppa S, Hattingen E, Klein JC, Deichmann R. Comparison of two quantitative proton density mapping methods in multiple sclerosis. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 30:75-83. [PMID: 27544270 DOI: 10.1007/s10334-016-0585-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/06/2016] [Accepted: 08/09/2016] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Proton density (PD) mapping requires correction for the receive profile (RP), which is frequently performed via bias-field correction. An alternative RP-mapping method utilizes a comparison of uncorrected PD-maps and a value ρ(T1) directly derived from T1-maps via the Fatouros equation. This may be problematic in multiple sclerosis (MS), if respective parameters are only valid for healthy brain tissue. We aimed to investigate whether the alternative method yields correct PD values in MS patients. MATERIALS/METHODS PD mapping was performed on 27 patients with relapsing-remitting MS and 27 healthy controls, utilizing both methods, yielding reference PD values (PDref, bias-field method) and PDalt (alternative method). RESULTS PDalt-values closely matched PDref, both for patients and controls. In contrast, ρ(T1) differed by up to 3 % from PDref, and the voxel-wise correlation between PDref and ρ(T1) was reduced in a patient subgroup with a higher degree of disability. Still, discrepancies between ρ(T1) and PDref were almost identical across different tissue types, thus translating into a scaling factor, which cancelled out during normalization to 100 % in CSF, yielding a good agreement between PDalt and PDref. CONCLUSION RP correction utilizing the auxiliary parameter ρ(T1) derived via the Fatouros equation provides accurate PD results in MS patients, in spite of discrepancies between ρ(T1) and actual PD values.
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Affiliation(s)
- René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt/Main, Germany. .,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.
| | - Sarah C Reitz
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Christoph Mayer
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
| | - Steffen Volz
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Stephanie-Michelle Hof
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.,Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Amgad Droby
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.,Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | | | - Sergiu Groppa
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany.,Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Johannes C Klein
- Department of Neurology, Goethe University, Frankfurt/Main, Germany.,Brain Imaging Center, Goethe University, Frankfurt/Main, Germany.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
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26
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Gracien RM, Jurcoane A, Wagner M, Reitz SC, Mayer C, Volz S, Hof SM, Fleischer V, Droby A, Steinmetz H, Zipp F, Hattingen E, Deichmann R, Klein JC. The Relationship between Gray Matter Quantitative MRI and Disability in Secondary Progressive Multiple Sclerosis. PLoS One 2016; 11:e0161036. [PMID: 27513853 PMCID: PMC4981438 DOI: 10.1371/journal.pone.0161036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/28/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE In secondary progressive Multiple Sclerosis (SPMS), global neurodegeneration as a driver of disability gains importance in comparison to focal inflammatory processes. However, clinical MRI does not visualize changes of tissue composition outside MS lesions. This quantitative MRI (qMRI) study investigated cortical and deep gray matter (GM) proton density (PD) values and T1 relaxation times to explore their potential to assess neuronal damage and its relationship to clinical disability in SPMS. MATERIALS AND METHODS 11 SPMS patients underwent quantitative T1 and PD mapping. Parameter values across the cerebral cortex and deep GM structures were compared with 11 healthy controls, and correlation with disability was investigated for regions exhibiting significant group differences. RESULTS PD was increased in the whole GM, cerebral cortex, thalamus, putamen and pallidum. PD correlated with disability in the whole GM, cerebral cortex, putamen and pallidum. T1 relaxation time was prolonged and correlated with disability in the whole GM and cerebral cortex. CONCLUSION Our study suggests that the qMRI parameters GM PD (which likely indicates replacement of neural tissue with water) and cortical T1 (which reflects cortical damage including and beyond increased water content) are promising qMRI candidates for the assessment of disease status, and are related to disability in SPMS.
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Affiliation(s)
- René-Maxime Gracien
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
- * E-mail:
| | - Alina Jurcoane
- Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Marlies Wagner
- Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Sarah C. Reitz
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Christoph Mayer
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
| | - Steffen Volz
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Stephanie-Michelle Hof
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Vinzenz Fleischer
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Amgad Droby
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | | | - Frauke Zipp
- Department of Neurology, Johannes Gutenberg University, Mainz, Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg-University, Mainz, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
| | - Johannes C. Klein
- Department of Neurology, Goethe University, Frankfurt/Main, Germany
- Brain Imaging Center, Goethe University, Frankfurt/Main, Germany
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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27
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Gracien RM, Jurcoane A, Wagner M, Reitz SC, Mayer C, Volz S, Hof SM, Fleischer V, Droby A, Steinmetz H, Groppa S, Hattingen E, Deichmann R, Klein JC. Multimodal quantitative MRI assessment of cortical damage in relapsing-remitting multiple sclerosis. J Magn Reson Imaging 2016; 44:1600-1607. [DOI: 10.1002/jmri.25297] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/19/2016] [Indexed: 11/05/2022] Open
Affiliation(s)
- René-Maxime Gracien
- Department of Neurology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Alina Jurcoane
- Department of Neuroradiology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Marlies Wagner
- Department of Neuroradiology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Sarah C. Reitz
- Department of Neurology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Christoph Mayer
- Department of Neurology; Goethe University; Frankfurt/Main Germany
| | - Steffen Volz
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Stephanie-Michelle Hof
- Department of Neurology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Vinzenz Fleischer
- Department of Neurology; Johannes Gutenberg University; Mainz Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN); Johannes Gutenberg-University; Mainz Germany
| | - Amgad Droby
- Department of Neurology; Johannes Gutenberg University; Mainz Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN); Johannes Gutenberg-University; Mainz Germany
| | | | - Sergiu Groppa
- Department of Neurology; Johannes Gutenberg University; Mainz Germany
- Neuroimaging Center (NIC) of the Focus Program Translational Neuroscience (FTN); Johannes Gutenberg-University; Mainz Germany
| | - Elke Hattingen
- Department of Neuroradiology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Ralf Deichmann
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
| | - Johannes C. Klein
- Department of Neurology; Goethe University; Frankfurt/Main Germany
- Brain Imaging Center; Goethe University; Frankfurt/Main Germany
- Nuffield Department of Clinical Neurosciences; University of Oxford; UK
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28
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Goubran M, Bernhardt BC, Cantor‐Rivera D, Lau JC, Blinston C, Hammond RR, de Ribaupierre S, Burneo JG, Mirsattari SM, Steven DA, Parrent AG, Bernasconi A, Bernasconi N, Peters TM, Khan AR. In vivo MRI signatures of hippocampal subfield pathology in intractable epilepsy. Hum Brain Mapp 2016; 37:1103-19. [PMID: 26679097 PMCID: PMC6867266 DOI: 10.1002/hbm.23090] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/20/2015] [Accepted: 12/05/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Our aim is to assess the subfield-specific histopathological correlates of hippocampal volume and intensity changes (T1, T2) as well as diff!usion MRI markers in TLE, and investigate the efficacy of quantitative MRI measures in predicting histopathology in vivo. EXPERIMENTAL DESIGN We correlated in vivo volumetry, T2 signal, quantitative T1 mapping, as well as diffusion MRI parameters with histological features of hippocampal sclerosis in a subfield-specific manner. We made use of on an advanced co-registration pipeline that provided a seamless integration of preoperative 3 T MRI with postoperative histopathological data, on which metrics of cell loss and gliosis were quantitatively assessed in CA1, CA2/3, and CA4/DG. PRINCIPAL OBSERVATIONS MRI volumes across all subfields were positively correlated with neuronal density and size. Higher T2 intensity related to increased GFAP fraction in CA1, while quantitative T1 and diffusion MRI parameters showed negative correlations with neuronal density in CA4 and DG. Multiple linear regression analysis revealed that in vivo multiparametric MRI can predict neuronal loss in all the analyzed subfields with up to 90% accuracy. CONCLUSION Our results, based on an accurate co-registration pipeline and a subfield-specific analysis of MRI and histology, demonstrate the potential of MRI volumetry, diffusion, and quantitative T1 as accurate in vivo biomarkers of hippocampal pathology.
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Affiliation(s)
- Maged Goubran
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
| | - Boris C. Bernhardt
- Neuroimaging of Epilepsy LaboratoryMcConnell Brain Imaging Center, Montreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Diego Cantor‐Rivera
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
| | - Jonathan C. Lau
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Charlotte Blinston
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
| | - Robert R. Hammond
- Department of PathologyDivision of NeuropathologyLondonOntarioCanada
| | - Sandrine de Ribaupierre
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
| | - Jorge G. Burneo
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Seyed M. Mirsattari
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
- Department of Medical ImagingWestern UniversityLondonOntarioCanada
| | - David A. Steven
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Andrew G. Parrent
- Department of Clinical Neurological SciencesEpilepsy Program, Western UniversityLondonOntarioCanada
| | - Andrea Bernasconi
- Neuroimaging of Epilepsy LaboratoryMcConnell Brain Imaging Center, Montreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Neda Bernasconi
- Neuroimaging of Epilepsy LaboratoryMcConnell Brain Imaging Center, Montreal Neurological Institute, McGill UniversityMontrealQuebecCanada
| | - Terry M. Peters
- Imaging Research Laboratories, Robarts Research InstituteLondonOntarioCanada
- Biomedical Engineering Graduate ProgramWestern UniversityLondonOntarioCanada
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
| | - Ali R. Khan
- Department of Medical BiophysicsWestern UniversityLondonOntarioCanada
- Department of Medical ImagingWestern UniversityLondonOntarioCanada
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29
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Blystad I, Håkansson I, Tisell A, Ernerudh J, Smedby Ö, Lundberg P, Larsson EM. Quantitative MRI for Analysis of Active Multiple Sclerosis Lesions without Gadolinium-Based Contrast Agent. AJNR Am J Neuroradiol 2015; 37:94-100. [PMID: 26471751 DOI: 10.3174/ajnr.a4501] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/15/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Contrast-enhancing MS lesions are important markers of active inflammation in the diagnostic work-up of MS and in disease monitoring with MR imaging. Because intravenous contrast agents involve an expense and a potential risk of adverse events, it would be desirable to identify active lesions without using a contrast agent. The purpose of this study was to evaluate whether pre-contrast injection tissue-relaxation rates and proton density of MS lesions, by using a new quantitative MR imaging sequence, can identify active lesions. MATERIALS AND METHODS Forty-four patients with a clinical suspicion of MS were studied. MR imaging with a standard clinical MS protocol and a quantitative MR imaging sequence was performed at inclusion (baseline) and after 1 year. ROIs were placed in MS lesions, classified as nonenhancing or enhancing. Longitudinal and transverse relaxation rates, as well as proton density were obtained from the quantitative MR imaging sequence. Statistical analyses of ROI values were performed by using a mixed linear model, logistic regression, and receiver operating characteristic analysis. RESULTS Enhancing lesions had a significantly (P < .001) higher mean longitudinal relaxation rate (1.22 ± 0.36 versus 0.89 ± 0.24), a higher mean transverse relaxation rate (9.8 ± 2.6 versus 7.4 ± 1.9), and a lower mean proton density (77 ± 11.2 versus 90 ± 8.4) than nonenhancing lesions. An area under the receiver operating characteristic curve value of 0.832 was obtained. CONCLUSIONS Contrast-enhancing MS lesions often have proton density and relaxation times that differ from those in nonenhancing lesions, with lower proton density and shorter relaxation times in enhancing lesions compared with nonenhancing lesions.
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Affiliation(s)
- I Blystad
- From the Departments of Radiology and Medical and Health Sciences (I.B., Ö.S.) Centre for Medical Image Science and Visualization (I.B., A.T., Ö.S., P.L., E.-M.L.)
| | - I Håkansson
- Departments of Neurology and Clinical and Experimental Medicine (I.H.)
| | - A Tisell
- Centre for Medical Image Science and Visualization (I.B., A.T., Ö.S., P.L., E.-M.L.) Departments of Radiation Physics and Medical and Health Sciences (A.T., P.L., E.-M.L.)
| | - J Ernerudh
- Departments of Clinical Immunology and Transfusion Medicine and Clinical and Experimental Medicine (J.E.), Linköping University, Linköping Sweden
| | - Ö Smedby
- From the Departments of Radiology and Medical and Health Sciences (I.B., Ö.S.) Centre for Medical Image Science and Visualization (I.B., A.T., Ö.S., P.L., E.-M.L.)
| | - P Lundberg
- Centre for Medical Image Science and Visualization (I.B., A.T., Ö.S., P.L., E.-M.L.) Departments of Radiation Physics and Medical and Health Sciences (A.T., P.L., E.-M.L.)
| | - E-M Larsson
- Centre for Medical Image Science and Visualization (I.B., A.T., Ö.S., P.L., E.-M.L.) Departments of Radiation Physics and Medical and Health Sciences (A.T., P.L., E.-M.L.) Department of Surgical Sciences/Radiology (E.-M.L.), Uppsala University, Uppsala, Sweden
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30
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Maarouf A, Ferré JC, Zaaraoui W, Le Troter A, Bannier E, Berry I, Guye M, Pierot L, Barillot C, Pelletier J, Tourbah A, Edan G, Audoin B, Ranjeva JP. Ultra-small superparamagnetic iron oxide enhancement is associated with higher loss of brain tissue structure in clinically isolated syndrome. Mult Scler 2015; 22:1032-9. [PMID: 26453679 DOI: 10.1177/1352458515607649] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 08/25/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND Macrophages are important components of inflammatory processes in multiple sclerosis, closely linked to axonal loss, and can now be observed in vivo using ultra-small superparamagnetic iron oxide (USPIO). In the present 1-year longitudinal study, we aimed to determine the prevalence and the impact on tissue injury of macrophage infiltration in patients after the first clinical event of multiple sclerosis. METHODS Thirty-five patients, 32 years mean age, were imaged in a mean of 66 days after their first event using conventional magnetic resonance imaging, gadolinium (Gd) to probe blood-brain barrier integrity, USPIO to study macrophage infiltration and magnetization transfer ratio (MTR) to assess tissue structure integrity. Statistics were performed using two-group repeated-measures ANOVA. Any patient received treatment at baseline. RESULTS At baseline, patients showed 17 USPIO-positive lesions reflecting infiltration of macrophages present from the onset. This infiltration was associated with local higher loss of tissue structure as emphasized by significant lower MTRnorm values (p<0.03) in USPIO(+)/Gd(+) lesions (n=16; MTRnormUSPIO(+)/Gd(+)=0.78 at baseline, MTRnormUSPIO(+)/Gd(+)=0.81 at M12) relative to USPIO(-)/Gd(+) lesions (n=67; MTRnormUSPIO(-)/Gd(+)=0.82 at baseline, MTRnormUSPIO(-)/Gd(+)=0.85 at M12). No interaction in MTR values was observed during the 12 months follow-up (lesion type × time). CONCLUSION Infiltration of activated macrophages evidenced by USPIO enhancement, is present at the onset of multiple sclerosis and is associated with higher and persistent local loss of tissue structure. Macrophage infiltration affects more tissue structure while tissue recovery during the following year has a similar pattern for USPIO and Gd-enhanced lesions, leading to relative higher persistent local loss of tissue structure in lesions showing USPIO enhancement at baseline.
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Affiliation(s)
- Adil Maarouf
- Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes, Service de Neurologie, Reims, France/Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France/APHM, Hôpital de la Timone, Pôle d'Imagerie Médicale, CEMEREM, Marseille, France
| | - Jean-Christophe Ferré
- CHU Rennes, Hôpital Pontchaillou, Service de Radiologie, Rennes, France/INRIA Rennes - VisAGeS Team, Rennes, France
| | - Wafaa Zaaraoui
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | - Arnaud Le Troter
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France
| | | | | | - Maxime Guye
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France/APHM, Hôpital de la Timone, Pôle d'Imagerie Médicale, CEMEREM, Marseille, France
| | - Laurent Pierot
- Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes, Service de Radiologie, Reims, France
| | | | - Jean Pelletier
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France/APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - Ayman Tourbah
- Centre Hospitalier Universitaire de Reims, Université de Reims Champagne Ardennes, Service de Neurologie, Reims, France/Laboratoire de Psychopathologie et de Neuropsychologie, EA 2027 Université Paris VIII, Saint-Denis Cedex, France
| | - Gilles Edan
- CHU Rennes, Hôpital Pontchaillou, Service de Neurologie, Rennes, France
| | - Bertrand Audoin
- Aix-Marseille Université, CNRS, CRMBM UMR 7339, Marseille, France/APHM, Hôpital de la Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
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31
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Hattingen E, Jurcoane A, Nelles M, Müller A, Nöth U, Mädler B, Mürtz P, Deichmann R, Schild HH. Quantitative MR Imaging of Brain Tissue and Brain Pathologies. Clin Neuroradiol 2015. [PMID: 26223371 DOI: 10.1007/s00062-015-0433-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Measurement of basic quantitative magnetic resonance (MR) parameters (e.g., relaxation times T1, T2*, T2 or respective rates R (1/T)) corrected for radiofrequency (RF) coil bias yields different conventional and new tissue contrasts as well as volumes for tissue segmentation. This approach also provides quantitative measures of microstructural and functional tissue changes. We herein demonstrate some prospects of quantitative MR imaging in neurological diagnostics and science.
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Affiliation(s)
- E Hattingen
- Neuroradiologie, Radiologische Klinik des Universitätsklinikums Bonn, Sigmund Freud Strasse 25, 53127, Bonn, Germany.
| | - A Jurcoane
- Neuroradiologie, Radiologische Klinik des Universitätsklinikums Bonn, Sigmund Freud Strasse 25, 53127, Bonn, Germany
| | - M Nelles
- Neuroradiologie, Radiologische Klinik des Universitätsklinikums Bonn, Sigmund Freud Strasse 25, 53127, Bonn, Germany
| | - A Müller
- Neuroradiologie, Radiologische Klinik des Universitätsklinikums Bonn, Sigmund Freud Strasse 25, 53127, Bonn, Germany
| | - U Nöth
- Brain Imaging Center, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - B Mädler
- Philips Medical Systems, Philips GmbH, Hamburg, Germany
| | - P Mürtz
- Neuroradiologie, Radiologische Klinik des Universitätsklinikums Bonn, Sigmund Freud Strasse 25, 53127, Bonn, Germany
| | - R Deichmann
- Brain Imaging Center, Universitätsklinikum Frankfurt, Frankfurt/Main, Germany
| | - H H Schild
- Radiologische Klinik des Universitätsklinikums Bonn, Sigmund Freud Strasse 25, 53127, Bonn, Germany
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Nöth U, Hattingen E, Bähr O, Tichy J, Deichmann R. Improved visibility of brain tumors in synthetic MP-RAGE anatomies with pure T1 weighting. NMR IN BIOMEDICINE 2015; 28:818-30. [PMID: 25960356 DOI: 10.1002/nbm.3324] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 03/17/2015] [Accepted: 04/13/2015] [Indexed: 05/05/2023]
Abstract
Conventional MRI for brain tumor diagnosis employs T2 -weighted and contrast-enhanced T1 -weighted sequences. Non-enhanced T1 -weighted images provide improved anatomical details for precise tumor location, but reduced tumor-to-background contrast as elevated T1 and proton density (PD) values in tumor tissue affect the signal inversely. Radiofrequency (RF) coil inhomogeneities may further mask tumor and edema outlines. To overcome this problem, the aims of this work were to employ quantitative MRI techniques to create purely T1 -weighted synthetic anatomies which can be expected to yield improved tissue and tumor-to-background contrasts, to compare the quality of conventional and synthetic anatomies, and to investigate optical contrast and visibility of brain tumors and edema in synthetic anatomies. Conventional magnetization-prepared rapid acquisition of gradient echoes (MP-RAGE) anatomies and maps of T1 , PD and RF coil profiles were acquired in comparable and clinically feasible times. Three synthetic MP-RAGE anatomies (PD T1 weighting both with and without RF bias; pure T1 weighting) were calculated for healthy subjects and 32 patients with brain tumors. In healthy subjects, the PD T1 -weighted synthetic anatomies with RF bias precisely matched the conventional anatomies, yielding high signal-to-noise (SNR) and contrast-to-noise (CNR) ratios. Pure T1 weighting yielded lower SNR, but high CNR, because of increased optical contrasts. In patients with brain tumors, synthetic anatomies with pure T1 weighting yielded significant increases in optical contrast and improved visibility of tumor and edema in comparison with anatomies reflecting conventional T1 contrasts. In summary, the optimized purely T1 -weighted synthetic anatomy with an isotropic resolution of 1 mm, as proposed in this work, considerably enhances optical contrast and visibility of brain tumors and edema.
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Affiliation(s)
- Ulrike Nöth
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Elke Hattingen
- Department of Neuroradiology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Oliver Bähr
- Dr Senckenberg Institute of Neurooncology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Julia Tichy
- Dr Senckenberg Institute of Neurooncology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University Frankfurt, Frankfurt/Main, Germany
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Naganawa S. The Technical and Clinical Features of 3D-FLAIR in Neuroimaging. Magn Reson Med Sci 2015; 14:93-106. [PMID: 25833275 DOI: 10.2463/mrms.2014-0132] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
In clinical MR neuroimaging, 3D fluid-attenuated inversion recovery (3D-FLAIR) with a variable-flip-angle turbo spin echo sequence is becoming popular. There are more than 100 reports regarding 3D-FLAIR in the PubMed database. In this article, the technical and clinical features of 3D-FLAIR for neuroimaging are reviewed and summarized. 3D-FLAIR allows thinner slices with multi-planar reformation capability, a higher flow sensitivity, high sensitivity to subtle T1 changes in fluid, images without cerebrospinal fluid (CSF) inflow artifacts, and a 3D dataset compatible with computer-aided analysis. In addition, 3D-FLAIR can be obtained within a clinically reasonable scan time. It is important for radiologists to be familiar with the features of 3D-FLAIR and to provide useful information for patients.
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Affiliation(s)
- Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine
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34
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Goubran M, Hammond RR, de Ribaupierre S, Burneo JG, Mirsattari S, Steven DA, Parrent AG, Peters TM, Khan AR. Magnetic resonance imaging and histology correlation in the neocortex in temporal lobe epilepsy. Ann Neurol 2014; 77:237-50. [PMID: 25424188 DOI: 10.1002/ana.24318] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 11/17/2014] [Accepted: 11/18/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the histopathological correlates of quantitative relaxometry and diffusion tensor imaging (DTI) and to determine their efficacy in epileptogenic lesion detection for preoperative evaluation of focal epilepsy. METHODS We correlated quantitative relaxometry and DTI with histological features of neuronal density and morphology in 55 regions of the temporal lobe neocortex, selected from 13 patients who underwent epilepsy surgery. We made use of a validated nonrigid image registration protocol to obtain accurate correspondences between in vivo magnetic resonance imaging and histology images. RESULTS We found T1 to be a predictor of neuronal density in the neocortical gray matter (GM) using linear mixed effects models with random effects for subjects. Fractional anisotropy (FA) was a predictor of neuronal density of large-caliber neurons only (pyramidal cells, layers 3 and 5). Comparing multivariate to univariate mixed effects models with nested variables demonstrated that employing T1 and FA together provided a significantly better fit than T1 or FA alone in predicting density of large-caliber neurons. Correlations with clinical variables revealed significant positive correlations between neuronal density and age (rs = 0.726, pfwe = 0.021). This study is the first to relate in vivo T1 and FA values to the proportion of neurons in GM. INTERPRETATION Our results suggest that quantitative T1 mapping and DTI may have a role in preoperative evaluation of focal epilepsy and can be extended to identify GM pathology in a variety of neurological disorders.
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Affiliation(s)
- Maged Goubran
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, London, Ontario, Canada
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35
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Lescher S, Jurcoane A, Veit A, Bähr O, Deichmann R, Hattingen E. Quantitative T1 and T2 mapping in recurrent glioblastomas under bevacizumab: earlier detection of tumor progression compared to conventional MRI. Neuroradiology 2014; 57:11-20. [DOI: 10.1007/s00234-014-1445-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 09/25/2014] [Indexed: 11/28/2022]
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36
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Dieringer MA, Deimling M, Santoro D, Wuerfel J, Madai VI, Sobesky J, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J, Niendorf T. Rapid parametric mapping of the longitudinal relaxation time T1 using two-dimensional variable flip angle magnetic resonance imaging at 1.5 Tesla, 3 Tesla, and 7 Tesla. PLoS One 2014; 9:e91318. [PMID: 24621588 PMCID: PMC3951399 DOI: 10.1371/journal.pone.0091318] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 02/08/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Visual but subjective reading of longitudinal relaxation time (T1) weighted magnetic resonance images is commonly used for the detection of brain pathologies. For this non-quantitative measure, diagnostic quality depends on hardware configuration, imaging parameters, radio frequency transmission field (B1+) uniformity, as well as observer experience. Parametric quantification of the tissue T1 relaxation parameter offsets the propensity for these effects, but is typically time consuming. For this reason, this study examines the feasibility of rapid 2D T1 quantification using a variable flip angles (VFA) approach at magnetic field strengths of 1.5 Tesla, 3 Tesla, and 7 Tesla. These efforts include validation in phantom experiments and application for brain T1 mapping. METHODS T1 quantification included simulations of the Bloch equations to correct for slice profile imperfections, and a correction for B1+. Fast gradient echo acquisitions were conducted using three adjusted flip angles for the proposed T1 quantification approach that was benchmarked against slice profile uncorrected 2D VFA and an inversion-recovery spin-echo based reference method. Brain T1 mapping was performed in six healthy subjects, one multiple sclerosis patient, and one stroke patient. RESULTS Phantom experiments showed a mean T1 estimation error of (-63±1.5)% for slice profile uncorrected 2D VFA and (0.2±1.4)% for the proposed approach compared to the reference method. Scan time for single slice T1 mapping including B1+ mapping could be reduced to 5 seconds using an in-plane resolution of (2×2) mm2, which equals a scan time reduction of more than 99% compared to the reference method. CONCLUSION Our results demonstrate that rapid 2D T1 quantification using a variable flip angle approach is feasible at 1.5T/3T/7T. It represents a valuable alternative for rapid T1 mapping due to the gain in speed versus conventional approaches. This progress may serve to enhance the capabilities of parametric MR based lesion detection and brain tissue characterization.
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Affiliation(s)
- Matthias A. Dieringer
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, HELIOS Clinics Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
- * E-mail:
| | - Michael Deimling
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- Siemens Healthcare, Erlangen, Germany
| | - Davide Santoro
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Jens Wuerfel
- Institute of Neuroradiology, University Medicine Göttingen, Göttingen, Germany
- NeuroCure Clinical Research Center, Charité University Medicine Berlin, Berlin, Germany
| | - Vince I. Madai
- Clinic for Neurology & Center for Stroke Research Berlin, Charité Medical Faculty Berlin, Berlin, Germany
| | - Jan Sobesky
- Clinic for Neurology & Center for Stroke Research Berlin, Charité Medical Faculty Berlin, Berlin, Germany
| | - Florian von Knobelsdorff-Brenkenhoff
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, HELIOS Clinics Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Jeanette Schulz-Menger
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, HELIOS Clinics Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.), Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
- Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine, Berlin, Germany
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