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Alzaidi AA, Panek R, Blockley NP. Quantitative BOLD (qBOLD) imaging of oxygen metabolism and blood oxygenation in the human body: A scoping review. Magn Reson Med 2024. [PMID: 39072791 DOI: 10.1002/mrm.30165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE There are many approaches to the quantitative BOLD (qBOLD) technique described in the literature, differing in pulse sequences, MRI parameters and data processing. Thus, in this review, we summarized the acquisition methods, approaches used for oxygenation quantification and clinical populations investigated. METHODS Three databases were systematically searched (Medline, Embase, and Web of Science) for published research that used qBOLD methods for quantification of oxygen metabolism. Data extraction and synthesis were performed by one author and reviewed by a second author. RESULTS A total of 93 relevant papers were identified. Acquisition strategies were summarized, and oxygenation parameters were found to have been investigated in many pathologies such as steno-occlusive diseases, stroke, glioma, and multiple sclerosis disease. CONCLUSION A summary of qBOLD approaches for oxygenation measurements and applications could help researchers to identify good practice and provide objective information to inform the development of future consensus recommendations.
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Affiliation(s)
- Ahlam A Alzaidi
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, UK
- Radiology Department, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Rafal Panek
- Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nicholas P Blockley
- David Greenfield Human Physiology Unit, School of Life Sciences, University of Nottingham, Nottingham, UK
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2
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Lee H, Xu J, Fernandez-Seara MA, Wehrli FW. Validation of a new 3D quantitative BOLD based cerebral oxygen extraction mapping. J Cereb Blood Flow Metab 2024; 44:1184-1198. [PMID: 38289876 PMCID: PMC11179617 DOI: 10.1177/0271678x231220332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 02/01/2024]
Abstract
Quantitative BOLD (qBOLD) MRI allows evaluation of oxidative metabolism of the brain based purely on an endogenous contrast mechanism. The method quantifies deoxygenated blood volume (DBV) and hemoglobin oxygen saturation level of venous blood (Yv), yielding oxygen extraction fraction (OEF), and along with a separate measurement of cerebral blood flow, cerebral metabolic rate of oxygen (CMRO2) maps. Here, we evaluated our recently reported 3D qBOLD method that rectifies a number of deficiencies in prior qBOLD approaches in terms of repeat reproducibility and sensitivity to hypercapnia on the metabolic parameters, and in comparison to dual-gas calibrated BOLD (cBOLD) MRI for determining resting-state oxygen metabolism. Results suggested no significant difference between test-retest qBOLD scans in either DBV and OEF. Exposure to hypercapnia yielded group averages of 38 and 28% for OEF and 151 and 146 µmol/min/100 g for CMRO2 in gray matter at baseline and hypercapnia, respectively. The decrease of OEF during hypercapnia was significant (p ≪ 0.01), whereas CMRO2 did not change significantly (p = 0.25). Finally, baseline OEF (37 vs. 39%) and CMRO2 (153 vs. 145 µmol/min/100 g) in gray matter using qBOLD and dual-gas cBOLD were found to be in good agreement with literature values, and were not significantly different from each other (p > 0.1).
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Affiliation(s)
- Hyunyeol Lee
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu, Republic of Korea
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Xu
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria A Fernandez-Seara
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiology, Clinica Universidad de Navarra, Pamplona, Spain
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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3
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Biondetti E, Cho J, Lee H. Cerebral oxygen metabolism from MRI susceptibility. Neuroimage 2023; 276:120189. [PMID: 37230206 PMCID: PMC10335841 DOI: 10.1016/j.neuroimage.2023.120189] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/26/2023] [Accepted: 05/23/2023] [Indexed: 05/27/2023] Open
Abstract
This article provides an overview of MRI methods exploiting magnetic susceptibility properties of blood to assess cerebral oxygen metabolism, including the tissue oxygen extraction fraction (OEF) and the cerebral metabolic rate of oxygen (CMRO2). The first section is devoted to describing blood magnetic susceptibility and its effect on the MRI signal. Blood circulating in the vasculature can have diamagnetic (oxyhemoglobin) or paramagnetic properties (deoxyhemoglobin). The overall balance between oxygenated and deoxygenated hemoglobin determines the induced magnetic field which, in turn, modulates the transverse relaxation decay of the MRI signal via additional phase accumulation. The following sections of this review then illustrate the principles underpinning susceptibility-based techniques for quantifying OEF and CMRO2. Here, it is detailed whether these techniques provide global (OxFlow) or local (Quantitative Susceptibility Mapping - QSM, calibrated BOLD - cBOLD, quantitative BOLD - qBOLD, QSM+qBOLD) measurements of OEF or CMRO2, and what signal components (magnitude or phase) and tissue pools they consider (intravascular or extravascular). Validations studies and potential limitations of each method are also described. The latter include (but are not limited to) challenges in the experimental setup, the accuracy of signal modeling, and assumptions on the measured signal. The last section outlines the clinical uses of these techniques in healthy aging and neurodegenerative diseases and contextualizes these reports relative to results from gold-standard PET.
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Affiliation(s)
- Emma Biondetti
- Department of Neuroscience, Imaging and Clinical Sciences, "D'Annunzio University" of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies, "D'Annunzio University" of Chieti-Pescara, Chieti, Italy
| | - Junghun Cho
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, New York, USA
| | - Hyunyeol Lee
- School of Electronic and Electrical Engineering, Kyungpook National University, Daegu, Republic of Korea; Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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4
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Gouel P, Decazes P, Vera P, Gardin I, Thureau S, Bohn P. Advances in PET and MRI imaging of tumor hypoxia. Front Med (Lausanne) 2023; 10:1055062. [PMID: 36844199 PMCID: PMC9947663 DOI: 10.3389/fmed.2023.1055062] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Tumor hypoxia is a complex and evolving phenomenon both in time and space. Molecular imaging allows to approach these variations, but the tracers used have their own limitations. PET imaging has the disadvantage of low resolution and must take into account molecular biodistribution, but has the advantage of high targeting accuracy. The relationship between the signal in MRI imaging and oxygen is complex but hopefully it would lead to the detection of truly oxygen-depleted tissue. Different ways of imaging hypoxia are discussed in this review, with nuclear medicine tracers such as [18F]-FMISO, [18F]-FAZA, or [64Cu]-ATSM but also with MRI techniques such as perfusion imaging, diffusion MRI or oxygen-enhanced MRI. Hypoxia is a pejorative factor regarding aggressiveness, tumor dissemination and resistance to treatments. Therefore, having accurate tools is particularly important.
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Affiliation(s)
- Pierrick Gouel
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Decazes
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Pierre Vera
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Isabelle Gardin
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France
| | - Sébastien Thureau
- QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,Département de Radiothérapie, Centre Henri Becquerel, Rouen, France
| | - Pierre Bohn
- Département d’Imagerie, Centre Henri Becquerel, Rouen, France,QuantIF-LITIS, EA 4108, IRIB, Université de Rouen, Rouen, France,*Correspondence: Pierre Bohn,
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5
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Li H, Wang C, Yu X, Luo Y, Wang H. Measurement of Cerebral Oxygen Extraction Fraction Using Quantitative BOLD Approach: A Review. PHENOMICS (CHAM, SWITZERLAND) 2023; 3:101-118. [PMID: 36939794 PMCID: PMC9883382 DOI: 10.1007/s43657-022-00081-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/29/2022] [Accepted: 10/11/2022] [Indexed: 12/12/2022]
Abstract
Quantification of brain oxygenation and metabolism, both of which are indicators of the level of brain activity, plays a vital role in understanding the cerebral perfusion and the pathophysiology of brain disorders. Magnetic resonance imaging (MRI), a widely used clinical imaging technique, which is very sensitive to magnetic susceptibility, has the possibility of substituting positron emission tomography (PET) in measuring oxygen metabolism. This review mainly focuses on the quantitative blood oxygenation level-dependent (qBOLD) method for the evaluation of oxygen extraction fraction (OEF) in the brain. Here, we review the theoretic basis of qBOLD, as well as existing acquisition and quantification methods. Some published clinical studies are also presented, and the pros and cons of qBOLD method are discussed as well.
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Affiliation(s)
- Hongwei Li
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
| | - Chengyan Wang
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
| | - Xuchen Yu
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
| | - Yu Luo
- Department of Radiology, Shanghai Fourth People’s Hospital Affiliated to Tongji University School of Medicine, Shanghai, 200434 China
| | - He Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, 220 Handan Road, Yangpu District, Shanghai, 200433 China
- Human Phenome Institute, Fudan University, Shanghai, 201203 China
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, (Fudan University), Ministry of Education, Shanghai, 200433 China
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6
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Chen JJ, Uthayakumar B, Hyder F. Mapping oxidative metabolism in the human brain with calibrated fMRI in health and disease. J Cereb Blood Flow Metab 2022; 42:1139-1162. [PMID: 35296177 PMCID: PMC9207484 DOI: 10.1177/0271678x221077338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Conventional functional MRI (fMRI) with blood-oxygenation level dependent (BOLD) contrast is an important tool for mapping human brain activity non-invasively. Recent interest in quantitative fMRI has renewed the importance of oxidative neuroenergetics as reflected by cerebral metabolic rate of oxygen consumption (CMRO2) to support brain function. Dynamic CMRO2 mapping by calibrated fMRI require multi-modal measurements of BOLD signal along with cerebral blood flow (CBF) and/or volume (CBV). In human subjects this "calibration" is typically performed using a gas mixture containing small amounts of carbon dioxide and/or oxygen-enriched medical air, which are thought to produce changes in CBF (and CBV) and BOLD signal with minimal or no CMRO2 changes. However non-human studies have demonstrated that the "calibration" can also be achieved without gases, revealing good agreement between CMRO2 changes and underlying neuronal activity (e.g., multi-unit activity and local field potential). Given the simpler set-up of gas-free calibrated fMRI, there is evidence of recent clinical applications for this less intrusive direction. This up-to-date review emphasizes technological advances for such translational gas-free calibrated fMRI experiments, also covering historical progression of the calibrated fMRI field that is impacting neurological and neurodegenerative investigations of the human brain.
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Affiliation(s)
- J Jean Chen
- Medical Biophysics, University of Toronto, Toronto, Canada.,Rotman Research Institute, Baycrest, Toronto, Canada
| | - Biranavan Uthayakumar
- Medical Biophysics, University of Toronto, Toronto, Canada.,Sunnybrook Research Institute, Toronto, Canada
| | - Fahmeed Hyder
- Magnetic Resonance Research Center (MRRC), Yale University, New Haven, Connecticut, USA.,Department of Radiology, Yale University, New Haven, Connecticut, USA.,Quantitative Neuroscience with Magnetic Resonance (QNMR) Research Program, Yale University, New Haven, Connecticut, USA.,Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
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7
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Stadlbauer A, Marhold F, Oberndorfer S, Heinz G, Buchfelder M, Kinfe TM, Meyer-Bäse A. Radiophysiomics: Brain Tumors Classification by Machine Learning and Physiological MRI Data. Cancers (Basel) 2022; 14:cancers14102363. [PMID: 35625967 PMCID: PMC9139355 DOI: 10.3390/cancers14102363] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 01/06/2023] Open
Abstract
Simple Summary The pretreatment diagnosis of contrast-enhancing brain tumors is still challenging in clinical neuro-oncology due to their very similar appearance on conventional MRI. A precise initial characterization, however, is essential to initiate appropriate treatment management, which can substantially differ between brain tumor entities. To overcome the disadvantage of the low specificity of conventional MRI, several new neuroimaging methods have been developed and validated over the past decades. This increasing amount of diagnostic information makes a timely evaluation without computational support impossible in a clinical setting. Artificial intelligence methods such as machine learning offer new options to support clinicians. In this study, we combined nine common machine learning algorithms with a physiological MRI technique (we named this approach “radiophysiomics”) to investigate the effectiveness of the multiclass classification of contrast-enhancing brain tumors in a clinical setting. We were able to demonstrate that radiophysiomics could be helpful in the routine diagnostics of contrast-enhancing brain tumors, but further automation using deep neural networks is required. Abstract The precise initial characterization of contrast-enhancing brain tumors has significant consequences for clinical outcomes. Various novel neuroimaging methods have been developed to increase the specificity of conventional magnetic resonance imaging (cMRI) but also the increased complexity of data analysis. Artificial intelligence offers new options to manage this challenge in clinical settings. Here, we investigated whether multiclass machine learning (ML) algorithms applied to a high-dimensional panel of radiomic features from advanced MRI (advMRI) and physiological MRI (phyMRI; thus, radiophysiomics) could reliably classify contrast-enhancing brain tumors. The recently developed phyMRI technique enables the quantitative assessment of microvascular architecture, neovascularization, oxygen metabolism, and tissue hypoxia. A training cohort of 167 patients suffering from one of the five most common brain tumor entities (glioblastoma, anaplastic glioma, meningioma, primary CNS lymphoma, or brain metastasis), combined with nine common ML algorithms, was used to develop overall 135 classifiers. Multiclass classification performance was investigated using tenfold cross-validation and an independent test cohort. Adaptive boosting and random forest in combination with advMRI and phyMRI data were superior to human reading in accuracy (0.875 vs. 0.850), precision (0.862 vs. 0.798), F-score (0.774 vs. 0.740), AUROC (0.886 vs. 0.813), and classification error (5 vs. 6). The radiologists, however, showed a higher sensitivity (0.767 vs. 0.750) and specificity (0.925 vs. 0.902). We demonstrated that ML-based radiophysiomics could be helpful in the clinical routine diagnosis of contrast-enhancing brain tumors; however, a high expenditure of time and work for data preprocessing requires the inclusion of deep neural networks.
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Affiliation(s)
- Andreas Stadlbauer
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, A-3100 St. Pölten, Austria;
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, D-91054 Erlangen, Germany; (M.B.); (T.M.K.)
- Correspondence:
| | - Franz Marhold
- Department of Neurosurgery, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, A-3100 St. Pölten, Austria;
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, A-3100 St. Pölten, Austria;
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, A-3100 St. Pölten, Austria;
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, D-91054 Erlangen, Germany; (M.B.); (T.M.K.)
| | - Thomas M. Kinfe
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, D-91054 Erlangen, Germany; (M.B.); (T.M.K.)
- Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, D-91054 Erlangen, Germany
| | - Anke Meyer-Bäse
- Department of Scientific Computing, Florida State University, 400 Dirac Science Library, Tallahassee, FL 32306-4120, USA;
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8
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Jiang D, Lu H. Cerebral oxygen extraction fraction MRI: Techniques and applications. Magn Reson Med 2022; 88:575-600. [PMID: 35510696 PMCID: PMC9233013 DOI: 10.1002/mrm.29272] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/20/2022] [Accepted: 03/29/2022] [Indexed: 12/20/2022]
Abstract
The human brain constitutes 2% of the body's total mass but uses 20% of the oxygen. The rate of the brain's oxygen utilization can be derived from a knowledge of cerebral blood flow and the oxygen extraction fraction (OEF). Therefore, OEF is a key physiological parameter of the brain's function and metabolism. OEF has been suggested to be a useful biomarker in a number of brain diseases. With recent advances in MRI techniques, several MRI-based methods have been developed to measure OEF in the human brain. These MRI OEF techniques are based on the T2 of blood, the blood signal phase, the magnetic susceptibility of blood-containing voxels, the effect of deoxyhemoglobin on signal behavior in extravascular tissue, and the calibration of the BOLD signal using gas inhalation. Compared to 15 O PET, which is considered the "gold standard" for OEF measurement, MRI-based techniques are non-invasive, radiation-free, and are more widely available. This article provides a review of these emerging MRI-based OEF techniques. We first briefly introduce the role of OEF in brain oxygen homeostasis. We then review the methodological aspects of different categories of MRI OEF techniques, including their signal mechanisms, acquisition methods, and data analyses. The strengths and limitations of the techniques are discussed. Finally, we review key applications of these techniques in physiological and pathological conditions.
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Affiliation(s)
- Dengrong Jiang
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, Maryland, USA
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9
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Stadlbauer A, Kinfe TM, Zimmermann M, Eyüpoglu I, Brandner N, Buchfelder M, Zaiss M, Dörfler A, Brandner S. Association between tissue hypoxia, perfusion restrictions, and microvascular architecture alterations with lesion-induced impairment of neurovascular coupling. J Cereb Blood Flow Metab 2022; 42:526-539. [PMID: 32787542 PMCID: PMC8985434 DOI: 10.1177/0271678x20947546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Functional magnetic resonance imaging (fMRI) has been mainly utilized for the preoperative localization of eloquent cortical areas. However, lesion-induced impairment of neurovascular coupling (NVC) in the lesion border zone may lead to false-negative fMRI results. The purpose of this study was to determine physiological factors impacting the NVC. Twenty patients suffering from brain lesions were preoperatively examined using multimodal neuroimaging including fMRI, magnetoencephalography (MEG) during language or sensorimotor tasks (depending on lesion location), and a novel physiologic MRI approach for the combined quantification of oxygen metabolism, perfusion state, and microvascular architecture. Congruence of brain activity patterns between fMRI and MEG were found in 13 patients. In contrast, we observed missing fMRI activity in perilesional cortex that demonstrated MEG activity in seven patients, which was interpreted as lesion-induced impairment of NVC. In these brain regions with impaired NVC, physiologic MRI revealed significant brain tissue hypoxia, as well as significantly decreased macro- and microvascular perfusion and microvascular architecture. We demonstrated that perilesional hypoxia with reduced vascular perfusion and architecture is associated with lesion-induced impairment of NVC. Our physiologic MRI approach is a clinically applicable method for preoperative risk assessment for the presence of false-negative fMRI results and may prevent severe postoperative functional deficits.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany.,Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Thomas M Kinfe
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany.,Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
| | - Max Zimmermann
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany.,Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Ilker Eyüpoglu
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
| | - Nadja Brandner
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
| | - Moritz Zaiss
- Department of Neuroradiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Sebastian Brandner
- Department of Neurosurgery, Friedrich-Alexander University (FAU) of Erlangen-Nürnberg, Erlangen, Germany
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10
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Kufer J, Preibisch C, Epp S, Göttler J, Schmitzer L, Zimmer C, Hyder F, Kaczmarz S. Imaging effective oxygen diffusivity in the human brain with multiparametric magnetic resonance imaging. J Cereb Blood Flow Metab 2022; 42:349-363. [PMID: 34590895 PMCID: PMC8795223 DOI: 10.1177/0271678x211048412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebrovascular diseases can impair blood circulation and oxygen extraction from the blood. The effective oxygen diffusivity (EOD) of the capillary bed is a potential biomarker of microvascular function that has gained increasing interest, both for clinical diagnosis and for elucidating oxygen transport mechanisms. Models of capillary oxygen transport link EOD to measurable oxygen extraction fraction (OEF) and cerebral blood flow (CBF). In this work, we confirm that two well established mathematical models of oxygen transport yield nearly equivalent EOD maps. Furthermore, we propose an easy-to-implement and clinically applicable multiparametric magnetic resonance imaging (MRI) protocol for quantitative EOD mapping. Our approach is based on imaging OEF and CBF with multiparametric quantitative blood oxygenation level dependent (mq-BOLD) MRI and pseudo-continuous arterial spin labeling (pCASL), respectively. We evaluated the imaging protocol by comparing MRI-EOD maps of 12 young healthy volunteers to PET data from a published study in different individuals. Our results show comparably good correlation between MRI- and PET-derived cortical EOD, OEF and CBF. Importantly, absolute values of MRI and PET showed high accordance for all three parameters. In conclusion, our data indicates feasibility of the proposed MRI protocol for EOD mapping, rendering the method promising for future clinical evaluation of patients with cerebrovascular diseases.
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Affiliation(s)
- Jan Kufer
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany
| | - Christine Preibisch
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,Clinic for Neurology, School of Medicine, Technical University of Munich (TUM), Munich, Germany
| | - Samira Epp
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany
| | - Jens Göttler
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,Department of Radiology & Biomedical Imaging (MRRC), Yale University, New Haven, CT, USA
| | - Lena Schmitzer
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany
| | - Fahmeed Hyder
- Department of Radiology & Biomedical Imaging (MRRC), Yale University, New Haven, CT, USA
| | - Stephan Kaczmarz
- Department of Neuroradiology, School of Medicine, Technical University of Munich (TUM), Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technical University of Munich (TUM), Munich, Germany.,Department of Radiology & Biomedical Imaging (MRRC), Yale University, New Haven, CT, USA.,Philips GmbH Market DACH, Hamburg, Germany
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11
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Stumpo V, Sebök M, van Niftrik CHB, Seystahl K, Hainc N, Kulcsar Z, Weller M, Regli L, Fierstra J. Feasibility of glioblastoma tissue response mapping with physiologic BOLD imaging using precise oxygen and carbon dioxide challenge. MAGMA (NEW YORK, N.Y.) 2022; 35:29-44. [PMID: 34874499 DOI: 10.1007/s10334-021-00980-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Innovative physiologic MRI development focuses on depiction of heterogenous vascular and metabolic features in glioblastoma. For this feasibility study, we employed blood oxygenation level-dependent (BOLD) MRI with standardized and precise carbon dioxide (CO2) and oxygen (O2) modulation to investigate specific tumor tissue response patterns in patients with newly diagnosed glioblastoma. MATERIALS AND METHODS Seven newly diagnosed untreated patients with suspected glioblastoma were prospectively included to undergo a BOLD study with combined CO2 and O2 standardized protocol. %BOLD signal change/mmHg during hypercapnic, hypoxic, and hyperoxic stimulus was calculated in the whole brain, tumor lesion and segmented volumes of interest (VOI) [contrast-enhancing (CE) - tumor, necrosis and edema] to analyze their tissue response patterns. RESULTS Quantification of BOLD signal change after gas challenges can be used to identify specific responses to standardized stimuli in glioblastoma patients. Integration of this approach with automatic VOI segmentation grants improved characterization of tumor subzones and edema. Magnitude of BOLD signal change during the 3 stimuli can be visualized at voxel precision through color-coded maps overlayed onto whole brain and identified VOIs. CONCLUSIONS Our preliminary investigation shows good feasibility of BOLD with standardized and precise CO2 and O2 modulation as an emerging physiologic imaging technique to detail specific glioblastoma characteristics. The unique tissue response patterns generated can be further investigated to better detail glioblastoma lesions and gauge treatment response.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolin Hainc
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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12
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Metabolic Tumor Microenvironment Characterization of Contrast Enhancing Brain Tumors Using Physiologic MRI. Metabolites 2021; 11:metabo11100668. [PMID: 34677383 PMCID: PMC8537028 DOI: 10.3390/metabo11100668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
The tumor microenvironment is a critical regulator of cancer development and progression as well as treatment response and resistance in brain neoplasms. The available techniques for investigation, however, are not well suited for noninvasive in vivo characterization in humans. A total of 120 patients (59 females; 61 males) with newly diagnosed contrast-enhancing brain tumors (64 glioblastoma, 20 brain metastases, 15 primary central nervous system (CNS) lymphomas (PCNSLs), and 21 meningiomas) were examined with a previously established physiological MRI protocol including quantitative blood-oxygen-level-dependent imaging and vascular architecture mapping. Six MRI biomarker maps for oxygen metabolism and neovascularization were fused for classification of five different tumor microenvironments: glycolysis, oxidative phosphorylation (OxPhos), hypoxia with/without neovascularization, and necrosis. Glioblastoma showed the highest metabolic heterogeneity followed by brain metastasis with a glycolysis-to-OxPhos ratio of approximately 2:1 in both tumor entities. In addition, glioblastoma revealed a significant higher percentage of hypoxia (24%) compared to all three other brain tumor entities: brain metastasis (7%; p < 0.001), PCNSL (8%; p = 0.001), and meningioma (8%; p = 0.003). A more aggressive biological brain tumor behavior was associated with a higher percentage of hypoxia and necrosis and a lower percentage of remaining vital tumor tissue and aerobic glycolysis. The proportion of oxidative phosphorylation, however, was rather similar (17–26%) for all four brain tumor entities. Tumor microenvironment (TME) mapping provides insights into neurobiological differences of contrast-enhancing brain tumors and deserves further clinical cancer research attention. Although there is a long roadmap ahead, TME mapping may become useful in order to develop new diagnostic and therapeutic approaches.
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13
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Stadlbauer A, Heinz G, Oberndorfer S, Zimmermann M, Kinfe TM, Buchfelder M, Dörfler A, Kremenevski N, Marhold F. Physiological MRI of microvascular architecture, neovascularization activity, and oxygen metabolism facilitate early recurrence detection in patients with IDH-mutant WHO grade 3 glioma. Neuroradiology 2021; 64:265-277. [PMID: 34115146 PMCID: PMC8789727 DOI: 10.1007/s00234-021-02740-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to determine the diagnostic performance of physiological MRI biomarkers including microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension for recurrence detection of IDH-mutant WHO grade 3 glioma. METHODS Sixty patients with IDH-mutant WHO grade 3 glioma who received overall 288 follow-up MRI examinations at 3 Tesla after standard treatment were retrospectively evaluated. A conventional MRI protocol was extended with a physiological MRI approach including vascular architecture mapping and quantitative blood-oxygen-level-dependent imaging which required 7 min extra data acquisition time. Custom-made MATLAB software was used for the calculation of MRI biomarker maps of microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension. Statistical procedures included receiver operating characteristic analysis. RESULTS Overall, 34 patients showed recurrence of the WHO grade 3 glioma; of these, in 15 patients, recurrence was detected one follow-up examination (averaged 160 days) earlier by physiological MRI data than by conventional MRI. During this time period, the tumor volume increased significantly (P = 0.001) on average 7.4-fold from 1.5 to 11.1 cm3. Quantitative analysis of MRI biomarkers demonstrated microvascular but no macrovascular hyperperfusion in early recurrence. Neovascularization activity (AUC = 0.833), microvascular perfusion (0.682), and oxygen metabolism (0.661) showed higher diagnostic performance for early recurrence detection of WHO grade 3 glioma compared to conventional MRI including cerebral blood volume (0.649). CONCLUSION This study demonstrated that the targeted assessment of microvascular features and tissue oxygen tension as an early sign of neovascularization activity provided valuable information for recurrence diagnostic of WHO grade 3 glioma.
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Affiliation(s)
- Andreas Stadlbauer
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, Dunant Platz 1, A-3100, St. Pölten, Austria.
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, Dunant Platz 1, A-3100, St. Pölten, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Max Zimmermann
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Thomas M Kinfe
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Natalia Kremenevski
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Franz Marhold
- Department of Neurosurgery, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
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14
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Cho J, Spincemaille P, Nguyen TD, Gupta A, Wang Y. Temporal clustering, tissue composition, and total variation for mapping oxygen extraction fraction using QSM and quantitative BOLD. Magn Reson Med 2021; 86:2635-2646. [PMID: 34110656 DOI: 10.1002/mrm.28875] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/02/2021] [Accepted: 05/10/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To improve the accuracy of quantitative susceptibility mapping plus quantitative blood oxygen level-dependent magnitude (QSM+qBOLD or QQ) based mapping of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2 ) using temporal clustering, tissue composition, and total variation (CCTV). METHODS Three-dimensional multi-echo gradient echo and arterial spin labeling images were acquired from 11 healthy subjects and 33 ischemic stroke patients. Diffusion-weighted imaging (DWI) was also obtained from patients. The CCTV mapping was developed for incorporating tissue-type information into clustering of the previous cluster analysis of time evolution (CAT) and applying total variation (TV). The QQ-based OEF and CMRO2 were reconstructed with CAT, CAT+TV (CATV), and the proposed CCTV, and results were compared using region-of-interest analysis, Kruskal-Wallis test, and post hoc Wilcoxson rank sum test. RESULTS In simulation, CCTV provided more accurate and precise OEF than CAT or CATV. In healthy subjects, QQ-based OEF was less noisy and more uniform with CCTV than CAT. In subacute stroke patients, OEF with CCTV had a greater contrast-to-noise ratio between DWI-defined lesions and the unaffected contralateral side than with CAT or CATV: 1.9 ± 1.3 versus 1.1 ± 0.7 (P = .01) versus 0.7 ± 0.5 (P < .001). CONCLUSION The CCTV mapping significantly improves the robustness of QQ-based OEF against noise.
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Affiliation(s)
- Junghun Cho
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Thanh D Nguyen
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, New York, USA.,Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
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15
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Hypoxia and Microvascular Alterations Are Early Predictors of IDH-Mutated Anaplastic Glioma Recurrence. Cancers (Basel) 2021; 13:cancers13081797. [PMID: 33918764 PMCID: PMC8068871 DOI: 10.3390/cancers13081797] [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: 02/19/2021] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Anaplastic gliomas (AGs) are considered the most common and aggressive primary brain tumors of young adults with inevitable recurrence and treatment failure. The aim of this study was to investigate whether the imaging biomarkers of hypoxia, microvascular architecture and neovascularization activity can be of assistance to detect pathophysiological changes in the early developmental stages of isocitrate-dehydrogenase (IDH) mutated AG recurrence. We evaluated 142 physiological magnetic resonance imaging follow-up examinations as a part of the conventional magnetic resonance imaging (MRI) protocol in 60 AG patients after standard therapy. Physiological MRI biomarkers showed intensifying local tissue hypoxia 250 days prior to radiological recurrence with following upregulation of neovascularization activity 50 to 70 days later. Integration of physiological MRI in the monitoring of AG patients may be of clinical significance to make personalized decision of early tumor recurrence without an additional delay for multimodal therapy. Abstract Anaplastic gliomas (AG) represents aggressive brain tumors that often affect young adults. Although isocitrate-dehydrogenase (IDH) gene mutation has been identified as a more favorable prognostic factor, most IDH-mutated AG patients are confronted with tumor recurrence. Hence, increased knowledge about pathophysiological precursors of AG recurrence is urgently needed in order to develop precise diagnostic monitoring and tailored therapeutic approaches. In this study, 142 physiological magnetic resonance imaging (phyMRI) follow-up examinations in 60 AG patients after standard therapy were evaluated and magnetic resonance imaging (MRI) biomarker maps for microvascular architecture and perfusion, neovascularization activity, oxygen metabolism, and hypoxia calculated. From these 60 patients, 34 patients developed recurrence of the AG, and 26 patients showed no signs for AG recurrence during the study period. The time courses of MRI biomarker changes were analyzed regarding early pathophysiological alterations over a one-year period before radiological AG recurrence or a one-year period of stable disease for patients without recurrence, respectively. We detected intensifying local tissue hypoxia 250 days prior to radiological recurrence which initiated upregulation of neovascularization activity 50 to 70 days later. These changes were associated with a switch from an avascular infiltrative to a vascularized proliferative phenotype of the tumor cells another 30 days later. The dynamic changes of blood perfusion, microvessel density, neovascularization activity, and oxygen metabolism showed a close physiological interplay in the one-year period prior to radiological recurrence of IDH-mutated AG. These findings may path the wave for implementing both new MR-based imaging modalities for routine follow-up monitoring of AG patients after standard therapy and furthermore may support the development of novel, tailored therapy options in recurrent AG.
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16
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Castellano A, Bailo M, Cicone F, Carideo L, Quartuccio N, Mortini P, Falini A, Cascini GL, Minniti G. Advanced Imaging Techniques for Radiotherapy Planning of Gliomas. Cancers (Basel) 2021; 13:cancers13051063. [PMID: 33802292 PMCID: PMC7959155 DOI: 10.3390/cancers13051063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0-961-369-4155
| | - Luciano Carideo
- National Cancer Institute, G. Pascale Foundation, 80131 Naples, Italy;
| | - Natale Quartuccio
- A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90144 Palermo, Italy;
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Andrea Falini
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Giuseppe Lucio Cascini
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
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17
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Lee H, Wehrli FW. Alternating unbalanced SSFP for 3D R 2 ' mapping of the human brain. Magn Reson Med 2020; 85:2391-2402. [PMID: 33331076 DOI: 10.1002/mrm.28637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/10/2022]
Abstract
PURPOSE Measuring the transverse-relaxation rate R 2 ' provides valuable information in quantitative evaluation of tissue microstructure, for example, in terms of oxygenation levels. Here, we propose an alternating unbalanced SSFP pulse sequence for rapid whole-brain 3D R 2 ' mapping. METHODS Unlike currently practiced, spin echo-based R 2 ' measurement techniques, the proposed method alternates between SSFP-FID and SSFP-ECHO modes for rapid 3D encoding of transverse relaxation rates expressed as R2 + R 2 ' and R2 - R 2 ' . Z-shimming gradients embedded into multi-echo trains of each SSFP module are designed to achieve relative immunity to large-scale magnetic-field variations (ΔB0 ). Appropriate models for the temporal evolution of the two groups of SSFP signals were constructed with ΔB0 -induced modulations accounted for, leading to ΔB0 -corrected estimation of R2 , R 2 ' , and R 2 ∗ (= R2 + R 2 ' ). Additionally, relative magnetic susceptibility (Δχ) maps were obtained by quantitative susceptibility mapping of the phase data. Numerical simulations were performed to optimize scan parameters, followed by in vivo studies at 3 T in 7 healthy subjects. Measured parameters were evaluated in six brain regions, and subjected to interparameter correlation analysis. RESULTS The resultant maps of R 2 ' and additionally derived R2 , R 2 ∗ , and Δχ all demonstrated the expected contrast across brain territories (eg, deep brain structures versus cortex), with the measured values in good agreement with previous reports. Furthermore, regression analyses yielded strong linear relationships for the transverse relaxation parameters ( R 2 ' , R2 , and R 2 ∗ ) against Δχ. CONCLUSION Results suggest feasibility of the proposed method as a practical and reliable means for measuring R 2 ' , R2 , R 2 ∗ , and Δχ across the entire brain.
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Affiliation(s)
- Hyunyeol Lee
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Felix W Wehrli
- Laboratory for Structural, Physiologic, and Functional Imaging, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Stadlbauer A, Kinfe TM, Eyüpoglu I, Zimmermann M, Kitzwögerer M, Podar K, Buchfelder M, Heinz G, Oberndorfer S, Marhold F. Tissue Hypoxia and Alterations in Microvascular Architecture Predict Glioblastoma Recurrence in Humans. Clin Cancer Res 2020; 27:1641-1649. [PMID: 33293375 DOI: 10.1158/1078-0432.ccr-20-3580] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 12/04/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Insufficient control of infiltrative glioblastoma (GBM) cells is a major cause of treatment failure and tumor recurrence. Hence, detailed insights into pathophysiologic changes that precede GBM recurrence are needed to develop more precise neuroimaging modalities for tailored diagnostic monitoring and therapeutic approaches. EXPERIMENTAL DESIGN Overall, 168 physiologic MRI follow-up examinations of 56 patients with GBM who developed recurrence after standard therapy were retrospectively evaluated, that is, two post-standard-therapeutic follow-ups before and one at radiological recurrence. MRI biomarkers for microvascular architecture and perfusion, neovascularization activity, oxygen metabolism, and hypoxia were determined for brain areas that developed in the further course into recurrence and for the recurrent GBM itself. The temporal pattern of biomarker changes was fitted with locally estimated scatterplot smoothing functions and analyzed for pathophysiologic changes preceding radiological GBM recurrence. RESULTS Our MRI approach demonstrated early pathophysiologic changes prior to radiological GBM recurrence in all patients. Analysis of the time courses revealed a model for the pathophysiology of GBM recurrence: 190 days prior to radiological recurrence, vascular cooption by GBM cells induced vessel regression, detected as decreasing vessel density/perfusion and increasing hypoxia. Seventy days later, neovascularization activity was upregulated, which reincreased vessel density and perfusion. Hypoxia, however, continued to intensify for 30 days and peaked 90 days before radiological recurrence. CONCLUSIONS Hypoxia may represent an early sign for GBM recurrence. This might become useful in the development of new combined diagnostic-therapeutic approaches for tailored clinical management of recurrent GBM. Further preclinical and in-human studies are required for validation and evaluation.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany.
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Thomas M Kinfe
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Division of Functional Neurosurgery and Stereotaxy, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Ilker Eyüpoglu
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Max Zimmermann
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
- Department of Preclinical Imaging and Radiopharmacy, University of Tübingen, Tübingen, Germany
| | - Melitta Kitzwögerer
- Department of Pathology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Klaus Podar
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Franz Marhold
- Department of Neurosurgery, University Clinic of St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
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19
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Oughourlian TC, Yao J, Hagiwara A, Nathanson DA, Raymond C, Pope WB, Salamon N, Lai A, Ji M, Nghiemphu PL, Liau LM, Cloughesy TF, Ellingson BM. Relative oxygen extraction fraction (rOEF) MR imaging reveals higher hypoxia in human epidermal growth factor receptor (EGFR) amplified compared with non-amplified gliomas. Neuroradiology 2020; 63:857-868. [PMID: 33106922 DOI: 10.1007/s00234-020-02585-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Epidermal growth factor receptor (EGFR) amplification promotes gliomagenesis and is linked to lack of oxygen within the tumor microenvironment. Using hypoxia-sensitive spin-and-gradient echo echo-planar imaging and perfusion MRI, we investigated the influence of EGFR amplification on tissue oxygen availability and utilization in human gliomas. METHODS This study included 72 histologically confirmed EGFR-amplified and non-amplified glioma patients. Reversible transverse relaxation rate (R2'), relative cerebral blood volume (rCBV), and relative oxygen extraction fraction (rOEF) were calculated for the contrast-enhancing and non-enhancing tumor regions. Using Student t test or Wilcoxon rank-sum test, median R2', rCBV, and rOEF were compared between EGFR-amplified and non-amplified gliomas. ROC analysis was performed to assess the ability of imaging characteristics to discriminate EGFR amplification status. Overall survival (OS) was determined using univariate and multivariate cox models. Kaplan-Meier survival curves were plotted and compared using the log-rank test. RESULTS EGFR amplified gliomas exhibited significantly higher median R2' and rOEF than non-amplified gliomas. ROC analysis suggested that R2' (AUC = 0.7190; P = 0.0048) and rOEF (AUC = 0.6959; P = 0.0156) could separate EGFR status. Patients with EGFR-amplified gliomas had a significantly shorter OS than non-amplified patients. Univariate cox regression analysis determined both R2' and rOEF significantly influence OS. No significant difference was observed in rCBV between patient cohorts nor was rCBV found to be an effective differentiator of EGFR status. CONCLUSION Imaging of tumor oxygen characteristics revealed EGFR-amplified gliomas to be more hypoxic and contribute to shorter patient survival than EGFR non-amplified gliomas.
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Affiliation(s)
- Talia C Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Neuroscience Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jingwen Yao
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, Henry Samueli School of Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA
| | - David A Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Matthew Ji
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.
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20
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Kaczmarz S, Hyder F, Preibisch C. Oxygen extraction fraction mapping with multi-parametric quantitative BOLD MRI: Reduced transverse relaxation bias using 3D-GraSE imaging. Neuroimage 2020; 220:117095. [PMID: 32599265 PMCID: PMC7730517 DOI: 10.1016/j.neuroimage.2020.117095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023] Open
Abstract
Magnetic resonance imaging (MRI)-based quantification of the blood-oxygenation-level-dependent (BOLD) effect allows oxygen extraction fraction (OEF) mapping. The multi-parametric quantitative BOLD (mq-BOLD) technique facilitates relative OEF (rOEF) measurements with whole brain coverage in clinically applicable scan times. Mq-BOLD requires three separate scans of cerebral blood volume and transverse relaxation rates measured by gradient-echo (1/T2*) and spin-echo (1/T2). Although the current method is of clinical merit in patients with stroke, glioma and internal carotid artery stenosis (ICAS), there are relaxation measurement artefacts that impede the sensitivity of mq-BOLD and artificially elevate reported rOEF values. We posited that T2-related biases caused by slice refocusing imperfections during rapid 2D-GraSE (Gradient and Spin Echo) imaging can be reduced by applying 3D-GraSE imaging sequences, because the latter requires no slice selective pulses. The removal of T2-related biases would decrease overestimated rOEF values measured by mq-BOLD. We characterized effects of T2-related bias in mq-BOLD by comparing the initially employed 2D-GraSE and two proposed 3D-GraSE sequences to multiple single spin-echo reference measurements, both in vitro and in vivo. A phantom and 25 participants, including young and elderly healthy controls as well as ICAS-patients, were scanned. We additionally proposed a procedure to reliably identify and exclude artefact affected voxels. In the phantom, 3D-GraSE derived T2 values had 57% lower deviation from the reference. For in vivo scans, the formerly overestimated rOEF was reduced by −27% (p < 0.001). We obtained rOEF = 0.51, which is much closer to literature values from positron emission tomography (PET) measurements. Furthermore, increased sensitivity to a focal rOEF elevation in an ICAS-patient was demonstrated. In summary, the application of 3D-GraSE improves the mq-BOLD-based rOEF quantification while maintaining clinically feasible scan times. Thus, mq-BOLD with non-slice selective T2 imaging is highly promising to improve clinical diagnostics of cerebrovascular diseases such as ICAS.
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Affiliation(s)
- Stephan Kaczmarz
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Munich, Germany; Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, 06520, USA; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Munich, Germany.
| | - Fahmeed Hyder
- Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, 06520, USA
| | - Christine Preibisch
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Diagnostic and Interventional Neuroradiology, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, TUM Neuroimaging Center, Munich, Germany; Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Clinic for Neurology, Munich, Germany
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21
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Andelius TCK, Pedersen MV, Andersen HB, Andersen M, Hjortdal VE, Pedersen M, Ringgaard S, Hansen LH, Henriksen TB, Kyng KJ. No Added Neuroprotective Effect of Remote Ischemic Postconditioning and Therapeutic Hypothermia After Mild Hypoxia-Ischemia in a Piglet Model. Front Pediatr 2020; 8:299. [PMID: 32676486 PMCID: PMC7333529 DOI: 10.3389/fped.2020.00299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/11/2020] [Indexed: 01/26/2023] Open
Abstract
Introduction: Hypoxic ischemic encephalopathy (HIE) is a major cause of death and disability in children worldwide. Apart from supportive care, the only established treatment for HIE is therapeutic hypothermia (TH). As TH is only partly neuroprotective, there is a need for additional therapies. Intermittent periods of limb ischemia, called remote ischemic postconditioning (RIPC), have been shown to be neuroprotective after HIE in rats and piglets. However, it is unknown whether RIPC adds to the effect of TH. We tested the neuroprotective effect of RIPC with TH compared to TH alone using magnetic resonance imaging and spectroscopy (MRI/MRS) in a piglet HIE model. Methods: Thirty-two male and female piglets were subjected to 45-min global hypoxia-ischemia (HI). Twenty-six animals were randomized to TH or RIPC plus TH; six animals received supportive care only. TH was induced through whole-body cooling. RIPC was induced 1 h after HI by four cycles of 5 min of ischemia and 5 min of reperfusion in both hind limbs. Primary outcome was Lac/NAA ratio at 24 h measured by MRS. Secondary outcomes were NAA/Cr, diffusion-weighted imaging (DWI), arterial spin labeling, aEGG score, and blood oxygen dependent (BOLD) signal measured by MRI/MRS at 6, 12, and 24 h after the hypoxic-ischemic insult. Results: All groups were subjected to a comparable but mild insult. No difference was found between the two intervention groups in Lac/NAA ratio, NAA/Cr ratio, DWI, arterial spin labeling, or BOLD signal. NAA/Cr ratio at 24 h was higher in the two intervention groups compared to supportive care only. There was no difference in aEEG score between the three groups. Conclusion: Treatment with RIPC resulted in no additional neuroprotection when combined with TH. However, insult severity was mild and only evaluated at 24 h after HI with a short MRS echo time. In future studies more subtle neurological effects may be detected with increased MRS echo time and post mortem investigations, such as brain histology. Thus, the possible neuroprotective effect of RIPC needs further evaluation.
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Affiliation(s)
| | - Mette V. Pedersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Mads Andersen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Vibeke E. Hjortdal
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lærke H. Hansen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine B. Henriksen
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper J. Kyng
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
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22
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Stadlbauer A, Zimmermann M, Bennani-Baiti B, Helbich TH, Baltzer P, Clauser P, Kapetas P, Bago-Horvath Z, Pinker K. Development of a Non-invasive Assessment of Hypoxia and Neovascularization with Magnetic Resonance Imaging in Benign and Malignant Breast Tumors: Initial Results. Mol Imaging Biol 2020; 21:758-770. [PMID: 30478507 DOI: 10.1007/s11307-018-1298-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To develop a novel magnetic resonance imaging (MRI) approach for the noninvasive assessment of hypoxia and neovascularization in breast tumors. PROCEDURES In this IRB-approved prospective study, 20 patients with suspicious breast lesions (BI-RADS 4/5) underwent multiparametric breast MRI including quantitative BOLD (qBOLD) and vascular architecture mapping (VAM). Custom-made in-house MatLab software was used for qBOLD and VAM data postprocessing and calculation of quantitative MRI biomarker maps of oxygen extraction fraction (OEF), metabolic rate of oxygen (MRO2), and mitochondrial oxygen tension (mitoPO2) to measure tissue hypoxia and neovascularization including vascular architecture including microvessel radius (VSI), density (MVD), and type (MTI). Histopathology was used as standard of reference. Appropriate statistics were performed to assess and compare correlations between MRI biomarkers for hypoxia and neovascularization. RESULTS qBOLD and VAM data with good quality were obtained from all patients with 13 invasive ductal carcinoma (IDC) and 7 benign breast tumors with a lesion diameter of at least 10 mm in all spatial directions. MRI biomarker maps of oxygen metabolism and neovascularization demonstrated intratumoral spatial heterogeneity with a broad range of biomarker values. Bulk tumor neovasculature consisted of draining venous microvasculature with slow flowing blood. High OEF and low mitoPO2 were associated with low MVD and vice versa. The heterogeneous pattern of MRO2 values showed spatial congruence with VSI. IDCs showed significantly higher MRO2 (P = 0.007), lower mitoPO2 (P = 0.021), higher MVD (P = 0.005), and lower (i.e., more pathologic) MTI (P = 0.001) compared with benign breast tumors. These results indicate that IDCs consume more oxygen and are more hypoxic and neovascularized than benign tumors. CONCLUSIONS We developed a novel MRI approach for the noninvasive assessment of hypoxia and neovascularization in benign and malignant breast tumors that can be easily integrated in a diagnostic MRI protocol and provides insight into intratumoral heterogeneity.
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Affiliation(s)
- Andreas Stadlbauer
- Institute of Medical Radiology, University Clinic of St. Pölten, Propst-Führer-Straße 4, St. Pölten, 3100, Austria.,Department of Neurosurgery, University of Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany
| | - Max Zimmermann
- Department of Neurosurgery, University of Erlangen-Nürnberg, Schwabachanlage 6, Erlangen, 91054, Germany
| | - Barbara Bennani-Baiti
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Zsuzsanna Bago-Horvath
- Department of Pathology, Medical University of Vienna, Weahringer Guertel 18-20, Vienna, 1090, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, 300 E 66th St, New York, NY, 10065, USA.
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23
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Predicting Glioblastoma Response to Bevacizumab Through MRI Biomarkers of the Tumor Microenvironment. Mol Imaging Biol 2020; 21:747-757. [PMID: 30361791 DOI: 10.1007/s11307-018-1289-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE Glioblastoma (GB) is one of the most vascularized of all solid tumors and, therefore, represents an attractive target for antiangiogenic therapies. Many lesions, however, quickly develop escape mechanisms associated with changes in the tumor microenvironment (TME) resulting in rapid treatment failure. To prevent patients from adverse effects of ineffective therapy, there is a strong need to better predict and monitor antiangiogenic treatment response. PROCEDURES We utilized a novel physiological magnetic resonance imaging (MRI) method combining the visualization of oxygen metabolism and neovascularization for classification of five different TME compartments: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation, and aerobic glycolysis. This approach, termed TME mapping, was used to monitor changes in tumor biology and pathophysiology within the TME in response to bevacizumab treatment in 18 patients with recurrent GB. RESULTS We detected dramatic changes in the TME by rearrangement of its compartments after the onset of bevacizumab treatment. All patients showed a decrease in active tumor volume and neovascularization as well as an increase in hypoxia and necrosis in the first follow-up after 3 months. We found that recurrent GB with a high percentage of neovascularization and active tumor before bevacizumab onset showed a poor or no treatment response. CONCLUSIONS TME mapping might be useful to develop strategies for patient stratification and response prediction before bevacizumab onset.
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24
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Kaczmarz S, Göttler J, Zimmer C, Hyder F, Preibisch C. Characterizing white matter fiber orientation effects on multi-parametric quantitative BOLD assessment of oxygen extraction fraction. J Cereb Blood Flow Metab 2020; 40:760-774. [PMID: 30952200 PMCID: PMC7168796 DOI: 10.1177/0271678x19839502] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/23/2019] [Accepted: 02/22/2019] [Indexed: 12/19/2022]
Abstract
Relative oxygen extraction fraction (rOEF) is a fundamental indicator of cerebral metabolic function. An easily applicable method for magnetic resonance imaging (MRI) based rOEF mapping is the multi-parametric quantitative blood oxygenation level dependent (mq-BOLD) approach with separate acquisitions of transverse relaxation times T 2 * and T2 and dynamic susceptibility contrast (DSC) based relative cerebral blood volume (rCBV). Given that transverse relaxation and rCBV in white matter (WM) strongly depend on nerve fiber orientation, mq-BOLD derived rOEF is expected to be affected as well. To investigate fiber orientation related rOEF artefacts, we present a methodological study characterizing anisotropy effects of WM as measured by diffusion tensor imaging (DTI) on mq-BOLD in 30 healthy volunteers. Using a 3T clinical MRI-scanner, we performed a comprehensive correlation of all parameters ( T 2 * , T2, R 2 ' , rCBV, rOEF, where R 2 ' =1/ T 2 * -1/T2) with DTI-derived fiber orientation towards the main magnetic field (B0). Our results confirm strong dependencies of transverse relaxation and rCBV on the nerve fiber orientation towards B0, with anisotropy-driven variations up to 37%. Comparably weak orientation-dependent variations of mq-BOLD derived rOEF (3.8%) demonstrate partially counteracting influences of R 2 ' and rCBV effects, possibly suggesting applicability of rOEF as an oxygenation sensitive biomarker. However, unresolved issues warrant caution when applying mq-BOLD to WM.
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Affiliation(s)
- Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fahmeed Hyder
- Departments of Radiology & Biomedical Imaging and of Biomedical Engineering, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Clinic for Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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25
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Stadlbauer A, Oberndorfer S, Zimmermann M, Renner B, Buchfelder M, Heinz G, Doerfler A, Kleindienst A, Roessler K. Physiologic MR imaging of the tumor microenvironment revealed switching of metabolic phenotype upon recurrence of glioblastoma in humans. J Cereb Blood Flow Metab 2020; 40:528-538. [PMID: 30732550 PMCID: PMC7026844 DOI: 10.1177/0271678x19827885] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Treating recurrent glioblastoma (GB) is one of the challenges in modern neurooncology. Hypoxia, neovascularization, and energy metabolism are of crucial importance for therapy failure and recurrence. Twenty-one patients with initially untreated GB who developed recurrence were examined with a novel MRI approach for noninvasive visualization of the tumor microenvironment (TME). Imaging biomarker information about oxygen metabolism (mitochondrial oxygen tension) and neovascularization (microvascular density and type) were fused for classification of five different TME compartments: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation, and glycolysis. Volume percentages of these TME compartments were compared between untreated and recurrent GB. At initial diagnosis, all 21 GB showed either the features of a glycolytic dominant phenotype with a high percentage of functional neovasculature (N = 12) or those of a necrotic/hypoxic dominant phenotype with a high percentage of defective tumor neovasculature (N = 9). At recurrence, all 21 GB revealed switching of the initial metabolic phenotype: either from the glycolytic to the necrotic/hypoxic dominant phenotype or vice-versa. A necrotic/hypoxic phenotype at recurrence was associated with a higher rate of multifocality of the recurrent lesions. Our MRI approach may be helpful for a better understanding of treatment-induced metabolic phenotype switching and for future studies developing targeted therapeutic strategies for recurrent GB.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.,Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Max Zimmermann
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Bertold Renner
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gertraud Heinz
- Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Andrea Kleindienst
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Roessler
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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26
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Cho J, Zhang S, Kee Y, Spincemaille P, Nguyen TD, Hubertus S, Gupta A, Wang Y. Cluster analysis of time evolution (CAT) for quantitative susceptibility mapping (QSM) and quantitative blood oxygen level-dependent magnitude (qBOLD)-based oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO 2 ) mapping. Magn Reson Med 2020; 83:844-857. [PMID: 31502723 PMCID: PMC6879790 DOI: 10.1002/mrm.27967] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/07/2019] [Accepted: 08/04/2019] [Indexed: 01/01/2023]
Abstract
PURPOSE To improve the accuracy of QSM plus quantitative blood oxygen level-dependent magnitude (QSM + qBOLD or QQ)-based mapping of the oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2 ) using cluster analysis of time evolution (CAT). METHODS 3D multi-echo gradient echo and arterial spin labeling images were acquired in 11 healthy subjects and 5 ischemic stroke patients. DWI was also carried out on patients. CAT was developed for analyzing signal evolution over TE. QQ-based OEF and CMRO2 were reconstructed with and without CAT, and results were compared using region of interest analysis and a paired t-test. RESULTS Simulations demonstrated that CAT substantially reduced noise error in QQ-based OEF. In healthy subjects, QQ-based OEF appeared less noisy and more uniform with CAT than without CAT; average OEF with and without CAT in cortical gray matter was 32.7 ± 4.0% and 37.9 ± 4.5%, with corresponding CMRO2 of 148.4 ± 23.8 and 171.4 ± 22.4 μmol/100 g/min, respectively. In patients, regions of low OEF were confined within the ischemic lesions defined on DWI when using CAT, which was not observed without CAT. CONCLUSION The cluster analysis of time evolution (CAT) significantly improves the robustness of QQ-based OEF against noise.
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Affiliation(s)
- Junghun Cho
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, United States
| | - Shun Zhang
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
- Department of Radiology, Tongji Hospital, Wuhan 430030, China
| | - Youngwook Kee
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Pascal Spincemaille
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Thanh D. Nguyen
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Simon Hubertus
- Computer Assisted Clinical Medicine, Heidelberg University, Mannheim 68167, Germany
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
| | - Yi Wang
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, United States
- Department of Radiology, Weill Cornell Medical College, New York, NY, United States
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27
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Taylor E, Zhou J, Lindsay P, Foltz W, Cheung M, Siddiqui I, Hosni A, Amir AE, Kim J, Hill RP, Jaffray DA, Hedley DW. Quantifying Reoxygenation in Pancreatic Cancer During Stereotactic Body Radiotherapy. Sci Rep 2020; 10:1638. [PMID: 32005829 PMCID: PMC6994660 DOI: 10.1038/s41598-019-57364-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/18/2019] [Indexed: 02/05/2023] Open
Abstract
Hypoxia, the state of low oxygenation that often arises in solid tumours due to their high metabolism and irregular vasculature, is a major contributor to the resistance of tumours to radiation therapy (RT) and other treatments. Conventional RT extends treatment over several weeks or more, and nominally allows time for oxygen levels to increase ("reoxygenation") as cancer cells are killed by RT, mitigating the impact of hypoxia. Recent advances in RT have led to an increase in the use stereotactic body radiotherapy (SBRT), which delivers high doses in five or fewer fractions. For cancers such as pancreatic adenocarcinoma for which hypoxia varies significantly between patients, SBRT might not be optimal, depending on the extent to which reoxygenation occurs during its short duration. We used fluoro-5-deoxy-α-D-arabinofuranosyl)-2-nitroimidazole positron-emission tomography (FAZA-PET) imaging to quantify hypoxia before and after 5-fraction SBRT delivered to patient-derived pancreatic cancer xenografts orthotopically implanted in mice. An imaging technique using only the pre-treatment FAZA-PET scan and repeat dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) scans throughout treatment was able to predict the change in hypoxia. Our results support the further testing of this technique for imaging of reoxygenation in the clinic.
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Affiliation(s)
- Edward Taylor
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Jitao Zhou
- Department of Abdominal Oncology, Cancer Center and Laboratory of Signal Transduction and Molecular Targeting Therapy, West China Hospital, Sichuan University, Chengdu, China
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Warren Foltz
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - May Cheung
- Ontario Cancer Institute, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Iram Siddiqui
- Department of Pathology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Ahmed El Amir
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - John Kim
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - Richard P Hill
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
- Ontario Cancer Institute, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - David A Jaffray
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada
| | - David W Hedley
- Ontario Cancer Institute, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
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28
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Göttler J, Kaczmarz S, Kallmayer M, Wustrow I, Eckstein HH, Zimmer C, Sorg C, Preibisch C, Hyder F. Flow-metabolism uncoupling in patients with asymptomatic unilateral carotid artery stenosis assessed by multi-modal magnetic resonance imaging. J Cereb Blood Flow Metab 2019; 39:2132-2143. [PMID: 29968499 PMCID: PMC6827123 DOI: 10.1177/0271678x18783369] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oxygen extraction (OEF), oxidative metabolism (CMRO2), and blood flow (CBF) in the brain, as well as the coupling between CMRO2 and CBF due to cerebral autoregulation are fundamental to brain's health. We used a clinically feasible MRI protocol to assess impairments of these parameters in the perfusion territories of stenosed carotid arteries. Twenty-nine patients with unilateral high-grade carotid stenosis and thirty age-matched healthy controls underwent multi-modal MRI scans. Pseudo-continuous arterial spin labeling (pCASL) yielded absolute CBF, whereas multi-parametric quantitative blood oxygenation level dependent (mqBOLD) modeling allowed imaging of relative OEF and CMRO2. Both CBF and CMRO2 were significantly reduced in the stenosed territory compared to the contralateral side, while OEF was evenly distributed across both hemispheres similarly in patients and controls. The CMRO2-CBF coupling was significantly different between both hemispheres in patients, i.e. significant interhemispheric flow-metabolism uncoupling was observed in patients compared to controls. Given that CBF and CMRO2 are intimately linked to brain function in health and disease, the proposed easily applicable MRI protocol of pCASL and mqBOLD imaging might serve as a valuable tool for early diagnosis of potentially harmful cerebral hemodynamic and metabolic states with the final aim to select clinically asymptomatic patients who would benefit from carotid revascularization therapy.
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Affiliation(s)
- Jens Göttler
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA.,Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,Department of Diagnostic and Interventional Radiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Stephan Kaczmarz
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA.,Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Michael Kallmayer
- Department of Vascular and Endovascular Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Isabel Wustrow
- I. Medizinische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Hans-Henning Eckstein
- Department of Vascular and Endovascular Surgery, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,Department of Psychiatry, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,TUM Neuroimaging Center (TUM-NIC), Technische Universität München, Klinikum rechts der Isar, Munich, Germany.,Clinic for Neurology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Fahmeed Hyder
- Department of Radiology & Biomedical Imaging, Magnetic Resonance Research Center, Yale University, New Haven, CT, USA.,Department of Biomedical Engineering, Yale University, New Haven, CT, USA
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Stadlbauer A, Zimmermann M, Doerfler A, Oberndorfer S, Buchfelder M, Coras R, Kitzwögerer M, Roessler K. Intratumoral heterogeneity of oxygen metabolism and neovascularization uncovers 2 survival-relevant subgroups of IDH1 wild-type glioblastoma. Neuro Oncol 2019; 20:1536-1546. [PMID: 29718366 DOI: 10.1093/neuonc/noy066] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The intratumoral heterogeneity of oxygen metabolism in combination with variable patterns of neovascularization (NV) as well as reprogramming of energy metabolism affects the landscape of tumor microenvironments (TMEs) in glioblastoma. Knowledge of the hypoxic and perivascular niches within the TME is essential for understanding treatment failure. Methods Fifty-two patients with untreated glioblastoma (isocitrate dehydrogenase 1 wild type [IDH1wt]) were examined with a physiological MRI protocol including a multiparametric quantitative blood oxygen level dependent (qBOLD) approach and vascular architecture mapping (VAM). Imaging biomarker information about oxygen metabolism (mitochondrial oxygen tension) and neovascularization (microvascular density and type) were fused for classification of 6 different TMEs: necrosis, hypoxia with/without neovascularization, oxidative phosphorylation (OxPhos), and glycolysis with/without neovascularization. Association of the different TME volume fractions with progression-free survival (PFS) was assessed using Kaplan-Meier analysis and Cox proportional hazards models. Results A common spatial structure of TMEs was detected: central necrosis surrounded by tumor hypoxia (with defective and functional neovasculature) and different TMEs with a predominance of OxPhos and glycolysis for energy production, respectively. The percentage of the different TMEs on the total tumor volume uncovered 2 clearly different subtypes of glioblastoma IDH1wt: a glycolytic dominated phenotype with predominantly functional neovasculature and a necrotic/hypoxic dominated phenotype with approximately 50% of defective neovasculature. Patients with a necrotic/hypoxic dominated phenotype showed significantly shorter PFS (P = 0.035). Conclusions Our non-invasive mapping approach allows for classification of the TME and detection of tumor-supportive niches in glioblastoma which may be helpful for both clinical patient management and research.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.,Institute of Medical Radiology, University Clinic of St Pölten, St Pölten, Austria
| | - Max Zimmermann
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic of St Pölten, St Pölten, Austria
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Roland Coras
- Department of Neuropathology, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Karl Roessler
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Hubertus S, Thomas S, Cho J, Zhang S, Wang Y, Schad LR. Using an artificial neural network for fast mapping of the oxygen extraction fraction with combined QSM and quantitative BOLD. Magn Reson Med 2019; 82:2199-2211. [PMID: 31273828 DOI: 10.1002/mrm.27882] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/28/2019] [Accepted: 06/05/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE To apply an artificial neural network (ANN) for fast and robust quantification of the oxygen extraction fraction (OEF) from a combined QSM and quantitative BOLD analysis of gradient echo data and to compare the ANN to a traditional quasi-Newton (QN) method for numerical optimization. METHODS Random combinations of OEF, deoxygenated blood volume ( ν ), R2 , and nonblood magnetic susceptibility ( χ nb ) with each parameter following a Gaussian distribution that represented physiological gray matter and white matter values were used to simulate quantitative BOLD signals and QSM values. An ANN was trained with the simulated data with added Gaussian noise. The ANN was applied to multigradient echo brain data of 7 healthy subjects, and the reconstructed parameters and maps were compared to QN results using Student t test and Bland-Altman analysis. RESULTS Intersubject means and SDs of gray matter were OEF = 43.5 ± 0.8 %, R 2 = 13.5 ± 0.3 Hz, ν = 3.4 ± 0.1 %, χ nb = - 25 ± 5 ppb for ANN; and OEF = 43.8 ± 5.2 %, R 2 = 12.2 ± 0.8 Hz, ν = 4.2 ± 0.6 %, χ nb = - 39 ± 7 ppb for QN, with a significant difference ( P < 0.05 ) for R 2 , ν , and χ nb . For white matter, they were OEF = 47.5 ± 1.1 %, R 2 = 17.1 ± 0.4 Hz, ν = 2.5 ± 0.2 %, χ nb = - 38 ± 5 ppb for ANN; and OEF = 42.3 ± 5.6 %, R 2 = 16.7 ± 0.7 Hz, ν = 2.9 ± 0.3 %, χ nb = - 45 ± 9 ppb for QN, with a significant difference ( P < 0.05 ) for OEF and ν . ANN revealed more gray-white matter contrast but less intersubject variation in OEF than QN. In contrast to QN, the ANN reconstruction did not need an additional sequence for parameter initialization and took approximately 1 s rather than roughly 1 h. CONCLUSION ANNs allow faster and, with regard to initialization, more robust reconstruction of OEF maps with lower intersubject variation than QN approaches.
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Affiliation(s)
- Simon Hubertus
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sebastian Thomas
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Junghun Cho
- Department of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Shun Zhang
- Department of Radiology, Weill Cornell Medical College, New York, New York.,Department of Radiology, Tongji Hospital, Wuhan, China
| | - Yi Wang
- Department of Biomedical Engineering, Cornell University, Ithaca, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Lothar Rudi Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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31
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Hubertus S, Thomas S, Cho J, Zhang S, Wang Y, Schad LR. Comparison of gradient echo and gradient echo sampling of spin echo sequence for the quantification of the oxygen extraction fraction from a combined quantitative susceptibility mapping and quantitative BOLD (QSM+qBOLD) approach. Magn Reson Med 2019; 82:1491-1503. [DOI: 10.1002/mrm.27804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Simon Hubertus
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | - Sebastian Thomas
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim Heidelberg University Mannheim Germany
| | - Junghun Cho
- Department of Biomedical Engineering Cornell University Ithaca New York
| | - Shun Zhang
- Department of Radiology Weill Cornell Medical College New York New York
- Department of Radiology Tongji Hospital Wuhan China
| | - Yi Wang
- Department of Biomedical Engineering Cornell University Ithaca New York
- Department of Radiology Weill Cornell Medical College New York New York
| | - Lothar Rudi Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim Heidelberg University Mannheim Germany
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Stone AJ, Harston GWJ, Carone D, Okell TW, Kennedy J, Blockley NP. Prospects for investigating brain oxygenation in acute stroke: Experience with a non-contrast quantitative BOLD based approach. Hum Brain Mapp 2019; 40:2853-2866. [PMID: 30860660 PMCID: PMC6563088 DOI: 10.1002/hbm.24564] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Metabolic markers of baseline brain oxygenation and tissue perfusion have an important role to play in the early identification of ischaemic tissue in acute stroke. Although well established MRI techniques exist for mapping brain perfusion, quantitative imaging of brain oxygenation is poorly served. Streamlined-qBOLD (sqBOLD) is a recently developed technique for mapping oxygenation that is well suited to the challenge of investigating acute stroke. In this study a noninvasive serial imaging protocol was implemented, incorporating sqBOLD and arterial spin labelling to map blood oxygenation and perfusion, respectively. The utility of these parameters was investigated using imaging based definitions of tissue outcome (ischaemic core, infarct growth and contralateral tissue). Voxel wise analysis revealed significant differences between all tissue outcomes using pairwise comparisons for the transverse reversible relaxation rate (R 2 '), deoxygenated blood volume (DBV) and deoxyghaemoglobin concentration ([dHb]; p < 0.01 in all cases). At the patient level (n = 9), a significant difference was observed for [dHb] between ischaemic core and contralateral tissue. Furthermore, serial analysis at the patient level (n = 6) revealed significant changes in R 2 ' between the presentation and 1 week scans for both ischaemic core (p < 0.01) and infarct growth (p < 0.05). In conclusion, this study presents evidence supporting the potential of sqBOLD for imaging oxygenation in stroke.
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Affiliation(s)
- Alan J Stone
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - George W J Harston
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Davide Carone
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas W Okell
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James Kennedy
- Acute Vascular Imaging Centre, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Nicholas P Blockley
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Seiler A, Blockley NP, Deichmann R, Nöth U, Singer OC, Chappell MA, Klein JC, Wagner M. The relationship between blood flow impairment and oxygen depletion in acute ischemic stroke imaged with magnetic resonance imaging. J Cereb Blood Flow Metab 2019; 39:454-465. [PMID: 28929836 PMCID: PMC6421246 DOI: 10.1177/0271678x17732448] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oxygenation-sensitive spin relaxation time T2' and relaxation rate R2' (1/T2') are presumed to be markers of the cerebral oxygen extraction fraction (OEF) in acute ischemic stroke. In this study, we investigate the relationship of T2'/R2' with dynamic susceptibility contrast-based relative cerebral blood flow (rCBF) in acute ischemic stroke to assess their plausibility as surrogate markers of the ischemic penumbra. Twenty-one consecutive patients with internal carotid artery and/or middle cerebral artery occlusion were studied at 3.0 T. A physiological model of the cerebral vasculature (VM) was used to process PWI raw data in addition to a conventional deconvolution technique. T2', R2', and rCBF values were extracted from the ischemic core and hypoperfused areas. Within hypoperfused tissue, no correlation was found between deconvolved rCBF and T2' ( r = -0.05, p = 0.788), or R2' ( r = 0.039, p = 0.836). In contrast, we found a strong positive correlation with T2' ( r = 0.444, p = 0.006) and negative correlation with R2' ( r = -0.494, p = 0.0025) for rCBFVM, indicating increasing OEF with decreasing CBF and that rCBF based on the vascular model may be more closely related to metabolic disturbances. Further research to refine and validate these techniques may enable their use as MRI-based surrogate markers of the ischemic penumbra for selecting stroke patients for interventional treatment strategies.
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Affiliation(s)
- Alexander Seiler
- 1 Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Nicholas P Blockley
- 2 Nuffield Department of Clinical Neurosciences, Oxford Center for Functional MRI of the Brain, University of Oxford, Oxford, UK
| | - Ralf Deichmann
- 3 Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Ulrike Nöth
- 3 Brain Imaging Center, Goethe University Frankfurt, Frankfurt, Germany
| | - Oliver C Singer
- 1 Department of Neurology, Goethe University Frankfurt, Frankfurt, Germany
| | - Michael A Chappell
- 2 Nuffield Department of Clinical Neurosciences, Oxford Center for Functional MRI of the Brain, University of Oxford, Oxford, UK.,4 Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Johannes C Klein
- 5 Nuffield Department of Clinical Neurosciences, Oxford University, and Department of Neurology, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Marlies Wagner
- 6 Institute of Neuroradiology, Goethe University Frankfurt, Frankfurt, Germany
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34
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BOLD signal physiology: Models and applications. Neuroimage 2019; 187:116-127. [DOI: 10.1016/j.neuroimage.2018.03.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 02/14/2018] [Accepted: 03/08/2018] [Indexed: 12/14/2022] Open
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Abstract
Gaining insights into brain oxygen metabolism has been one of the key areas of research in neurosciences. Extensive efforts have been devoted to developing approaches capable of providing measures of brain oxygen metabolism not only under normal physiological conditions but, more importantly, in various pathophysiological conditions such as cerebral ischemia. In particular, quantitative measures of cerebral metabolic rate of oxygen using positron emission tomography (PET) have been shown to be capable of discerning brain tissue viability during ischemic insults. However, the complex logistics associated with oxygen-15 PET have substantially hampered its wide clinical applicability. In contrast, magnetic resonance imaging (MRI)-based approaches have provided quantitative measures of cerebral oxygen metabolism similar to that obtained using PET. Given the wide availability, MRI-based approaches may have broader clinical impacts, particularly in cerebral ischemia, when time is a critical factor in deciding treatment selection. In this article, we review the pathophysiological basis of altered cerebral hemodynamics and oxygen metabolism in cerebral ischemia, how quantitative measures of cerebral metabolism were obtained using the Kety-Schmidt approach, the physical concepts of non-invasive oxygen metabolism imaging approaches, and, finally, clinical applications of the discussed imaging approaches.
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Affiliation(s)
- Weili Lin
- 1 Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - William J Powers
- 2 Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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36
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Interleaved quantitative BOLD: Combining extravascular R 2' - and intravascular R 2-measurements for estimation of deoxygenated blood volume and hemoglobin oxygen saturation. Neuroimage 2018; 174:420-431. [PMID: 29580967 DOI: 10.1016/j.neuroimage.2018.03.043] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/19/2018] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
Quantitative BOLD (qBOLD), a non-invasive MRI method for assessment of hemodynamic and metabolic properties of the brain in the baseline state, provides spatial maps of deoxygenated blood volume fraction (DBV) and hemoglobin oxygen saturation (HbO2) by means of an analytical model for the temporal evolution of free-induction-decay signals in the extravascular compartment. However, mutual coupling between DBV and HbO2 in the signal model results in considerable estimation uncertainty precluding achievement of a unique set of solutions. To address this problem, we developed an interleaved qBOLD method (iqBOLD) that combines extravascular R2' and intravascular R2 mapping techniques so as to obtain prior knowledge for the two unknown parameters. To achieve these goals, asymmetric spin echo and velocity-selective spin-labeling (VSSL) modules were interleaved in a single pulse sequence. Prior to VSSL, arterial blood and CSF signals were suppressed to produce reliable estimates for cerebral venous blood volume fraction (CBVv) as well as venous blood R2 (to yield HbO2). Parameter maps derived from the VSSL module were employed to initialize DBV and HbO2 in the qBOLD processing. Numerical simulations and in vivo experiments at 3 T were performed to evaluate the performance of iqBOLD in comparison to the parent qBOLD method. Data obtained in eight healthy subjects yielded plausible values averaging 60.1 ± 3.3% for HbO2 and 3.1 ± 0.5 and 2.0 ± 0.4% for DBV in gray and white matter, respectively. Furthermore, the results show that prior estimates of CBVv and HbO2 from the VSSL component enhance the solution stability in the qBOLD processing, and thus suggest the feasibility of iqBOLD as a promising alternative to the conventional technique for quantifying neurometabolic parameters.
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37
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Stadlbauer A, Mouridsen K, Doerfler A, Bo Hansen M, Oberndorfer S, Zimmermann M, Buchfelder M, Heinz G, Roessler K. Recurrence of glioblastoma is associated with elevated microvascular transit time heterogeneity and increased hypoxia. J Cereb Blood Flow Metab 2018; 38:422-432. [PMID: 28273720 PMCID: PMC5851132 DOI: 10.1177/0271678x17694905] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Dynamic susceptibility contrast (DSC) perfusion MRI provide information about differences in macro- and microvasculature when executed with gradient-echo (GE; sensitive to macrovasculature) and spin-echo (SE; sensitive to microvasculature) contrast. This study investigated whether there are differences between macro- and microvascular transit time heterogeneity (MVTH and µVTH) and tissue oxygen tension (PO2mit) in newly-diagnosed and recurrent glioblastoma. Fifty-seven patients with glioblastoma (25 newly-diagnosed/32 recurrent) were examined with GE- and SE-DSC perfusion sequences, and a quantitative blood-oxygen-level-dependent (qBOLD) approach. Maps of MVTH, µVTH and coefficient of variation (MCOV and µCOV) were calculated from GE- and SE-DSC data, respectively, using an extended flow-diffusion equation. PO2mit maps were calculated from qBOLD data. Newly-diagnosed and recurrent glioblastoma showed significantly lower ( P ≤ 0.001) µCOV values compared to both normal brain and macrovasculature (MCOV) of the lesions. Recurrent glioblastoma had significantly higher µVTH ( P = 0.014) and µCOV ( P = 0.039) as well as significantly lower PO2mit values ( P = 0.008) compared to newly-diagnosed glioblastoma. The macrovasculature, however, showed no significant differences. Our findings provide evidence of microvascular adaption in the disorganized tumor vasculature for retaining the metabolic demands in stress response of therapeutically-uncontrolled glioblastomas. Thus, µVTH and PO2mit mapping gives insight into the tumor microenvironment (vascular and hypoxic niches) responsible for therapy resistance.
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Affiliation(s)
- Andreas Stadlbauer
- 1 Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany.,2 Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Kim Mouridsen
- 3 Center of Functionally Integrative Neuroscience and MIND Lab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Arnd Doerfler
- 4 Department of Neuroradiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Mikkel Bo Hansen
- 3 Center of Functionally Integrative Neuroscience and MIND Lab, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stefan Oberndorfer
- 5 Department of Neurology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Max Zimmermann
- 1 Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- 1 Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gertraud Heinz
- 2 Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria
| | - Karl Roessler
- 1 Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Preibisch C, Shi K, Kluge A, Lukas M, Wiestler B, Göttler J, Gempt J, Ringel F, Al Jaberi M, Schlegel J, Meyer B, Zimmer C, Pyka T, Förster S. Characterizing hypoxia in human glioma: A simultaneous multimodal MRI and PET study. NMR IN BIOMEDICINE 2017; 30:e3775. [PMID: 28805936 DOI: 10.1002/nbm.3775] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 06/19/2017] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Hypoxia plays an important role for the prognosis and therapy response of cancer. Thus, hypoxia imaging would be a valuable tool for pre-therapeutic assessment of tumor malignancy. However, there is no standard validated technique for clinical application available yet. Therefore, we performed a study in 12 patients with high-grade glioma, where we directly compared the two currently most promising techniques, namely the MR-based relative oxygen extraction fraction (MR-rOEF) and the PET hypoxia marker H-1-(3-[18 F]-fluoro-2-hydroxypropyl)-2-nitroimidazole ([18 F]-FMISO). MR-rOEF was determined from separate measurements of T2 , T2 * and relative cerebral blood volume (rCBV) employing a multi-parametric approach for quantification of the blood-oxygenation-level-dependent (BOLD) effect. With respect to [18 F]-FMISO-PET, besides the commonly used late uptake between 120 and 130 min ([18 F]-FMISO120-130 min ), we also analyzed the hypoxia specific uptake rate [18 F]-FMISO-k3 , as obtained by pharmacokinetic modeling of dynamic uptake data. Since pharmacokinetic modeling of partially acquired dynamic [18 F]-FMISO data was sensitive to a low signal-to-noise-ratio, analysis was restricted to high-uptake tumor regions. Individual spatial analyses of deoxygenation and hypoxia-related parameter maps revealed that high MR-rOEF values clustered in (edematous) peritumoral tissue, while areas with high [18 F]-FMISO120-130 min concentrated in and around active tumor with disrupted blood-brain barrier, i.e. contrast enhancement in T1 -weighted MRI. Volume-of-interest-based correlations between MR-rOEF and [18 F]-FMISO120-130 min as well as [18 F]-FMISO-k3 , and voxel-wise analyses in individual patients, yielded limited correlations, supporting the notion that [18 F]-FMISO uptake, even after 2 h, might still be influenced by perfusion while [18 F]-FMISO-k3 was severely hampered by noise. According to these results, vascular deoxygenation, as measured by MR-rOEF, and severe tissue hypoxia, as measured by [18 F]-FMISO, show a poor spatial correspondence. Overall, the two methods appear to rather provide complementary than redundant information about high-grade glioma biology.
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Affiliation(s)
- Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
- Clinic for Neurology, Technische Universität München, Munich, Germany
| | - Kuangyu Shi
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Anne Kluge
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Mathias Lukas
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Jens Göttler
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Mohamed Al Jaberi
- Department of Neuropathology, Technische Universität München, Munich, Germany
| | - Jürgen Schlegel
- Department of Neuropathology, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Technische Universität München, Munich, Germany
| | - Thomas Pyka
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
| | - Stefan Förster
- Clinic for Nuclear Medicine, Technische Universität München, Munich, Germany
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Chang YCC, Ackerstaff E, Tschudi Y, Jimenez B, Foltz W, Fisher C, Lilge L, Cho H, Carlin S, Gillies RJ, Balagurunathan Y, Yechieli RL, Subhawong T, Turkbey B, Pollack A, Stoyanova R. Delineation of Tumor Habitats based on Dynamic Contrast Enhanced MRI. Sci Rep 2017; 7:9746. [PMID: 28851989 PMCID: PMC5575347 DOI: 10.1038/s41598-017-09932-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 08/01/2017] [Indexed: 02/03/2023] Open
Abstract
Tumor heterogeneity can be elucidated by mapping subregions of the lesion with differential imaging characteristics, called habitats. Dynamic Contrast Enhanced (DCE-)MRI can depict the tumor microenvironments by identifying areas with variable perfusion and vascular permeability, since individual tumor habitats vary in the rate and magnitude of the contrast uptake and washout. Of particular interest is identifying areas of hypoxia, characterized by inadequate perfusion and hyper-permeable vasculature. An automatic procedure for delineation of tumor habitats from DCE-MRI was developed as a two-part process involving: (1) statistical testing in order to determine the number of the underlying habitats; and (2) an unsupervised pattern recognition technique to recover the temporal contrast patterns and locations of the associated habitats. The technique is examined on simulated data and DCE-MRI, obtained from prostate and brain pre-clinical cancer models, as well as clinical data from sarcoma and prostate cancer patients. The procedure successfully identified habitats previously associated with well-perfused, hypoxic and/or necrotic tumor compartments. Given the association of tumor hypoxia with more aggressive tumor phenotypes, the obtained in vivo information could impact management of cancer patients considerably.
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Affiliation(s)
| | - Ellen Ackerstaff
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Yohann Tschudi
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Bryan Jimenez
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Warren Foltz
- STTARR Innovation Centre, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Carl Fisher
- Department of Medical Biophysics, University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Lothar Lilge
- Department of Medical Biophysics, University of Toronto and Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - HyungJoon Cho
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea
| | - Sean Carlin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Robert J Gillies
- Cancer Imaging and Metabolism, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | | | - Raphael L Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Alan Pollack
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Radka Stoyanova
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA.
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Duyn JH, Schenck J. Contributions to magnetic susceptibility of brain tissue. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3546. [PMID: 27240118 PMCID: PMC5131875 DOI: 10.1002/nbm.3546 10.1002/nbm.3546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/19/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2023]
Abstract
This review discusses the major contributors to the subtle magnetic properties of brain tissue and how they affect MRI contrast. With the increased availability of high-field scanners, the use of magnetic susceptibility contrast for the study of human brain anatomy and function has increased dramatically. This has not only led to novel applications, but has also improved our understanding of the complex relationship between MRI contrast and magnetic susceptibility. Chief contributors to the magnetic susceptibility of brain tissue have been found to include myelin as well as iron. In the brain, iron exists in various forms with diverse biological roles, many of which are now only starting to be uncovered. An interesting aspect of magnetic susceptibility contrast is its sensitivity to the microscopic distribution of iron and myelin, which provides opportunities to extract information at spatial scales well below MRI resolution. For example, in white matter, the myelin sheath that surrounds the axons can provide tissue contrast that is dependent on the axonal orientation and reflects the relative size of intra- and extra-axonal water compartments. The extraction of such ultrastructural information, together with quantitative information about iron and myelin concentrations, is an active area of research geared towards the characterization of brain structure and function, and their alteration in disease. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeff H. Duyn
- Advanced MRI Section, Laboratory of Functional and Molecular
Imaging, National Institutes of Neurological Disorders and Stroke, National
Institutes of Health, Bethesda, Maryland 20892, USA
| | - John Schenck
- MRI Technologies and Systems, General Electric
Global Research Center, 1 Research Circle, Schenectady, New York 12309, USA
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Duyn JH, Schenck J. Contributions to magnetic susceptibility of brain tissue. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3546. [PMID: 27240118 PMCID: PMC5131875 DOI: 10.1002/nbm.3546] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/19/2016] [Accepted: 03/31/2016] [Indexed: 05/08/2023]
Abstract
This review discusses the major contributors to the subtle magnetic properties of brain tissue and how they affect MRI contrast. With the increased availability of high-field scanners, the use of magnetic susceptibility contrast for the study of human brain anatomy and function has increased dramatically. This has not only led to novel applications, but has also improved our understanding of the complex relationship between MRI contrast and magnetic susceptibility. Chief contributors to the magnetic susceptibility of brain tissue have been found to include myelin as well as iron. In the brain, iron exists in various forms with diverse biological roles, many of which are now only starting to be uncovered. An interesting aspect of magnetic susceptibility contrast is its sensitivity to the microscopic distribution of iron and myelin, which provides opportunities to extract information at spatial scales well below MRI resolution. For example, in white matter, the myelin sheath that surrounds the axons can provide tissue contrast that is dependent on the axonal orientation and reflects the relative size of intra- and extra-axonal water compartments. The extraction of such ultrastructural information, together with quantitative information about iron and myelin concentrations, is an active area of research geared towards the characterization of brain structure and function, and their alteration in disease. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jeff H. Duyn
- Advanced MRI Section, Laboratory of Functional and Molecular
Imaging, National Institutes of Neurological Disorders and Stroke, National
Institutes of Health, Bethesda, Maryland 20892, USA
| | - John Schenck
- MRI Technologies and Systems, General Electric
Global Research Center, 1 Research Circle, Schenectady, New York 12309, USA
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Stadlbauer A, Merkel A, Zimmermann M, Sommer B, Buchfelder M, Meyer-Bäse A, Rössler K. Intraoperative Magnetic Resonance Imaging of Cerebral Oxygen Metabolism During Resection of Brain Lesions. World Neurosurg 2017; 100:388-394. [PMID: 28137548 DOI: 10.1016/j.wneu.2017.01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Tissue oxygen tension is an important parameter for brain tissue viability and its noninvasive intraoperative monitoring in the whole brain is of highly clinical relevance. The purpose of this study was the introduction of a multiparametric quantitative blood oxygenation dependent magnetic resonance imaging (MRI) approach for intraoperative examination of oxygen metabolism during the resection of brain lesions. METHODS Sixteen patients suffering from brain lesions were examined intraoperatively twice (before craniotomy and after gross-total resection) via the quantitative blood oxygenation dependent technique and a 1.5-Tesla MRI scanner, which is installed in an operating room. The MRI protocol included T2*- and T2 mapping and dynamic susceptibility weighted perfusion. Data analysis was performed with a custom-made, in-house MatLab software for calculation of maps of oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) as well as of cerebral blood volume and cerebral blood flow. RESULTS Perilesional edema showed a significant increase in both perfusion (cerebral blood volume +21%, cerebral blood flow +13%) and oxygen metabolism (OEF +32%, CMRO2 +16%) after resection of the lesions. In perilesional nonedematous tissue only, however, oxygen metabolism (OEF +19%, CMRO2 +11%) was significantly increased, but not perfusion. No changes were found in normal brain. Fortunately, no neurovascular adverse events were observed. CONCLUSIONS This approach for intraoperative examination of oxygen metabolism in the whole brain is a new application of intraoperative MRI additionally to resection control (residual tumor detection) and updating of neuronavigation (brain shift detection). It may help to detect neurovascular adverse events early during surgery.
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Affiliation(s)
- Andreas Stadlbauer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany; Institute of Medical Radiology, University Clinic of St. Pölten, St. Pölten, Austria.
| | - Andreas Merkel
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Max Zimmermann
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Björn Sommer
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Anke Meyer-Bäse
- Department of Scientific Computing, Florida State University, Tallahassee, Florida, USA
| | - Karl Rössler
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
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Stadlbauer A, Zimmermann M, Kitzwögerer M, Oberndorfer S, Rössler K, Dörfler A, Buchfelder M, Heinz G. MR Imaging-derived Oxygen Metabolism and Neovascularization Characterization for Grading and IDH Gene Mutation Detection of Gliomas. Radiology 2016; 283:799-809. [PMID: 27982759 DOI: 10.1148/radiol.2016161422] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To explore the diagnostic performance of physiological magnetic resonance (MR) imaging of oxygen metabolism and neovascularization activity for grading and characterization of isocitrate dehydrogenase (IDH) gene mutation status of gliomas. Materials and Methods This retrospective study had institutional review board approval; written informed consent was obtained from all patients. Eighty-three patients with histopathologically proven glioma (World Health Organization [WHO] grade II-IV) were examined with quantitative blood oxygen level-dependent imaging and vascular architecture mapping. Biomarker maps of neovascularization activity (microvessel radius, microvessel density, and microvessel type indicator [MTI]) and oxygen metabolism (oxygen extraction fraction [OEF] and cerebral metabolic rate of oxygen [CMRO2]) were calculated. Receiver operating characteristic analysis was used to determine diagnostic performance for grading and detection of IDH gene mutation status. Results Low-grade (WHO grade II) glioma showed areas with increased OEF (+18%, P < .001, n = 20), whereas anaplastic glioma (WHO grade III) and glioblastoma (WHO grade IV) showed decreased OEF when compared with normal brain tissue (-54% [P < .001, n = 21] and -49% [P < .001, n = 41], respectively). This allowed clear differentiation between low- and high-grade glioma (area under the receiver operating characteristic curve [AUC], 1) for the patient cohort. MTI had the highest diagnostic performance (AUC, 0.782) for differentiation between gliomas of grades III and IV among all biomarkers. CMRO2 was decreased (P = .037) in low-grade glioma with a mutated IDH gene, and MTI was significantly increased in glioma grade III with IDH mutation (P = .013) when compared with the IDH wild-type counterparts. CMRO2 showed the highest diagnostic performance for IDH gene mutation detection in low-grade glioma (AUC, 0.818) and MTI in high-grade glioma (AUC, 0.854) and for all WHO grades (AUC, 0.899) among all biomarkers. Conclusion MR imaging-derived oxygen metabolism and neovascularization characterization may be useful for grading and IDH mutation detection of gliomas and requires only 7 minutes of extra imaging time. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Andreas Stadlbauer
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Max Zimmermann
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Melitta Kitzwögerer
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Oberndorfer
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Karl Rössler
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Arnd Dörfler
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Buchfelder
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
| | - Gertraud Heinz
- From the Institute of Medical Radiology (A.S., G.H.), Department of Pathology (M.K.), and Department of Neurology (S.O.), University Clinic of St Pölten, Propst Führer-Strasse 4, A-3100 St Pölten, Austria; and Departments of Neurosurgery (A.S., M.Z., K.R., M.B.) and Neuroradiology (A.D.), University of Erlangen-Nürnberg, Erlangen, Germany
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Stone AJ, Blockley NP. A streamlined acquisition for mapping baseline brain oxygenation using quantitative BOLD. Neuroimage 2016; 147:79-88. [PMID: 27915118 DOI: 10.1016/j.neuroimage.2016.11.057] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/08/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022] Open
Abstract
Quantitative BOLD (qBOLD) is a non-invasive MR technique capable of producing quantitative measurements of the haemodynamic and metabolic properties of the brain. Here we propose a refinement of the qBOLD methodology, dubbed streamlined-qBOLD, in order to provide a clinically feasible method for mapping baseline brain oxygenation. In streamlined-qBOLD confounding signal contributions are minimised during data acquisition through the application of (i) a Fluid Attenuated Inversion Recovery (FLAIR) preparation to remove cerebral spinal fluid (CSF) signal contamination, (ii) a Gradient Echo Slice Excitation Profile Imaging (GESEPI) acquisition to reduce the effect of macroscopic magnetic field gradients and (iii) an Asymmetric Spin Echo (ASE) pulse sequence to directly measure the reversible transverse relaxation rate, R2'. Together these features simplify the application of the qBOLD model, improving the robustness of the resultant parametric maps. A theoretical optimisation framework was used to optimise acquisition parameters in relation to signal to noise ratio. In a healthy subject group (n = 7) apparent elevations in R2' caused by partial volumes of CSF were shown to be reduced with the application of CSF nulling. Significant decreases in R2' (p < 0.001) and deoxygenated blood volume (p < 0.01) were seen in cortical grey matter, across the group, with the application of CSF suppression. Quantitative baseline brain oxygenation parameter maps were calculated using qBOLD modelling and compared with literature values.
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Affiliation(s)
- Alan J Stone
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Nicholas P Blockley
- FMRIB Centre, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Jog MA, Yan L, Kilroy E, Krasileva K, Jann K, LeClair H, Elashoff D, Wang DJJ. Developmental trajectories of cerebral blood flow and oxidative metabolism at baseline and during working memory tasks. Neuroimage 2016; 134:587-596. [PMID: 27103136 DOI: 10.1016/j.neuroimage.2016.04.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 04/11/2016] [Accepted: 04/14/2016] [Indexed: 01/12/2023] Open
Abstract
The neurobiological interpretation of developmental BOLD fMRI findings remains difficult due to the confounding issues of potentially varied baseline of brain function and varied strength of neurovascular coupling across age groups. The central theme of the present research is to study the development of brain function and neuronal activity through in vivo assessments of cerebral blood flow (CBF), oxygen extraction fraction (OEF) and cerebral metabolic rate of oxygen (CMRO2) both at baseline and during the performance of a working memory task in a cohort of typically developing children aged 7 to 18years. Using a suite of 4 emerging MRI technologies including MR blood oximetry, phase-contrast MRI, pseudo-continuous arterial spin labeling (pCASL) perfusion MRI and concurrent CBF/BOLD fMRI, we found: 1) At baseline, both global CBF and CMRO2 showed an age related decline while global OEF was stable across the age group; 2) During the working memory task, neither BOLD nor CBF responses showed significant variations with age in the activated fronto-parietal brain regions. Nevertheless, detailed voxel-wise analyses revealed sub-regions within the activated fronto-parietal regions that show significant decline of fractional CMRO2 responses with age. These findings suggest that the brain may become more "energy efficient" with age during development.
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Affiliation(s)
- Mayank A Jog
- Laboratory of FMRI Technology (LOFT), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Lirong Yan
- Laboratory of FMRI Technology (LOFT), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Emily Kilroy
- Laboratory of FMRI Technology (LOFT), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kate Krasileva
- Laboratory of FMRI Technology (LOFT), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Kay Jann
- Laboratory of FMRI Technology (LOFT), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Holly LeClair
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine Statistics Core, UCLA, Los Angeles, CA, USA
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA.
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Arterial Spin Labeling Techniques 2009-2014. J Med Imaging Radiat Sci 2016; 47:98-107. [PMID: 31047171 DOI: 10.1016/j.jmir.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 07/03/2015] [Accepted: 08/18/2015] [Indexed: 12/23/2022]
Abstract
PURPOSE Arterial spin labeling (ASL) techniques have been implemented across a diverse range of clinical and experimental applications. This review aims to evaluate the current feasibility of ASL in clinical neuroradiology based on recent improvements to ASL sequences and highlight areas for potential clinical applications. METHODS AND MATERIALS In December 2014, a literature search was conducted on PubMed Central, EMBASE, and Scopus using the search terms: "arterial spin labeling, neuroradiology," for studies published between 2009 and 2014 (inclusive). Of 483 studies matching the inclusion criteria, the number of studies using continuous, pseudocontinuous, pulsed, and velocity-selective ASL sequences was 42, 209, 226, and 3, respectively. Studies were classified based on several common clinical applications according to the type of ASL sequence used. Studies using pulsed ASL and pseudo-continuous ASL were grouped based on common sequences. RESULTS The number of clinical studies was 264. Numerous studies applied ASL to stroke management (43 studies), drug testing (21 studies), neurodegenerative diseases (40 studies), and psychiatric disorders (26 studies). CONCLUSIONS This review discusses several factors hindering the implementation of clinical ASL and ASL-related radiofrequency safety issues encountered in clinical practice. However, a limited number of search terms were used. Further development of robust sequences with multislice imaging capabilities and reduced radiofrequency energy deposition will hopefully improve the clinical acceptance of ASL.
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Bouvier J, Detante O, Tahon F, Attye A, Perret T, Chechin D, Barbieux M, Boubagra K, Garambois K, Tropres I, Grand S, Barbier EL, Krainik A. Reduced CMRO₂ and cerebrovascular reserve in patients with severe intracranial arterial stenosis: a combined multiparametric qBOLD oxygenation and BOLD fMRI study. Hum Brain Mapp 2014; 36:695-706. [PMID: 25307948 DOI: 10.1002/hbm.22657] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 09/23/2014] [Accepted: 10/01/2014] [Indexed: 11/08/2022] Open
Abstract
Multiparametric quantitative blood oxygenation level dependent (mqBOLD) magnetic resonance Imaging (MRI) approach allows mapping tissular oxygen saturation (StO2 ) and cerebral metabolic rate of oxygen (CMRO2 ). To identify hemodynamic alteration related to severe intracranial arterial stenosis (SIAS), functional MRI of cerebrovascular reserve (CVR BOLD fMRI) to hypercapnia has been proposed. Diffusion imaging suggests chronic low grade ischemia in patients with impaired CVR. The aim of the present study was to evaluate how oxygen parameters (StO2 and CMRO2 ), assessed with mqBOLD approach, correlate with CVR in patients (n = 12) with SIAS and without arterial occlusion. The perfusion (dynamic susceptibility contrast), oxygenation, and CVR were compared. The MRI protocol conducted at 3T lasted approximately 1 h. Regions of interest measures on maps were delineated on segmented gray matter (GM) of middle cerebral artery territories. We have shown that decreased CVR is spatially associated with decreased CMRO2 in GM of patients with SIAS. Further, the degree of ipsilateral CVR reduction was well-correlated with the amplitude of the CMRO2 deficit. The altered CMRO2 suggests the presence of a moderate ischemia explained by both a decrease in perfusion and in CVR. CVR and mqBOLD method may be helpful in the selection of patients with SIAS to advocate for medical therapy or percutaneous transluminal angioplasty-stenting.
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Affiliation(s)
- Julien Bouvier
- Inserm, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France; Philips France (Healthcare Activity), Suresnes, France
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Hirsch NM, Toth V, Förschler A, Kooijman H, Zimmer C, Preibisch C. Technical considerations on the validity of blood oxygenation level-dependent-based MR assessment of vascular deoxygenation. NMR IN BIOMEDICINE 2014; 27:853-862. [PMID: 24809665 DOI: 10.1002/nbm.3131] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
A blood oxygenation level-dependent (BOLD)-based apparent relative oxygen extraction fraction (rOEF) as a semi-quantitative marker of vascular deoxygenation has recently been introduced in clinical studies of patients with glioma and stroke, yielding promising results. These rOEF measurements are based on independent quantification of the transverse relaxation times T2 and T2* and relative cerebral blood volume (rCBV). Simulations demonstrate that small errors in any of the underlying measures may result in a large deviation of the calculated rOEF. Therefore, we investigated the validity of such measurements. For this, we evaluated the quantitative measurements of T2 and T2* at 3 T in a gel phantom, in healthy subjects and in healthy tissue of patients with brain tumors. We calculated rOEF maps covering large portions of the brain from T2, T2* and rCBV [routinely measured in patients using dynamic susceptibility contrast (DSC)], and obtained rOEF values of 0.63 ± 0.16 and 0.90 ± 0.21 in healthy-appearing gray matter (GM) and white matter (WM), respectively; values of about 0.4 are usually reported. Quantitative T2 mapping using the fast, clinically feasible, multi-echo gradient spin echo (GRASE) approach yields significantly higher values than much slower multiple single spin echo (SE) experiments. Although T2* mapping is reliable in magnetically homogeneous tissues, uncorrectable macroscopic background gradients and other effects (e.g. iron deposition) shorten T2*. Cerebral blood volume (CBV) measurement using DSC and normalization to WM yields robust estimates of rCBV in healthy-appearing brain tissue; absolute quantification of the venous fraction of CBV, however, is difficult to achieve. Our study demonstrates that quantitative measurements of rOEF are currently biased by inherent difficulties in T2 and CBV quantification, but also by inadequacies of the underlying model. We argue, however, that standardized, reproducible measurements of apparent T2, T2* and rCBV may still allow the estimation of a meaningful apparent rOEF, which requires further validation in clinical studies.
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Affiliation(s)
- Nuria M Hirsch
- Department of Neuroradiology, Technische Universität München, Munich, Germany
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Domsch S, Mie MB, Wenz F, Schad LR. Non-invasive multiparametric qBOLD approach for robust mapping of the oxygen extraction fraction. Z Med Phys 2014; 24:231-42. [PMID: 24743060 DOI: 10.1016/j.zemedi.2014.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The quantitative blood oxygenation level-dependent (qBOLD) method has not become clinically established yet because long acquisition times are necessary to achieve an acceptable certainty of the parameter estimates. In this work, a non-invasive multiparametric (nimp) qBOLD approach based on a simple analytical model is proposed to facilitate robust oxygen extraction fraction (OEF) mapping within clinically acceptable acquisition times by using separate measurements. METHODS The protocol consisted of a gradient-echo sampled spin-echo sequence (GESSE), a T2-weighted Carr-Purcell-Meiboom-Gill (CPMG) sequence, and a T2(*)-weighted multi-slice multi-echo gradient echo (MMGE) sequence. The GESSE acquisition time was less than 5 minutes and the extra measurement time for CPMG/MMGE was below 2 minutes each. The proposed nimp-qBOLD approach was validated in healthy subjects (N = 5) and one patient. RESULTS The proposed nimp-qBOLD approach facilitated more robust OEF mapping with significantly reduced inter- and intra-subject variability compared to the standard qBOLD method. Thereby, an average OEF in all subjects of 27±2% in white matter (WM) and 29±2% in gray matter (GM) using the nimp-qBOLD method was more stable compared to 41±10% (WM) and 46±10% (GM) with standard qBOLD. Moreover, the spatial variance in the image slice (i.e. standard deviation divided by mean) was on average reduced from 35% to 25%. In addition, the preliminary results of the patient are encouraging. CONCLUSION The proposed nimp-qBOLD technique provides a promising tool for robust OEF mapping within clinically acceptable acquisition times and could therefore provide an important contribution for analyzing tumors or monitoring the success of radio and chemo therapies.
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Affiliation(s)
- Sebastian Domsch
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Germany.
| | - Moritz B Mie
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Medical Faculty Mannheim, Heidelberg University, Germany
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Pannetier NA, Sohlin M, Christen T, Schad L, Schuff N. Numerical modeling of susceptibility-related MR signal dephasing with vessel size measurement: phantom validation at 3T. Magn Reson Med 2013; 72:646-58. [PMID: 24167116 DOI: 10.1002/mrm.24968] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 08/05/2013] [Accepted: 09/04/2013] [Indexed: 11/09/2022]
Abstract
PURPOSE MRI is used to obtain quantitative oxygenation and blood volume information from the susceptibility-related MR signal dephasing induced by blood vessels. However, analytical models that fit the MR signal are usually not accurate over the range of small blood vessels. Moreover, recent studies have demonstrated limitations in the simultaneous assessment of oxygenation and blood volume. In this study, a multiparametric MRI framework that aims to measure vessel radii in addition to magnetic susceptibility and volume fraction was introduced. METHODS The protocol consisted of gradient-echo sampling of the spin-echo, diffusion, T2, and B0 acquisitions. After correction steps, the data were postprocessed with a versatile numerical model of the MR signal. An important analytical model was implemented for comparison. The approach was validated in phantoms with coiling strings as proxy for blood vessels. RESULTS The feasibility of the vessel radius measurement is demonstrated. The numerical model shows an improved accuracy compared with the analytical approach. However, both methods overestimate the radius. The simultaneous measurement of the magnetic susceptibility and the volume fraction remains challenging. CONCLUSION The results suggest that this approach could be interesting in vivo to better characterize the microvasculature without contrast agent.
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Affiliation(s)
- Nicolas A Pannetier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Center for Imaging of Neurodegenerative Diseases, Department of Veterans Affairs Medical Center, San Francisco, California, USA
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