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Indoria A, Kulanthaivelu K, Prasad C, Srinivas D, Rao S, Sinha N, Potluri V, Netravathi M, Nalini A, Saini J. Radiomics features for the discrimination of tuberculomas from high grade gliomas and metastasis: a multimodal study. Neuroradiology 2024:10.1007/s00234-024-03435-7. [PMID: 39102087 DOI: 10.1007/s00234-024-03435-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/18/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Tuberculomas are prevalent in developing countries and demonstrate variable signals on MRI resulting in the overlap of the conventional imaging phenotype with other entities including glioma and brain metastasis. An accurate MRI diagnosis is important for the early institution of anti-tubercular therapy, decreased patient morbidity, mortality, and prevents unnecessary neurosurgical excision. This study aims to assess the potential of radiomics features of regular contrast images including T1W, T2W, T2W FLAIR, T1W post contrast images, and ADC maps, to differentiate between tuberculomas, high-grade-gliomas and metastasis, the commonest intra parenchymal mass lesions encountered in the clinical practice. METHODS This retrospective study includes 185 subjects. Images were resampled, co-registered, skull-stripped, and zscore-normalized. Automated lesion segmentation was performed followed by radiomics feature extraction, train-test split, and features reduction. All machine learning algorithms that natively support multiclass classification were trained and assessed on features extracted from individual modalities as well as combined modalities. Model explainability of the best performing model was calculated using the summary plot obtained by SHAP values. RESULTS Extra tree classifier trained on the features from ADC maps was the best classifier for the discrimination of tuberculoma from high-grade-glioma and metastasis with AUC-score of 0.96, accuracy-score of 0.923, Brier-score of 0.23. CONCLUSION This study demonstrates that radiomics features are effective in discriminating between tuberculoma, metastasis, and high-grade-glioma with notable accuracy and AUC scores. Features extracted from the ADC maps surfaced as the most robust predictors of the target variable.
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Affiliation(s)
- Abhilasha Indoria
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Neelam Sinha
- Centre for Brain Research, Indian Institute of Science Campus, Bengaluru, Karnataka, India
| | - Vivek Potluri
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, 560029, India.
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Muthukrishnan V, Jaipurkar S, Damodaran N. Continuum topological derivative - a novel application tool for denoising CT and MRI medical images. BMC Med Imaging 2024; 24:182. [PMID: 39048968 PMCID: PMC11267933 DOI: 10.1186/s12880-024-01341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND CT and MRI modalities are important diagnostics tools for exploring the anatomical and tissue properties, respectively of the human beings. Several advancements like HRCT, FLAIR and Propeller have advantages in diagnosing the diseases very accurately, but still have enough space for improvements due to the presence of inherent and instrument noises. In the case of CT and MRI, the quantum mottle and the Gaussian and Rayleigh noises, respectively are still present in their advanced modalities of imaging. This paper addresses the denoising problem with continuum topological derivative technique and proved its trustworthiness based on the comparative study with other traditional filtration methods such as spatial, adaptive, frequency and transformation techniques using measures like visual inspection and performance metrics. METHODS This research study focuses on identifying a novel method for denoising by testing different filters on HRCT (High-Resolution Computed Tomography) and MR (Magnetic Resonance) images. The images were acquired from the Image Art Radiological Scan Centre using the SOMATOM CT and SIGNA Explorer (operating at 1.5 Tesla) machines. To compare the performance of the proposed CTD (Continuum Topological Derivative) method, various filters were tested on both HRCT and MR images. The filters tested for comparison were Gaussian (2D convolution operator), Wiener (deconvolution operator), Laplacian and Laplacian diagonal (2nd order partial differential operator), Average, Minimum, and Median (ordinary spatial operators), PMAD (Anisotropic diffusion operator), Kuan (statistical operator), Frost (exponential convolution operator), and HAAR Wavelet (time-frequency operator). The purpose of the study was to evaluate the effectiveness of the CTD method in removing noise compared to the other filters. The performance metrics were analyzed to assess the diligence of noise removal achieved by the CTD method. The primary outcome of the study was the removal of quantum mottle noise in HRCT images, while the secondary outcome focused on removing Gaussian (foreground) and Rayleigh (background) noise in MR images. The study aimed to observe the dynamics of noise removal by examining the values of the performance metrics. In summary, this study aimed to assess the denoising ability of various filters in HRCT and MR images, with the CTD method being the proposed approach. The study evaluated the performance of each filter using specific metrics and compared the results to determine the effectiveness of the CTD method in removing noise from the images. RESULTS Based on the calculated performance metric values, it has been observed that the CTD method successfully removed quantum mottle noise in HRCT images and Gaussian as well as Rayleigh noise in MRI. This can be evidenced by the PSNR (Peak Signal-to-Noise Ratio) metric, which consistently exhibited values ranging from 50 to 65 for all the tested images. Additionally, the CTD method demonstrated remarkably low residual values, typically on the order of e-09, which is a distinctive characteristic across all the images. Furthermore, the performance metrics of the CTD method consistently outperformed those of the other tested methods. Consequently, the results of this study have significant implications for the quality, structural similarity, and contrast of HRCT and MR images, enabling clinicians to obtain finer details for diagnostic purposes. CONCLUSION Continuum topological derivative algorithm is found to be constructive in removing prominent noises in both CT and MRI images and can serve as a potential tool for recognition of anatomical details in case of diseased and normal ones. The results obtained from this research work are highly inspiring and offer great promise in obtaining accurate diagnostic information for critical cases such as Thoracic Cavity Carina, Brain SPI Globe Lens 4th Ventricle, Brain-Middle Cerebral Artery, Brain-Middle Cerebral Artery and neoplastic lesions. These findings lay the foundation for implementing the proposed CTD technique in routine clinical diagnosis.
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Affiliation(s)
- Viswanath Muthukrishnan
- Central Instrumentation & Service Laboratory, Guindy Campus, University of Madras, Chennai, India
| | | | - Nedumaran Damodaran
- Central Instrumentation & Service Laboratory, Guindy Campus, University of Madras, Chennai, India.
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Lee J, Chen MM, Liu HL, Ucisik FE, Wintermark M, Kumar VA. MR Perfusion Imaging for Gliomas. Magn Reson Imaging Clin N Am 2024; 32:73-83. [PMID: 38007284 DOI: 10.1016/j.mric.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Accurate diagnosis and treatment evaluation of patients with gliomas is imperative to make clinical decisions. Multiparametric MR perfusion imaging reveals physiologic features of gliomas that can help classify them according to their histologic and molecular features as well as distinguish them from other neoplastic and nonneoplastic entities. It is also helpful in distinguishing tumor recurrence or progression from radiation necrosis, pseudoprogression, and pseudoresponse, which is difficult with conventional MR imaging. This review provides an update on MR perfusion imaging for the diagnosis and treatment monitoring of patients with gliomas following standard-of-care chemoradiation therapy and other treatment regimens such as immunotherapy.
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Affiliation(s)
- Jina Lee
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Melissa M Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - F Eymen Ucisik
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Max Wintermark
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX 77030, USA.
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Chaganti SS, Sidhom G, Chaganti J. Multiparametric imaging in the evaluation of intracerebral abscesses. Pract Neurol 2023; 23:376-385. [PMID: 37248041 DOI: 10.1136/pn-2023-003694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/31/2023]
Abstract
Cerebral abscesses are uncommon space occupying lesions; they are associated with high morbidity and mortality, though are potentially treatable. Patients often present with non-specific symptoms and may have few clinical signs. Routine clinical imaging may not give a definite diagnosis, as the findings can be indistinguishable from those of other intracranial mass lesions. We review the role of advanced MR techniques to characterise brain abscesses and discuss the role of imaging in monitoring their response to the treatment.
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Affiliation(s)
- Sai Sivananda Chaganti
- Fellow, Department of Neurology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - George Sidhom
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
| | - Joga Chaganti
- Department of Radiology, St Vincent's Health Australia Ltd, Sydney, New South Wales, Australia
- Department of Radiology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia
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Wang H, Yan R, Li Z, Wang B, Jin X, Guo Z, Liu W, Zhang M, Wang K, Guo J, Han D. Quantitative dynamic contrast-enhanced parameters and intravoxel incoherent motion facilitate the prediction of TP53 status and risk stratification of early-stage endometrial carcinoma. Radiol Oncol 2023; 57:257-269. [PMID: 37341203 DOI: 10.2478/raon-2023-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/06/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND The aim of the study was to investigate the value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and intravoxel incoherent motion (IVIM) in differentiating TP53-mutant from wild type, low-risk from non-low-risk early-stage endometrial carcinoma (EC). PATIENTS AND METHODS A total of 74 EC patients underwent pelvic MRI. Parameters volume transfer constant (Ktrans), rate transfer constant (Kep), the volume of extravascular extracellular space per unit volume of tissue (Ve), true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and microvascular volume fraction (f) were compared. The combination of parameters was investigated by logistic regression and evaluated by bootstrap (1000 samples), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA). RESULTS In the TP53-mutant group, Ktrans and Kep were higher and D was lower than in the TP53-wild group; Ktrans, Ve, f, and D were lower in the non-low-risk group than in the low-risk group (all P < 0.05). In the identification of TP53-mutant and TP53-wild early-stage EC, Ktrans and D were independent predictors, and the combination of them had an optimal diagnostic efficacy (AUC, 0.867; sensitivity, 92.00%; specificity, 80.95%), which was significantly better than D (Z = 2.169, P = 0.030) and Ktrans (Z = 2.572, P = 0.010). In the identification of low-risk and non-low-risk early-stage EC, Ktrans, Ve, and f were independent predictors, and the combination of them had an optimal diagnostic efficacy (AUC, 0.947; sensitivity, 83.33%; specificity, 93.18%), which was significantly better than D (Z = 3.113, P = 0.002), f (Z = 4.317, P < 0.001), Ktrans (Z = 2.713, P = 0.007), and Ve (Z = 3.175, P = 0.002). The calibration curves showed that the above two combinations of independent predictors, both have good consistency, and DCA showed that these combinations were reliable clinical prediction tools. CONCLUSIONS Both DCE-MRI and IVIM facilitate the prediction of TP53 status and risk stratification in early-stage EC. Compare with each single parameter, the combination of independent predictors provided better predictive power and may serve as a superior imaging marker.
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Affiliation(s)
- Hongxia Wang
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Ruifang Yan
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Zhong Li
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Beiran Wang
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Xingxing Jin
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Zhenfang Guo
- Department of Neurology, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Wangyi Liu
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Meng Zhang
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
| | - Kaiyu Wang
- MR Research China, GE Healthcare, Beijing, China
| | - Jinxia Guo
- MR Research China, GE Healthcare, Beijing, China
| | - Dongming Han
- Department of MR, the First Affiliated Hospital of Xinxiang Medical University, Weihui, China
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Sharma S, Saini J, Khanna G, Goyal A, Mahadevan A, Deora H, Gupta RK. Varied imaging and clinical presentations of acute bacterial cerebritis. Emerg Radiol 2022; 29:791-799. [PMID: 35482173 DOI: 10.1007/s10140-022-02051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
Infectious diseases affecting the central nervous system remain an important cause of morbidity and mortality in developing countries and in immunocompromised patients. Cerebritis refers to pyogenic inflammation of the brain parenchyma that may lead to abscess formation if left untreated. Cerebritis is an uncommon diagnosis as patients are usually diagnosed at the stage of abscess formation. We present three cases of bacterial cerebritis with different clinical manifestations and varied appearances on MRI. To our knowledge, only few case reports of bacterial cerebritis have been published in the literature, and imaging findings are not fully elucidated. These cases of bacterial cerebritis add valuable information to the existing literature and would be helpful in making the appropriate diagnosis of this uncommon condition that can be medically managed if diagnosed appropriately. We recommend that cerebritis should be considered in the differential diagnosis of such lesions.
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Affiliation(s)
- Shalini Sharma
- Department of Radiology, Fortis Memorial Research Institute, Gurugram, Haryana, 122001, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Gaurav Khanna
- Department of Pathology, SRL Diagnostics Ltd, Gurugram, Haryana, India
| | - Aditi Goyal
- Department of Neuropathology, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Harsh Deora
- Department of Neurosurgery, National Institute for Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Rakesh K Gupta
- Department of Radiology, Fortis Memorial Research Institute, Gurugram, Haryana, 122001, India.
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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Vanherp L, Govaerts K, Riva M, Poelmans J, Coosemans A, Lagrou K, Gsell W, Vande Velde G, Himmelreich U. CryptoCEST: A promising tool for spatially resolved identification of fungal brain lesions and their differentiation from brain tumors with MRI. NEUROIMAGE-CLINICAL 2021; 31:102737. [PMID: 34225021 PMCID: PMC8261661 DOI: 10.1016/j.nicl.2021.102737] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 02/01/2023]
Abstract
The fungal disaccharide trehalose generates a concentration-dependent CEST MRI contrast. CEST MRI can detect endogenous trehalose in Cryptococcus neoformans and C. gattii cells. This enables spatially resolved identification of fungal lesions in the mouse brain. The CryptoCEST contrast can differentiate cryptococcal brain lesions from gliomas. CryptoCEST holds potential for non-invasive differential diagnosis of cryptococcomas.
Infectious brain lesions caused by the pathogenic fungi Cryptococcus neoformans and C. gattii, also referred to as cryptococcomas, could be diagnosed incorrectly as cystic brain tumors if only based on conventional magnetic resonance (MR) images. Previous MR spectroscopy (MRS) studies showed high local concentrations of the fungal disaccharide trehalose in cryptococcomas. The aim of this study was to detect and localize fungal brain lesions caused by Cryptococcus species based on Chemical Exchange Saturation Transfer (CEST) MR imaging of endogenous trehalose, and hereby to distinguish cryptococcomas from gliomas. In phantoms, trehalose and cryptococcal cells generated a concentration-dependent CEST contrast in the 0.2 – 2 ppm chemical shift range, similar to glucose, but approximately twice as strong. In vivo single voxel MRS of a murine cryptococcoma model confirmed the presence of trehalose in cryptococcomas, but mainly for lesions that were large enough compared to the size of the MRS voxel. With CEST MRI, combining the more specific CEST signal at 0.7 ppm with the higher signal-to-noise ratio signal at 4 ppm in the CryptoCEST contrast enabled localization and distinction of cryptococcomas from the normal brain and from gliomas, even for lesions smaller than 1 mm3. Thanks to the high endogenous concentration of the fungal biomarker trehalose in cryptococcal cells, the CryptoCEST contrast allowed identification of cryptococcomas with high spatial resolution and differentiation from gliomas in mice. Furthermore, the CryptoCEST contrast was tested to follow up antifungal treatment of cryptococcomas. Translation of this non-invasive method to the clinic holds potential for improving the differential diagnosis and follow-up of cryptococcal infections in the brain.
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Affiliation(s)
- Liesbeth Vanherp
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Kristof Govaerts
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Matteo Riva
- Laboratory of Tumor Immunology and Immunotherapy, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium; Department of Neurosurgery, Mont-Godinne Hospital, UCL Namur, Yvoir, Belgium
| | - Jennifer Poelmans
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - An Coosemans
- Laboratory of Tumor Immunology and Immunotherapy, Department of Oncology, Leuven Cancer Institute, KU Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Laboratory of Clinical Bacteriology and Mycology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium; National Reference Centre for Mycosis, Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Willy Gsell
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Greetje Vande Velde
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Uwe Himmelreich
- Biomedical MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium.
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Kumar S, Singh P, Vyas S, Modi M, Agarwal V, Goyal MK, Sankhyan N. Assessment of Blood-Brain Barrier Integrity in Tuberculous Meningitis Using Dynamic Contrast-Enhanced MR Perfusion. Indian J Radiol Imaging 2021; 31:30-36. [PMID: 34316109 PMCID: PMC8299480 DOI: 10.1055/s-0041-1729119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Tuberculous meningitis (TBM) is the most common form of central nervous system tuberculosis. The aim of the study was to quantitatively evaluate blood-brain barrier (BBB) perfusion changes in TBM patients using dynamic contrast-enhanced (DCE) MR perfusion. Methods and Material Thirty untreated patients of TBM and 10 healthy controls were prospectively evaluated by conventional imaging and DCE MR perfusion. Mean permeability indices- K trans and Ve-were calculated from multiple regions of interest (ROIs) placed in basal cisterns and comparison was done between the patients and controls. Results The permeability indices were significantly higher (where p < 0.001) in cisterns of TBM patients who showed basal meningeal enhancement when compared with healthy controls. Significant differences in permeability were observed between "enhancing" cases and controls as well as in "enhancing" cases when compared with the "non-enhancing" cases. However, no significant difference was observed in the mean cisternal value between "non-enhancing" cases and the controls. K trans with a cutoff value of > 0.0838 had 81.6% sensitivity and 78.6% specificity in differentiating cases and controls while V e mean value with a cutoff value of 0.0703 showed 86.8% sensitivity and 91.4% specificity in predicting the permeability difference between the cases and controls. Conclusion DCE MR perfusion is useful in the quantitative measurement of disruption of BBB and perfusion alterations in patients of TBM.
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Affiliation(s)
- Shruti Kumar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Paramjeet Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sameer Vyas
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manish Modi
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vivek Agarwal
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manoj Kumar Goyal
- Department of Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatric Neurology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rehman MU, Cho S, Kim J, Chong KT. BrainSeg-Net: Brain Tumor MR Image Segmentation via Enhanced Encoder-Decoder Network. Diagnostics (Basel) 2021; 11:diagnostics11020169. [PMID: 33504047 PMCID: PMC7911842 DOI: 10.3390/diagnostics11020169] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/15/2021] [Accepted: 01/22/2021] [Indexed: 11/28/2022] Open
Abstract
Efficient segmentation of Magnetic Resonance (MR) brain tumor images is of the utmost value for the diagnosis of tumor region. In recent years, advancement in the field of neural networks has been used to refine the segmentation performance of brain tumor sub-regions. The brain tumor segmentation has proven to be a complicated task even for neural networks, due to the small-scale tumor regions. These small-scale tumor regions are unable to be identified, the reason being their tiny size and the huge difference between area occupancy by different tumor classes. In previous state-of-the-art neural network models, the biggest problem was that the location information along with spatial details gets lost in deeper layers. To address these problems, we have proposed an encoder–decoder based model named BrainSeg-Net. The Feature Enhancer (FE) block is incorporated into the BrainSeg-Net architecture which extracts the middle-level features from low-level features from the shallow layers and shares them with the dense layers. This feature aggregation helps to achieve better performance of tumor identification. To address the problem associated with imbalance class, we have used a custom-designed loss function. For evaluation of BrainSeg-Net architecture, three benchmark datasets are utilized: BraTS2017, BraTS 2018, and BraTS 2019. Segmentation of Enhancing Core (EC), Whole Tumor (WT), and Tumor Core (TC) is carried out. The proposed architecture have exhibited good improvement when compared with existing baseline and state-of-the-art techniques. The MR brain tumor segmentation by BrainSeg-Net uses enhanced location and spatial features, which performs better than the existing plethora of brain MR image segmentation approaches.
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Affiliation(s)
- Mobeen Ur Rehman
- Department of Electronics and Information Engineering, Jeonbuk National University, Jeonju 54896, Korea; (M.U.R.); (S.C.)
- Department of Avionics Engineering, Air University, Islamabad 44000, Pakistan
| | - SeungBin Cho
- Department of Electronics and Information Engineering, Jeonbuk National University, Jeonju 54896, Korea; (M.U.R.); (S.C.)
| | - Jeehong Kim
- Department of New & Renewable Energy, VISION College of Jeonju, Jeonju 55069, Korea
- Correspondence: (J.K.); (K.T.C.)
| | - Kil To Chong
- Department of Electronics and Information Engineering, Jeonbuk National University, Jeonju 54896, Korea; (M.U.R.); (S.C.)
- Advanced Electronics and Information Research Center, Jeonbuk National University, Jeonju 54896, Korea
- Correspondence: (J.K.); (K.T.C.)
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Soni N, Kumar S, Srindharan K, Mishra P, Gupta N, Bathla G, kalita J, Behari S. Comparative Evaluation of Brain Tuberculosis and Metastases Using Combined Analysis of Arterial Spin Labeling Perfusion and Diffusion Tensor Imaging. Curr Probl Diagn Radiol 2019; 48:547-553. [DOI: 10.1067/j.cpradiol.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/17/2018] [Accepted: 09/28/2018] [Indexed: 11/22/2022]
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Inglese M, Ordidge KL, Honeyfield L, Barwick TD, Aboagye EO, Waldman AD, Grech-Sollars M. Reliability of dynamic contrast-enhanced magnetic resonance imaging data in primary brain tumours: a comparison of Tofts and shutter speed models. Neuroradiology 2019; 61:1375-1386. [PMID: 31392385 PMCID: PMC6848046 DOI: 10.1007/s00234-019-02265-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/12/2019] [Indexed: 12/12/2022]
Abstract
Purpose The purpose of this study is to investigate the robustness of pharmacokinetic modelling of DCE-MRI brain tumour data and to ascertain reliable perfusion parameters through a model selection process and a stability test. Methods DCE-MRI data of 14 patients with primary brain tumours were analysed using the Tofts model (TM), the extended Tofts model (ETM), the shutter speed model (SSM) and the extended shutter speed model (ESSM). A no-effect model (NEM) was implemented to assess overfitting of data by the other models. For each lesion, the Akaike Information Criteria (AIC) was used to build a 3D model selection map. The variability of each pharmacokinetic parameter extracted from this map was assessed with a noise propagation procedure, resulting in voxel-wise distributions of the coefficient of variation (CV). Results The model selection map over all patients showed NEM had the best fit in 35.5% of voxels, followed by ETM (32%), TM (28.2%), SSM (4.3%) and ESSM (< 0.1%). In analysing the reliability of Ktrans, when considering regions with a CV < 20%, ≈ 25% of voxels were found to be stable across all patients. The remaining 75% of voxels were considered unreliable. Conclusions The majority of studies quantifying DCE-MRI data in brain tumours only consider a single model and whole tumour statistics for the output parameters. Appropriate model selection, considering tissue biology and its effects on blood brain barrier permeability and exchange conditions, together with an analysis on the reliability and stability of the calculated parameters, is critical in processing robust brain tumour DCE-MRI data.
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Affiliation(s)
- Marianna Inglese
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.
| | | | - Lesley Honeyfield
- Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Tara D Barwick
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
| | - Eric O Aboagye
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Adam D Waldman
- Department of Medicine, Imperial College London, London, UK.,Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Matthew Grech-Sollars
- Department of Surgery and Cancer, GN1 Commonwealth building, Hammersmith Hospital, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Department of Imaging, Imperial College Healthcare NHS Trust, London, UK
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13
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Lakshmi A, Choudary GPV, Bodagala VD, Chandra VVR, Thota N, Chowhan A. Perfusion-weighted imaging in differentiating ring-enhancing lesions in brain. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2019. [DOI: 10.4103/jdrntruhs.jdrntruhs_63_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Lin L, Chen X, Jiang R, Zhong T, Du X, Xu G, Duan Q, Xue Y. Differentiation between vestibular schwannomas and meningiomas with atypical appearance using diffusion kurtosis imaging and three-dimensional arterial spin labeling imaging. Eur J Radiol 2018; 109:13-18. [DOI: 10.1016/j.ejrad.2018.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/06/2018] [Accepted: 10/11/2018] [Indexed: 02/08/2023]
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15
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Woodall RT, Barnes SL, Hormuth DA, Sorace AG, Quarles CC, Yankeelov TE. The effects of intravoxel contrast agent diffusion on the analysis of DCE-MRI data in realistic tissue domains. Magn Reson Med 2018; 80:330-340. [PMID: 29115690 PMCID: PMC5876107 DOI: 10.1002/mrm.26995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/17/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE Quantitative evaluation of dynamic contrast enhanced MRI (DCE-MRI) allows for estimating perfusion, vessel permeability, and tissue volume fractions by fitting signal intensity curves to pharmacokinetic models. These compart mental models assume rapid equilibration of contrast agent within each voxel. However, there is increasing evidence that this assumption is violated for small molecular weight gadolinium chelates. To evaluate the error introduced by this invalid assumption, we simulated DCE-MRI experiments with volume fractions computed from entire histological tumor cross-sections obtained from murine studies. METHODS A 2D finite element model of a diffusion-compensated Tofts-Kety model was developed to simulate dynamic T1 signal intensity data. Digitized histology slices were segmented into vascular (vp ), cellular and extravascular extracellular (ve ) volume fractions. Within this domain, Ktrans (the volume transfer constant) was assigned values from 0 to 0.5 min-1 . A representative signal enhancement curve was then calculated for each imaging voxel and the resulting simulated DCE-MRI data analyzed by the extended Tofts-Kety model. RESULTS Results indicated parameterization errors of -19.1% ± 10.6% in Ktrans , -4.92% ± 3.86% in ve , and 79.5% ± 16.8% in vp for use of Gd-DTPA over 4 tumor domains. CONCLUSION These results indicate a need for revising the standard model of DCE-MRI to incorporate a correction for slow diffusion of contrast agent. Magn Reson Med 80:330-340, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Ryan T. Woodall
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78732,Center for Computational Oncology, Institute for Computational and Engineering Sciences, The University of Texas at Austin, Austin, Texas 78732
| | - Stephanie L. Barnes
- Center for Computational Oncology, Institute for Computational and Engineering Sciences, The University of Texas at Austin, Austin, Texas 78732
| | - David A. Hormuth
- Center for Computational Oncology, Institute for Computational and Engineering Sciences, The University of Texas at Austin, Austin, Texas 78732
| | - Anna G. Sorace
- Department of Internal Medicine, The University of Texas at Austin, Austin, Texas 78732
| | | | - Thomas E. Yankeelov
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas 78732,Department of Internal Medicine, The University of Texas at Austin, Austin, Texas 78732,Center for Computational Oncology, Institute for Computational and Engineering Sciences, The University of Texas at Austin, Austin, Texas 78732,Livestrong Cancer Institutes, The University of Texas at Austin, Austin, Texas 78732
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16
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Soni N, Srindharan K, Kumar S, Mishra P, Bathla G, Kalita J, Behari S. Arterial spin labeling perfusion: Prospective MR imaging in differentiating neoplastic from non-neoplastic intra-axial brain lesions. Neuroradiol J 2018; 31:544-553. [PMID: 29890916 DOI: 10.1177/1971400918783058] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The purpose of this article is to assess the diagnostic performance of arterial spin-labeling (ASL) magnetic resonance perfusion imaging to differentiate neoplastic from non-neoplastic brain lesions. MATERIAL AND METHODS This prospective study included 60 consecutive, newly diagnosed, untreated patients with intra-axial lesions with perilesional edema (PE) who underwent clinical magnetic resonance imaging including ASL sequences at 3T. Region of interest analysis was performed to obtain mean cerebral blood flow (CBF) values from lesion (L), PE and normal contralateral white matter (CWM). Normalized (n) CBF ratio was obtained by dividing the mean CBF value of L and PE by mean CBF value of CWM. Discriminant analyses were performed to determine the best cutoff value of nCBFL and nCBFPE in differentiating neoplastic from non-neoplastic lesions. RESULTS Thirty patients were in the neoplastic group (15 high-grade gliomas (HGGs), 15 metastases) and 30 in the non-neoplastic group (12 tuberculomas, 10 neurocysticercosis, four abscesses, two fungal granulomas and two tumefactive demyelination) based on final histopathology and clincoradiological diagnosis. We found higher nCBFL (6.65 ± 4.07 vs 1.68 ± 0.80, p < 0.001) and nCBFPE (1.86 ± 1.43 vs 0.74 ± 0.21, p < 0.001) values in the neoplastic group than non-neoplastic. For predicting neoplastic lesions, we found an nCBFL cutoff value of 1.89 (AUC 0.917; 95% CI 0.854 to 0.980; sensitivity 90%; specificity 73%) and nCBFPE value of 0.76 (AUC 0.783; 95% CI 0.675 to 0.891; sensitivity 80%; specificity 58%). Mean nCBFL was higher in HGGs (8.70 ± 4.16) compared to tuberculomas (1.98 ± 0.87); and nCBFPE was higher in HGGs (3.06 ± 1.53) compared to metastases (0.86 ± 0.34) and tuberculomas (0.73 ± 0.22) ( p < 0.001). CONCLUSION ASL perfusion may help in distinguishing neoplastic from non-neoplastic brain lesions.
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Affiliation(s)
- Neetu Soni
- 1 Neuroradiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Karthika Srindharan
- 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Sunil Kumar
- 2 Department of Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- 3 Department of Biostatistics and Health Informatics, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Girish Bathla
- 1 Neuroradiology Department, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jyantee Kalita
- 4 Department of Neurology, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- 5 Department of Neurosurgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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17
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Differentiation of brain infection from necrotic glioblastoma using combined analysis of diffusion and perfusion MRI. J Magn Reson Imaging 2018; 49:184-194. [DOI: 10.1002/jmri.26053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
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18
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Lin L, Xue Y, Duan Q, Sun B, Lin H, Huang X, Chen X. The role of cerebral blood flow gradient in peritumoral edema for differentiation of glioblastomas from solitary metastatic lesions. Oncotarget 2018; 7:69051-69059. [PMID: 27655705 PMCID: PMC5356611 DOI: 10.18632/oncotarget.12053] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/02/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Differentiation of glioblastomas from solitary brain metastases using conventional MRI remains an important unsolved problem. In this study, we introduced the conception of the cerebral blood flow (CBF) gradient in peritumoral edema-the difference in CBF values from the proximity of the enhancing tumor to the normal-appearing white matter, and investigated the contribution of perfusion metrics on the discrimination of glioblastoma from a metastatic lesion. MATERIALS AND METHODS Fifty-two consecutive patients with glioblastoma or a solitary metastatic lesion underwent three-dimensional arterial spin labeling (3D-ASL) before surgical resection. The CBF values were measured in the peritumoral edema (near: G1; Intermediate: G2; Far: G3). The CBF gradient was calculated as the subtractions CBFG1 -CBFG3, CBFG1 - CBFG2 and CBFG2 - CBFG3. A receiver operating characteristic (ROC) curve analysis was used to seek for the best cutoff value permitting discrimination between these two tumors. RESULTS The absolute/related CBF values and the CBF gradient in the peritumoral regions of glioblastomas were significantly higher than those in metastases(P < 0.038). ROC curve analysis reveals, a cutoff value of 1.92 ml/100g for the CBF gradient of CBFG1 -CBFG3 generated the best combination of sensitivity (92.86%) and specificity (100.00%) for distinguishing between a glioblastoma and metastasis. CONCLUSION The CBF gradient in peritumoral edema appears to be a more promising ASL perfusion metrics in differentiating high grade glioma from a solitary metastasis.
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Affiliation(s)
- Lin Lin
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yunjing Xue
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Qing Duan
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Bin Sun
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hailong Lin
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xinming Huang
- Department of Radiology, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaodan Chen
- Department of Radiology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China
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19
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Di N, Yao C, Cheng W, Ren Y, Qu J, Wang B, Yao Z. Correlation of dynamic contrast-enhanced MRI derived volume transfer constant with histological angiogenic markers in high-grade gliomas. J Med Imaging Radiat Oncol 2018; 62:464-470. [PMID: 29330968 DOI: 10.1111/1754-9485.12701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To ascertain if the volume transfer constant (Ktrans ) derived from T1 dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) correlates with the immunohistological markers of angiogenesis in high-grade gliomas. METHODS Fifty-one image-guided biopsy specimens in 34 patients with newly presenting high-grade gliomas (grade III = 16; grade IV = 18) underwent preoperative imaging (conventional imaging and T1 DCE-MRI). We correlated vascular endothelial growth factor (VEGF) expression and the microvessel density (MVD) of MRI-guided biopsy specimens with the corresponding DCE-derived Ktrans . Histological sections were stained with VEGF and CD34, and examined under light microscopy. These histological and molecular markers of angiogenesis were correlated with the Ktrans of the region of interest corresponding to the biopsy specimen. RESULTS The Ktrans showed a significant positive correlation with VEGF expression (ρ = 0.582, P = 0.001) but not with MVD stained with CD34 antibody (ρ = 0.328, P = 0.072). CONCLUSION The Ktrans derived from DCE-MRI can reflect the VEGF expression of high-grade gliomas but not the MVD.
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Affiliation(s)
- Ningning Di
- Department of Radiology, Binzhou Medical University Hospital, Binzhou, China
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | - Chenjun Yao
- Department of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China
| | - Wenna Cheng
- Department of Pharmacy, Binzhou Medical University Affiliated Hospital, Binzhou, China
| | - Yan Ren
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | | | - Bin Wang
- Department of Medical Imaging and Nuclear Medicine, Binzhou Medical University, Yantai, China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
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20
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Abrahamov D, Levran O, Naparstek S, Refaeli Y, Kaptson S, Abu Salah M, Ishai Y, Sahar G. Blood-Brain Barrier Disruption After Cardiopulmonary Bypass: Diagnosis and Correlation to Cognition. Ann Thorac Surg 2017; 104:161-169. [PMID: 28193536 DOI: 10.1016/j.athoracsur.2016.10.043] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiopulmonary bypass (CPB) elicits a systemic inflammatory response that may impair blood-brain barrier (BBB) integrity. BBB disruption can currently be detected by dynamic contrast enhancement magnetic resonance imaging (MRI), reflected by an increase in the permeability constant (Ktrans). We aimed to determine (1) whether CPB induces BBB disruption, (2) duration until BBB disruption resolution, and (3) the obtainable correlation between BBB injury (location and intensity) and neurocognitive dysfunction. METHODS Seven patients undergoing CPB with coronary artery bypass grafting (CABG) were assigned to serial cerebral designated MRI evaluations, preoperatively and on postoperative day (POD) 1 and 5. Examinations were analyzed for BBB disruption and microemboli using dynamic contrast enhancement MRI and diffusion-weighted imaging methods, respectively. Neuropsychologic tests were performed 1 day preoperatively and on POD 5. RESULTS A significant local Ktrans increase (0.03 min-1 vs 0.07 min-1, p = 0.033) compatible with BBB disruption was evident in 5 patients (71%) on POD 1. Resolution was observed by POD 5 (mean, 0.012 min-1). The location of the disruption was most prominent in the frontal lobes (400% vs 150% Ktrans levels upsurge, p = 0.05). MRI evidence of microembolization was demonstrated in only 1 patient (14%). The postoperative global cognitive score was reduced in all patients (98.2 ± 12 vs 95.1 ± 11, p = 0.032), predominantly in executive and attention (frontal lobe-related) functions (91.8 ± 13 vs 86.9 ± 12, p = 0.042). The intensity of the dynamic contrast enhancement MRI BBB impairment correlated with the magnitude of cognition reduction (r = 0.69, p = 0.04). CONCLUSIONS BBB disruption was evident in most patients, primarily in the frontal lobes. The location and intensity of the BBB disruption, rather than the microembolic load, correlated with postoperative neurocognitive dysfunction.
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Affiliation(s)
- Dan Abrahamov
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
| | - Oren Levran
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sharon Naparstek
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yael Refaeli
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shani Kaptson
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Mahmud Abu Salah
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yaron Ishai
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
| | - Gideon Sahar
- Department of Cardiothoracic Surgery, Soroka University Medical Center, Beer-Sheva, Israel
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21
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Dibble EH, Boxerman JL, Baird GL, Donahue JE, Rogg JM. Toxoplasmosis versus lymphoma: Cerebral lesion characterization using DSC-MRI revisited. Clin Neurol Neurosurg 2016; 152:84-89. [PMID: 27940418 DOI: 10.1016/j.clineuro.2016.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/21/2016] [Accepted: 11/30/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE CNS toxoplasmosis and lymphoma are often indistinguishable by conventional contrast-enhanced MRI. There is limited literature on the diagnostic efficacy of dynamic susceptibility contrast (DSC) MRI for differentiating these entities. This study assesses the clinical utility of relative cerebral blood volume (rCBV) for making a diagnosis and determines rCBV thresholds for differentiation using contemporary DSC-MRI. PATIENTS AND METHODS Thirteen patients with 25 lesions (13 toxoplasmosis and 12 lymphoma) and pre-treatment DSC-MRI were identified retrospectively. Volumetric regions of interest of segmented enhancement were used to extract mean rCBV normalized to normal-appearing white matter for each lesion. We compared average mean rCBV between all toxoplasmosis and lymphoma lesions using a general mixed model. Three models were also compared for evaluating rCBV-based disease status in each patient: 1) mean rCBV of each lesion using a generalized estimating equation, 2) volume-weighted mean rCBV, and 3) maximum mean rCBV of all lesions using logistic regression. RESULTS The average mean rCBV for all toxoplasmosis lesions was 0.98 (95% CI 0.55-1.41) compared to 2.07 (95% CI 1.71-2.43) for all lymphoma lesions, a significant difference (1.09, 95% CI 0.53-1.65, p=0.0013). For the three models used to evaluate rCBV-based disease status in each patient, a significant relationship was observed, with an optimal rCBV threshold of approximately 1.5 for distinguishing lymphoma from toxoplasmosis in each model. CONCLUSION RCBV derived from contemporary DSC-MRI is helpful for distinguishing between cerebral toxoplasmosis and cerebral lymphoma on an individual patient basis and may facilitate more timely initiation of appropriate directed therapy.
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Affiliation(s)
- Elizabeth H Dibble
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jerrold L Boxerman
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Grayson L Baird
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - John E Donahue
- Rhode Island Hospital, Department of Neuropathology, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
| | - Jeffrey M Rogg
- Rhode Island Hospital, Department of Diagnostic Imaging, 593 Eddy Street, Providence, RI, 02903, United States; The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI, 02903, United States.
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22
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Kim R, Choi SH, Yun TJ, Lee ST, Park CK, Kim TM, Kim JH, Park SW, Sohn CH, Park SH, Kim IH. Prognosis prediction of non-enhancing T2 high signal intensity lesions in glioblastoma patients after standard treatment: application of dynamic contrast-enhanced MR imaging. Eur Radiol 2016; 27:1176-1185. [PMID: 27357131 DOI: 10.1007/s00330-016-4464-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 05/30/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To identify candidate imaging biomarkers for early disease progression in glioblastoma multiforme (GBM) patients by analysis of dynamic contrast-enhanced (DCE) MR parameters of non-enhancing T2 high signal intensity (SI) lesions. METHODS Forty-nine GBM patients who had undergone preoperative DCE MR imaging and received standard treatment were retrospectively included. According to the Response Assessment in Neuro-Oncology criteria, patients were classified into progression (n = 21) or non-progression (n = 28) groups. We analysed the pharmacokinetic parameters of Ktrans, Ve and Vp within non-enhancing T2 high SI lesions of each tumour. The best percentiles of each parameter from cumulative histograms were identified by the area under the receiver operating characteristic curve (AUC) and were compared using multivariate stepwise logistic regression. RESULTS For the differentiation of early disease progression, the highest AUC values were found in the 99th percentile of Ktrans (AUC 0.954), the 97th percentile of Ve (AUC 0.815) and the 94th percentile of Vp (AUC 0.786) (all p < 0.05). The 99th percentile of Ktrans was the only significant independent variable from the multivariate stepwise logistic regression (p = 0.002). CONCLUSIONS We found that the Ktrans of non-enhancing T2 high SI lesions in GBM patients holds potential as a candidate prognostic marker in future prospective studies. KEY POINTS • DCE MR imaging provides candidate prognostic marker of GBM after standard treatment. • Cumulative histogram was applied to include entire non-enhancing T2 high SI lesions. • The 99th percentile value of Ktrans was the most likely potential biomarker.
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Affiliation(s)
- Rihyeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea. .,Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul National University, Daehak-dong, Gwanak-gu, Seoul, 151-742, Republic of Korea. .,School of Chemical and Biological Engineering, Seoul National University, Daehak-dong, Gwanak-gu, Seoul, 151-742, Republic of Korea.
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Sun-Won Park
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
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23
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Yang C, Lee DH, Mangraviti A, Su L, Zhang K, Zhang Y, Zhang B, Li W, Tyler B, Wong J, Wang KKH, Velarde E, Zhou J, Ding K. Quantitative correlational study of microbubble-enhanced ultrasound imaging and magnetic resonance imaging of glioma and early response to radiotherapy in a rat model. Med Phys 2016; 42:4762-72. [PMID: 26233204 DOI: 10.1118/1.4926550] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Radiotherapy remains a major treatment method for malignant tumors. Magnetic resonance imaging (MRI) is the standard modality for assessing glioma treatment response in the clinic. Compared to MRI, ultrasound imaging is low-cost and portable and can be used during intraoperative procedures. The purpose of this study was to quantitatively compare contrast-enhanced ultrasound (CEUS) imaging and MRI of irradiated gliomas in rats and to determine which quantitative ultrasound imaging parameters can be used for the assessment of early response to radiation in glioma. METHODS Thirteen nude rats with U87 glioma were used. A small thinned skull window preparation was performed to facilitate ultrasound imaging and mimic intraoperative procedures. Both CEUS and MRI with structural, functional, and molecular imaging parameters were performed at preradiation and at 1 day and 4 days postradiation. Statistical analysis was performed to determine the correlations between MRI and CEUS parameters and the changes between pre- and postradiation imaging. RESULTS Area under the curve (AUC) in CEUS showed significant difference between preradiation and 4 days postradiation, along with four MRI parameters, T2, apparent diffusion coefficient, cerebral blood flow, and amide proton transfer-weighted (APTw) (all p < 0.05). The APTw signal was correlated with three CEUS parameters, rise time (r = - 0.527, p < 0.05), time to peak (r = - 0.501, p < 0.05), and perfusion index (r = 458, p < 0.05). Cerebral blood flow was correlated with rise time (r = - 0.589, p < 0.01) and time to peak (r = - 0.543, p < 0.05). CONCLUSIONS MRI can be used for the assessment of radiotherapy treatment response and CEUS with AUC as a new technique and can also be one of the assessment methods for early response to radiation in glioma.
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Affiliation(s)
- Chen Yang
- Department of Ultrasound, Zhejiang Cancer Hospital, Hangzhou, Zhejiang 310022, China
| | - Dong-Hoon Lee
- Division of MR Research, Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287
| | - Antonella Mangraviti
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287
| | - Lin Su
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
| | - Kai Zhang
- Division of MR Research, Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287
| | - Yin Zhang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
| | - Bin Zhang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
| | - Wenxiao Li
- Division of MR Research, Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287
| | - Betty Tyler
- Department of Neurosurgery, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
| | - Esteban Velarde
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21287
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, School of Medicine, Baltimore, Maryland 21231
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Wong AMC, Yeh CH, Liu HL, Lin KL, Wang HS, Toh CH. Arterial spin-labeling perfusion imaging of childhood meningitis: a case series. Childs Nerv Syst 2016; 32:563-7. [PMID: 26248672 DOI: 10.1007/s00381-015-2858-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/26/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Conventional magnetic resonance imaging (MRI), which is mainly used to detect complications, is ineffective in determining the neurological status of patients with meningitis. Hemodynamic change in the brain may be more indicative of the neurological status but few imaging studies have verified this. Arterial spin-labeling (ASL) perfusion, a noninvasive MR method requiring no contrast agent injection, can be used to measure cerebral blood flow (CBF). CASE REPORTS We describe three pediatric patients with meningitis, who all showed regions of increased CBF on perfusion imaging. One patient, presenting with headache and conscious disturbance, had CBF changes in the frontal, temporal, and occipital regions. The other two patients, presenting with hallucinations, memory deficits, and seizures, had CBF changes in the frontal and temporal regions. CONCLUSION ASL perfusion imaging may be helpful in assessing patients with meningitis, demonstrating CBF changes more strongly correlating with the neurological status, and detecting active brain abnormalities.
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Affiliation(s)
- Alex Mun-Ching Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelong, Linkou Medical Center and Chang Gung University, 5 Fu-Hsing Street, Tao Yuan, 333, Taiwan
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelong, Linkou Medical Center and Chang Gung University, 5 Fu-Hsing Street, Tao Yuan, 333, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Kuang-Lin Lin
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan
| | - Huei-Shyong Wang
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan
| | - Cheng-Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Keelong, Linkou Medical Center and Chang Gung University, 5 Fu-Hsing Street, Tao Yuan, 333, Taiwan.
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Usinskiene J, Ulyte A, Bjørnerud A, Venius J, Katsaros VK, Rynkeviciene R, Letautiene S, Norkus D, Suziedelis K, Rocka S, Usinskas A, Aleknavicius E. Optimal differentiation of high- and low-grade glioma and metastasis: a meta-analysis of perfusion, diffusion, and spectroscopy metrics. Neuroradiology 2016; 58:339-50. [DOI: 10.1007/s00234-016-1642-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/06/2016] [Indexed: 12/01/2022]
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Hemorrhagic Cerebellar Abscess. World Neurosurg 2016; 88:692.e17-692.e22. [PMID: 26724627 DOI: 10.1016/j.wneu.2015.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/04/2015] [Accepted: 12/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Brain abscess represents a significant medical problem, accounting for 1 in every 10,000 U.S. hospital admissions and imposing a mortality of 17%-32%. Treatment success depends on early diagnosis, allowing for prompt intervention before a potentially catastrophic rupture. However, diagnosis can be difficult because currently no magnetic resonance imaging signal characteristics are pathognomonic. The presence of hemorrhage may further complicate the radiographic detection of an abscess, potentially leading to delayed treatment. CLINICAL PRESENTATION A 71-year-old man was diagnosed with hemorrhagic cerebellar abscess as a complication of groin abscess after cardiac catheterization. After surgical resection of the cerebellar abscess and culture-based antibiotic treatment, the patient suffered repeat hemorrhages into the abscess cavity, of which he died. We describe his clinical course with emphasis on radiology-based differential diagnosis. We also describe the possible pathogenesis of this rare case, based on review of the literature. CONCLUSIONS To our knowledge, this is the first report on recurrent hemorrhages in a cerebellar abscess. Hemorrhagic brain abscess has a complex radiologic appearance, which may delay diagnosis and treatment. A high degree of clinical suspicion is necessary to ensure timely treatment of this potentially lethal lesion.
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Dural Tuberculoma Mimicking Meningioma: A Clinicoradiologic Review of Dural En-Plaque Lesions. World Neurosurg 2015; 88:686.e1-686.e7. [PMID: 26608386 DOI: 10.1016/j.wneu.2015.10.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 10/30/2015] [Accepted: 10/31/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tuberculosis has long been a major health concern in developing countries and now has troubled developed world as well, owing to increase in patients with human immunodeficiency virus and immigration. Central nervous system tuberculosis accounts for approximately 1% of cases of tuberculosis. The pathologic presentation is varied, with intraparenchymal tuberculomas and pachymeningitis being the most common. Being a great mimicker, it simulates numerous diseases radiologically, and this is best realized when atypical forms are encountered. Here an atypical case of dural en-plaque tuberculoma is presented with comprehensive review of dural en-plaque lesions with their differentiating features. CASE REPORT A 20-year-old man presented with features of increased intracranial pressure. On imaging, there was an enhancing dural-based lesion in the left frontoparietal region. In view of herniation syndrome, urgent surgical decompression of the lesion was performed. Histopathology showed features of tuberculosis. The patient is now asymptomatic with antitubercular therapy without any residual lesion at 6 months of follow-up. CONCLUSIONS Tuberculoma en-plaque is an unusual entity characterized by a plaque-like meningitic process without exudation. It is easily confused with meningiomas as can other dural-based lesions comprising benign to malignant neoplastic, infectious, and granulomatous lesions. A preoperative diagnosis is imperative to differentiate it at least from neoplastic lesions, which are usually curable with surgical intervention in contrast to tuberculosis, which needs only optimal chemotherapy in most of the cases. Knowledge of differentiating imaging features, in corroboration with clinical history and high index of suspicion, helps in a proper preoperative diagnosis and optimal patient treatment.
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Khalifa F, Soliman A, El-Baz A, Abou El-Ghar M, El-Diasty T, Gimel'farb G, Ouseph R, Dwyer AC. Models and methods for analyzing DCE-MRI: a review. Med Phys 2015; 41:124301. [PMID: 25471985 DOI: 10.1118/1.4898202] [Citation(s) in RCA: 199] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To present a review of most commonly used techniques to analyze dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), discusses their strengths and weaknesses, and outlines recent clinical applications of findings from these approaches. METHODS DCE-MRI allows for noninvasive quantitative analysis of contrast agent (CA) transient in soft tissues. Thus, it is an important and well-established tool to reveal microvasculature and perfusion in various clinical applications. In the last three decades, a host of nonparametric and parametric models and methods have been developed in order to quantify the CA's perfusion into tissue and estimate perfusion-related parameters (indexes) from signal- or concentration-time curves. These indexes are widely used in various clinical applications for the detection, characterization, and therapy monitoring of different diseases. RESULTS Promising theoretical findings and experimental results for the reviewed models and techniques in a variety of clinical applications suggest that DCE-MRI is a clinically relevant imaging modality, which can be used for early diagnosis of different diseases, such as breast and prostate cancer, renal rejection, and liver tumors. CONCLUSIONS Both nonparametric and parametric approaches for DCE-MRI analysis possess the ability to quantify tissue perfusion.
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Affiliation(s)
- Fahmi Khalifa
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292 and Electronics and Communication Engineering Department, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed Soliman
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292
| | - Ayman El-Baz
- BioImaging Laboratory, Department of Bioengineering, University of Louisville, Louisville, Kentucky 40292
| | - Mohamed Abou El-Ghar
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Tarek El-Diasty
- Radiology Department, Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Georgy Gimel'farb
- Department of Computer Science, University of Auckland, Auckland 1142, New Zealand
| | - Rosemary Ouseph
- Kidney Transplantation-Kidney Disease Center, University of Louisville, Louisville, Kentucky 40202
| | - Amy C Dwyer
- Kidney Transplantation-Kidney Disease Center, University of Louisville, Louisville, Kentucky 40202
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Mathur A, Jain N, Kesavadas C, Thomas B, Kapilamoorthy TR. Imaging of skull base pathologies: Role of advanced magnetic resonance imaging techniques. Neuroradiol J 2015; 28:426-37. [PMID: 26427895 DOI: 10.1177/1971400915609341] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Imaging plays a vital role in evaluation of skull base pathologies as this region is not directly accessible for clinical evaluation. Computerized tomography (CT) and magnetic resonance imaging (MRI) have played complementary roles in the diagnosis of the various neoplastic and non-neoplastic lesions of the skull base. However, CT and conventional MRI may at times be insufficient to correctly pinpoint the accurate diagnosis. Advanced MRI techniques, though difficult to apply in the skull base region, in conjunction with CT and conventional MRI can however help in improving the diagnostic accuracy. This article aims to highlight the importance of advanced MRI techniques like diffusion-weighted imaging, susceptibility-weighted imaging, perfusion-weighted imaging, and MR spectroscopy in differentiation of various lesions involving the skull base.
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Affiliation(s)
| | | | - C Kesavadas
- SCTIMST Trivandrum, Thiruvanathapuram, India
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Jain KK, Sahoo P, Tyagi R, Mehta A, Patir R, Vaishya S, Prakash N, Vasudev N, Gupta RK. Prospective glioma grading using single-dose dynamic contrast-enhanced perfusion MRI. Clin Radiol 2015; 70:1128-35. [PMID: 26152879 DOI: 10.1016/j.crad.2015.06.076] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 03/31/2015] [Accepted: 06/01/2015] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the sensitivity and specificity of single-dose dynamic contrast-enhanced (DCE) perfusion magnetic resonance imaging (MRI) in prospective evaluation of glioma grading and to correlate the relative cerebral blood volume (rCBV) values with mitotic and ki-67 indexes obtained at histopathology. MATERIALS AND METHODS A total of 53 histologically proven patients with glioma were included in this study. DCE-MRI perfusion with a single dose of contrast medium was included in brain tumour protocol and prospective grading of glioma into low and high grade was done based on a previously reported rCBV cut-off value of 3. Tumours with rCBV ≥ 3 were considered to be high grade and rCBV < 3 were considered to be low grade. The sensitivity and specificity of the cut-off value were estimated. Ki-67 and mitotic indexes were also obtained on histopathological analysis along with histological grading. RESULTS Based on pre-defined rCBV cut-off values, prospective grading of low- and high-grade glioma was achieved with a sensitivity and specificity of 97.22% and 100%, respectively. Significant correlation was found between the mitotic/ki-67 indexes and rCBV values when data for high- and low-grade tumours was combined. CONCLUSION DCE-MRI performed with a single dose of contrast medium is as effective as a protocol with a double-dose of contrast medium for glioma grading using 3 T MRI and could be added to the routine evaluation protocol of brain tumours.
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Affiliation(s)
- K K Jain
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India
| | - P Sahoo
- Philips Healthcare, Philips India Ltd, Gurgaon, India
| | - R Tyagi
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India
| | - A Mehta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India
| | - R Patir
- Neurosurgery, Fortis Memorial Research Institute, Gurgaon, India
| | - S Vaishya
- Neurosurgery, Fortis Memorial Research Institute, Gurgaon, India
| | - N Prakash
- Pathology, Fortis Memorial Research Institute, Gurgaon, India
| | - N Vasudev
- Pathology, Fortis Memorial Research Institute, Gurgaon, India
| | - R K Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurgaon, India.
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Jia ZZ, Gu HM, Zhou XJ, Shi JL, Li MD, Zhou GF, Wu XH. The assessment of immature microvascular density in brain gliomas with dynamic contrast-enhanced magnetic resonance imaging. Eur J Radiol 2015; 84:1805-9. [PMID: 26066470 DOI: 10.1016/j.ejrad.2015.05.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/19/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study was designed to quantitatively evaluate the immature microvascular density (MVD) of brain gliomas using the volume transfer constant (K(trans)) and volume of extravascular extracellular space per unit volume of tissue (Ve) from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) noninvasively. MATERIALS AND METHODS Fifty-seven patients (35 males, 22 females; age range, 14-70, mean age 46±12 years old) with brain glioma were included in this study. The maximal values of K(trans) and Ve of all patients with brain glioma (grade II 24, III 7 and IV 26) were obtained. The CD105-microvascular density (CD105-MVD) of each tumor was measured in surgical specimen. The differences of K(trans), Ve and CD105-MVD between the different grades of gliomas were analyzed using the Mann-Whitney U-test. The Pearman correlation coefficient was determined between K(trans), Ve and CD105-MVD. A P-value of less than 0.05 was considered statistically significant. RESULTS The differences in K(trans), Ve and CD105-MVD were statistically significant between low-grade glioma (LGG) and high-grade glioma (HGG) (P=0.001, P<0.001, P<0.001). The K(trans), Ve and CD105-MVD of grade II were significantly lower than those of grade III and IV. K(trans) and Ve were positively correlated with CD105-MVD in HGG (P<0.001, P<0.001). CONCLUSIONS Our results suggest DCE-MRI plays an important part in noninvasively evaluating the immature MVD of brain gliomas.
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Affiliation(s)
- Zhong Zheng Jia
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Hong Mei Gu
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Xue Jun Zhou
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Jin Long Shi
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, Jiangsu, PR China.
| | - Min Da Li
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Guo Feng Zhou
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Xian Hua Wu
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
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Quantitative analysis of 3-Tesla magnetic resonance imaging in the differential diagnosis of breast lesions. Exp Ther Med 2014; 9:913-918. [PMID: 25667653 PMCID: PMC4316864 DOI: 10.3892/etm.2014.2154] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 10/30/2014] [Indexed: 01/23/2023] Open
Abstract
The aim of this study was to investigate the value of quantitative 3-Tesla (3T) magnetic resonance (MR) assessment in the diagnosis of breast lesions. A total of 44 patients with breast lesions were selected. All the patients underwent MR plain scanning and T1 dynamic contrast-enhanced imaging. The vascular function parameters of the lesions, namely volume transfer constant (Ktrans), rate constant (Kep), extravascular extracellular volume fraction (Ve) and integrated area under the curve (iAUC), were acquired. These parameters were compared between benign and malignant breast lesions, and also among differential grades of invasive ductal carcinoma. The values of Ktrans, Kep and iAUC were significantly different between the benign and malignant tumors; however, the values of Ve in the benign and malignant tumors were not significantly different. The values of Ktrans, Kep and iAUC in invasive ductal carcinoma were significantly different between grade I and grade II, and between grade I and grade III; however, there was no significant difference between grade II and grade III. The Ve values in invasive ductal carcinoma did not significantly differ among grades I, II and III. Among the vascular function parameters, Ktrans exhibited the highest sensitivity and specificity in the differentiation of benign and malignant lesions. Quantitative 3-T MR assessment is valuable in the diagnosis of benign and malignant breast lesions. It can also provide reference values for the differentiation of the histological grade of breast invasive ductal carcinoma.
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Differentiation of brain abscesses from glioblastomas and metastatic brain tumors: comparisons of diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MR imaging before and after mathematic contrast leakage correction. PLoS One 2014; 9:e109172. [PMID: 25330386 PMCID: PMC4201450 DOI: 10.1371/journal.pone.0109172] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 09/09/2014] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the diagnostic performance of dynamic susceptibility contrast-enhanced perfusion MRI before and after mathematic contrast leakage correction in differentiating pyogenic brain abscesses from glioblastomas and/or metastatic brain tumors. Materials and Methods Cerebral blood volume (CBV), leakage-corrected CBV and leakage coefficient K2 were measured in enhancing rims, perifocal edema and contralateral normal appearing white matter (NAWM) of 17 abscesses, 19 glioblastomas and 20 metastases, respectively. The CBV and corrected CBV were normalized by dividing the values in the enhancing rims or edema to those of contralateral NAWM. For each study group, a paired t test was used to compare the K2 of the enhancing rims or edema with those of NAWM, as well as between CBV and corrected CBV of the enhancing rims or edema. ANOVA was used to compare CBV, corrected CBV and K2 among three lesion types. The diagnostic performance of CBV and corrected CBV was assessed with receiver operating characteristic (ROC) curve analysis. Results The CBV and correction CBV of enhancing rim were 1.45±1.17 and 1.97±1.01 for abscesses, 3.85±2.19 and 4.39±2.33 for glioblastomas, and 2.39±0.90 and 2.97±0.78 for metastases, respectively. The CBV and corrected CBV in the enhancing rim of abscesses were significantly lower than those of glioblastomas and metastases (P = 0.001 and P = 0.007, respectively). In differentiating abscesses from glioblastomas and metastases, the AUC values of corrected CBV (0.822) were slightly higher than those of CBV (0.792). Conclusions Mathematic leakage correction slightly increases the diagnostic performance of CBV in differentiating pyogenic abscesses from necrotic glioblastomas and cystic metastases. Clinically, DSC perfusion MRI may not need mathematic leakage correction in differentiating abscesses from glioblastomas and/or metastases.
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Barnes SL, Quarles CC, Yankeelov TE. Modeling the effect of intra-voxel diffusion of contrast agent on the quantitative analysis of dynamic contrast enhanced magnetic resonance imaging. PLoS One 2014; 9:e108726. [PMID: 25275536 PMCID: PMC4183533 DOI: 10.1371/journal.pone.0108726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/02/2014] [Indexed: 01/22/2023] Open
Abstract
Quantitative dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) provides estimates of physiologically relevant parameters related to tissue blood flow, vascular permeability, and tissue volume fractions which can then be used for prognostic and diagnostic reasons. However, standard techniques for DCE-MRI analysis ignore intra-voxel diffusion, which may play an important role in contrast agent distribution and voxel signal intensity and, thus, will affect quantification of the aforementioned parameters. To investigate the effect of intra-voxel diffusion on quantitative DCE-MRI, we developed a finite element model of contrast enhancement at the voxel level. For diffusion in the range of that expected for gadolinium chelates in tissue (i.e., 1×10−4 to 4×10−4 mm2/s), parameterization errors range from −58% to 12% for Ktrans, −9% to 8% for ve, and −60% to 213% for vp over the range of Ktrans, ve, vp, and temporal resolutions investigated. Thus the results show that diffusion has a significant effect on parameterization using standard techniques.
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Affiliation(s)
- Stephanie L. Barnes
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
| | - C. Chad Quarles
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Program in Chemical and Physical Biology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Thomas E. Yankeelov
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Physics and Astronomy, Vanderbilt University, Nashville, Tennessee, United States of America
- Department of Cancer Biology, Vanderbilt University, Nashville, Tennessee, United States of America
- Vanderbilt-Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee, United States of America
- Program in Chemical and Physical Biology, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail:
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Heye AK, Culling RD, Valdés Hernández MDC, Thrippleton MJ, Wardlaw JM. Assessment of blood-brain barrier disruption using dynamic contrast-enhanced MRI. A systematic review. NEUROIMAGE-CLINICAL 2014; 6:262-74. [PMID: 25379439 PMCID: PMC4215461 DOI: 10.1016/j.nicl.2014.09.002] [Citation(s) in RCA: 260] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/04/2014] [Accepted: 09/05/2014] [Indexed: 01/31/2023]
Abstract
There is increasing recognition of the importance of blood-brain barrier (BBB) disruption in aging, dementia, stroke and multiple sclerosis in addition to more commonly-studied pathologies such as tumors. Dynamic contrast-enhanced MRI (DCE-MRI) is a method for studying BBB disruption in vivo. We review pathologies studied, scanning protocols and data analysis procedures to determine the range of available methods and their suitability to different pathologies. We systematically review the existing literature up to February 2014, seeking studies that assessed BBB integrity using T1-weighted DCE-MRI techniques in animals and humans in normal or abnormal brain tissues. The literature search provided 70 studies that were eligible for inclusion, involving 417 animals and 1564 human subjects in total. The pathologies most studied are intracranial neoplasms and acute ischemic strokes. There are large variations in the type of DCE-MRI sequence, the imaging protocols and the contrast agents used. Moreover, studies use a variety of different methods for data analysis, mainly based on model-free measurements and on the Patlak and Tofts models. Consequently, estimated K (Trans) values varied widely. In conclusion, DCE-MRI is shown to provide valuable information in a large variety of applications, ranging from common applications, such as grading of primary brain tumors, to more recent applications, such as assessment of subtle BBB dysfunction in Alzheimer's disease. Further research is required in order to establish consensus-based recommendations for data acquisition and analysis and, hence, improve inter-study comparability and promote wider use of DCE-MRI.
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Affiliation(s)
- Anna K Heye
- Neuroimaging Sciences, University of Edinburgh, Edinburgh, UK
| | - Ross D Culling
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Abstract
While traditional computed tomography (CT) and magnetic resonance (MR) imaging illustrate the structural morphology of brain pathology, newer, dynamic imaging techniques are able to show the movement of contrast throughout the brain parenchyma and across the blood-brain barrier (BBB). These data, in combination with pharmacokinetic models, can be used to investigate BBB permeability, which has wide-ranging applications in the diagnosis and management of central nervous system (CNS) tumors in children. In the first part of this paper, we review the technical principles underlying four imaging modalities used to evaluate BBB permeability: PET, dynamic CT, dynamic T1-weighted contrast-enhanced MR imaging, and dynamic T2-weighted susceptibility contrast MR. We describe the data that can be derived from each method, provide some caveats to data interpretation, and compare the advantages and disadvantages of the different techniques. In the second part of this paper, we review the clinical applications that have been reported with permeability imaging data, including diagnosing the nature of a lesion found on imaging (neoplastic versus non-neoplastic, tumor type, tumor grade, recurrence versus pseudoprogression), predicting the natural history of a tumor, monitoring angiogenesis and tracking response to anti-angiogenic agents, optimizing chemotherapy agent selection, and aiding in the development of new antineoplastic drugs and methods to increase local delivery of chemotherapeutics.
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Affiliation(s)
- Sandi Lam
- 1 Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA ; 2 Functional and Stereotactic Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Yimo Lin
- 1 Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA ; 2 Functional and Stereotactic Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Peter C Warnke
- 1 Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA ; 2 Functional and Stereotactic Neurosurgery, Department of Surgery, University of Chicago, Chicago, Illinois, USA
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Muccio CF, Caranci F, D'Arco F, Cerase A, De Lipsis L, Esposito G, Tedeschi E, Andreula C. Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol 2014; 41:153-67. [PMID: 24957685 DOI: 10.1016/j.neurad.2014.05.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 10/25/2022]
Abstract
The aim of this paper is to illustrate the potential of magnetic resonance imaging (MRI) in diagnosis, differential diagnosis, treatment planning and evaluation of therapy effectiveness of pyogenic brain abscesses, through the use of morphological (or conventional) and functional (or advanced) sequences. Conventional MRI study is useful for the identification of lesions, to determine the location and morphology and allows a correct hypothesis of nature in the most typical cases. However, the differential diagnosis from other brain lesions, such as non-pyogenic abscesses or necrotic tumors (high-grade gliomas and metastases) is often only possible through the use of functional sequences, as the measurement of diffusion with apparent diffusion coefficient (DWI-ADC), proton magnetic resonance spectroscopy ((1)H-MRS) and perfusion weighted imaging (PWI), which complement the morphological sequences and provide essential information on structural, metabolic and hemodynamic characteristics allowing greater neuroradiological confidence. Modern diagnostic MRI of pyogenic brain abscesses cannot be separated from knowledge, integration and proper use of the morphological and functional sequences.
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Affiliation(s)
- Carmine Franco Muccio
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Ferdinando Caranci
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Felice D'Arco
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy.
| | - Alfonso Cerase
- Unit of Neuroradiology, Department of Neuroscience, University "Santa Maria alle Scotte", Siena, Italy
| | - Luca De Lipsis
- Department of Critical Care Medicine, Hospital "Fatebenefratelli", Benevento, Italy
| | - Gennaro Esposito
- Unit of Neuroradiology, Department of Neuroscience, Hospital "Gaetano Rummo", Benevento, Italy
| | - Enrico Tedeschi
- Unit of Neuroradiology, Department of Advanced Biomedical Sciences, University "Federico II", Naples, Italy
| | - Cosma Andreula
- Unit of Radiology and Neuroradiology, Anthea Hospital, Bari, Italy
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Poulin É, Lebel R, Croteau É, Blanchette M, Tremblay L, Lecomte R, Bentourkia M, Lepage M. Optimization of the reference region method for dual pharmacokinetic modeling using Gd-DTPA/MRI and (18) F-FDG/PET. Magn Reson Med 2014; 73:740-8. [PMID: 24604379 DOI: 10.1002/mrm.25151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/06/2022]
Abstract
PURPOSE The combination of MRI and positron emission tomography (PET) offers new possibilities for the development of novel methodologies. In pharmacokinetic image analysis, the blood concentration of the imaging compound as a function of time, [i.e., the arterial input function (AIF)] is required for MRI and PET. In this study, we tested whether an AIF extracted from a reference region (RR) in MRI can be used as a surrogate for the manually sampled (18) F-FDG AIF for pharmacokinetic modeling. METHODS An MRI contrast agent, gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) and a radiotracer, (18) F-fluorodeoxyglucose ((18) F-FDG), were simultaneously injected in a F98 glioblastoma rat model. A correction to the RR AIF for Gd-DTPA is proposed to adequately represent the manually sampled AIF. A previously published conversion method was applied to convert this AIF into a (18) F-FDG AIF. RESULTS The tumor metabolic rate of glucose (TMRGlc) calculated with the manually sampled (18) F-FDG AIF, the (18) F-FDG AIF converted from the RR AIF and the (18) F-FDG AIF converted from the corrected RR AIF were found not statistically different (P>0.05). CONCLUSION An AIF derived from an RR in MRI can be accurately converted into a (18) F-FDG AIF and used in PET pharmacokinetic modeling.
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Affiliation(s)
- Éric Poulin
- Centre d'imagerie moléculaire de Sherbrooke, Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, Canada
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Floriano VH, Torres US, Spotti AR, Ferraz-Filho JRL, Tognola WA. The role of dynamic susceptibility contrast-enhanced perfusion MR imaging in differentiating between infectious and neoplastic focal brain lesions: results from a cohort of 100 consecutive patients. PLoS One 2013; 8:e81509. [PMID: 24324699 PMCID: PMC3855761 DOI: 10.1371/journal.pone.0081509] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 10/14/2013] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Differentiating between infectious and neoplastic focal brain lesions that are detected by conventional structural magnetic resonance imaging (MRI) may be a challenge in routine practice. Brain perfusion-weighted MRI (PWI) may be employed as a complementary non-invasive tool, providing relevant data on hemodynamic parameters, such as the degree of angiogenesis of lesions. We aimed to employ dynamic susceptibility contrast-enhanced perfusion MR imaging (DSC-MRI) to differentiate between infectious and neoplastic brain lesions by investigating brain microcirculation changes. Materials and Methods DSC-MRI perfusion studies of one hundred consecutive patients with non-cortical neoplastic (n = 54) and infectious (n = 46) lesions were retrospectively assessed. MRI examinations were performed using a 1.5-T scanner. A preload of paramagnetic contrast agent (gadolinium) was administered 30 seconds before acquisition of dynamic images, followed by a standard dose 10 seconds after starting imaging acquisitions. The relative cerebral blood volume (rCBV) values were determined by calculating the regional cerebral blood volume in the solid areas of lesions, normalized to that of the contralateral normal-appearing white matter. Discriminant analyses were performed to determine the cutoff point of rCBV values that would allow the differentiation of neoplastic from infectious lesions and to assess the corresponding diagnostic performance of rCBV when using this cutoff value. Results Neoplastic lesions had higher rCBV values (4.28±2.11) than infectious lesions (0.63±0.49) (p<0.001). When using an rCBV value <1.3 as the parameter to define infectious lesions, the sensitivity of the method was 97.8% and the specificity was 92.6%, with a positive predictive value of 91.8%, a negative predictive value of 98.0%, and an accuracy of 95.0%. Conclusion PWI is a useful complementary tool in distinguishing between infectious and neoplastic brain lesions; an elevated discriminatory value for diagnosis of infectious brain lesions was observed in this sample of patients when the rCBV cutoff value was set to 1.3.
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Affiliation(s)
- Valdeci Hélio Floriano
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
- * E-mail:
| | - Ulysses S. Torres
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Antonio Ronaldo Spotti
- Department of Neurological Sciences, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - José Roberto Lopes Ferraz-Filho
- Department of Radiology, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
| | - Waldir Antônio Tognola
- Department of Neurological Sciences, Hospital de Base, São José do Rio Preto Medical School (FAMERP), São José do Rio Preto, São Paulo, Brazil
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Jensen RL, Mumert ML, Gillespie DL, Kinney AY, Schabel MC, Salzman KL. Preoperative dynamic contrast-enhanced MRI correlates with molecular markers of hypoxia and vascularity in specific areas of intratumoral microenvironment and is predictive of patient outcome. Neuro Oncol 2013; 16:280-91. [PMID: 24305704 DOI: 10.1093/neuonc/not148] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Measures of tumor vascularity and hypoxia have been correlated with glioma grade and outcome. Dynamic contrast-enhanced (DCE) MRI can noninvasively map tumor blood flow, vascularity, and permeability. In this prospective observational cohort pilot study, preoperative imaging was correlated with molecular markers of hypoxia, vascularity, proliferation, and progression-free and overall patient survival. METHODS Pharmacokinetic modeling methods were used to generate maps of tumor blood flow, extraction fraction, permeability-surface area product, transfer constant, washout rate, interstitial volume, blood volume, capillary transit time, and capillary heterogeneity from preoperative DCE-MRI data in human glioma patients. Tissue was obtained from areas of peritumoral edema, active tumor, hypoxic penumbra, and necrotic core and evaluated for vascularity, proliferation, and expression of hypoxia-regulated molecules. DCE-MRI parameter values were correlated with hypoxia-regulated protein expression at tissue sample sites. RESULTS Patient survival correlated with DCE parameters in 2 cases: capillary heterogeneity in active tumor and interstitial volume in areas of peritumoral edema. Statistically significant correlations were observed between several DCE parameters and tissue markers. In addition, MIB-1 index was predictive of overall survival (P = .044) and correlated with vascular endothelial growth factor expression in hypoxic penumbra (r = 0.7933, P = .0071) and peritumoral edema (r = 0.4546). Increased microvessel density correlated with worse patient outcome (P = .026). CONCLUSIONS Our findings suggest that DCE-MRI may facilitate noninvasive preoperative predictions of areas of tumor with increased hypoxia and proliferation. Both imaging and hypoxia biomarkers are predictive of patient outcome. This has the potential to allow unprecedented prognostic decisions and to guide therapies to specific tumor areas.
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Affiliation(s)
- Randy L Jensen
- Corresponding author: Randy L. Jensen, MD, PhD, Huntsman Cancer Institute and Departments of Neurosurgery, Radiation Oncology, Oncological Sciences, Clinical Neuroscience Center, University of Utah, 175 North Medical Drive, Salt Lake City, Utah 84132.
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Comparative Evaluation of 3-Dimensional Pseudocontinuous Arterial Spin Labeling With Dynamic Contrast-Enhanced Perfusion Magnetic Resonance Imaging in Grading of Human Glioma. J Comput Assist Tomogr 2013; 37:321-6. [DOI: 10.1097/rct.0b013e318282d7e2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gadolinium chelate with DO3A conjugated 2-(diphenylphosphoryl)-ethyldiphenylphosphonium cation as potential tumor-selective MRI contrast agent. Biomaterials 2012; 33:9225-31. [DOI: 10.1016/j.biomaterials.2012.08.071] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 08/30/2012] [Indexed: 12/21/2022]
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Abstract
This article presents an overview of advanced magnetic resonance (MR) imaging techniques using contrast media in neuroimaging, focusing on T2*-weighted dynamic susceptibility contrast MR imaging and T1-weighted dynamic contrast-enhanced MR imaging. Image acquisition and data processing methods and their clinical application in brain tumors, stroke, dementia, and multiple sclerosis are discussed.
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Affiliation(s)
- Jean-Christophe Ferré
- Department of Radiology, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, USA.
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Larsson C, Kleppestø M, Rasmussen I, Salo R, Vardal J, Brandal P, Bjørnerud A. Sampling requirements in DCE-MRI based analysis of high grade gliomas: simulations and clinical results. J Magn Reson Imaging 2012; 37:818-29. [PMID: 23086710 DOI: 10.1002/jmri.23866] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 09/06/2012] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the effect of variations in temporal resolution and total measurement times on the estimations of kinetic parameters derived from dynamic contrast-enhanced (DCE) MRI in patients with high-grade gliomas (HGGs). MATERIALS AND METHODS DCE-MRI with high temporal resolution (dynamic sampling time (T(s)) = 2.1 s and 3.4 s) and total sampling time (T(acq)) of 5.2 min was acquired in 101 examinations from 15 patients. Using the modified Tofts model K(trans), k(ep) v(e) and v(p) were estimated. The effects of increasing T(s) and reducing T(acq) on the estimated kinetic parameters were estimated through down-sampling and data truncation, and the results were compared with numerical simulations. RESULTS There was an overall dependence of all four kinetic parameters on T(s) and T(acq). Increasing T(s) resulted in under-estimation of K(trans) and over-estimation of V(p), whereas k(ep) and V(e) varied in a less predictable manner. Reducing T(acq) resulted in over-estimation of K(trans) and k(ep) and under-estimation of v(p) and v(e). Increasing T(s) and reducing T(acq) resulted in increased relative error for all four parameters. CONCLUSION Estimated K(trans), K(ep), and V(e) in HGGs were within 15% of the high sampling rate reference values for T(s) <20 s. Increasing T(s) and reducing T(acq) leads to reduced precision of the estimated values.
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Thompson G, Mills SJ, Coope DJ, O'Connor JPB, Jackson A. Imaging biomarkers of angiogenesis and the microvascular environment in cerebral tumours. Br J Radiol 2012; 84 Spec No 2:S127-44. [PMID: 22433824 DOI: 10.1259/bjr/66316279] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Conventional contrast-enhanced CT and MRI are now in routine clinical use for the diagnosis, treatment and monitoring of diseases in the brain. The presence of contrast enhancement is a proxy for the pathological changes that occur in the normally highly regulated brain vasculature and blood-brain barrier. With recognition of the limitations of these techniques, and a greater appreciation for the nuanced mechanisms of microvascular change in a variety of pathological processes, novel techniques are under investigation for their utility in further interrogating the microvasculature of the brain. This is particularly important in tumours, where the reliance on angiogenesis (new vessel formation) is crucial for tumour growth, and the resulting microvascular configuration and derangement has profound implications for diagnosis, treatment and monitoring. In addition, novel therapeutic approaches that seek to directly modify the microvasculature require more sensitive and specific biological markers of baseline tumour behaviour and response. The currently used imaging biomarkers of angiogenesis and brain tumour microvascular environment are reviewed.
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Affiliation(s)
- G Thompson
- Wolfson Molecular Imaging Centre, University of Manchester, Withington, Manchester, UK
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46
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Poulin E, Lebel R, Croteau E, Blanchette M, Tremblay L, Lecomte R, Bentourkia M, Lepage M. Conversion of arterial input functions for dual pharmacokinetic modeling using Gd-DTPA/MRI and 18F-FDG/PET. Magn Reson Med 2012; 69:781-92. [PMID: 22570280 DOI: 10.1002/mrm.24318] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 04/10/2012] [Accepted: 04/11/2012] [Indexed: 01/15/2023]
Abstract
Reaching the full potential of magnetic resonance imaging (MRI)-positron emission tomography (PET) dual modality systems requires new methodologies in quantitative image analyses. In this study, methods are proposed to convert an arterial input function (AIF) derived from gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) in MRI, into a (18)F-fluorodeoxyglucose ((18)F-FDG) AIF in PET, and vice versa. The AIFs from both modalities were obtained from manual blood sampling in a F98-Fisher glioblastoma rat model. They were well fitted by a convolution of a rectangular function with a biexponential clearance function. The parameters of the biexponential AIF model were found statistically different between MRI and PET. Pharmacokinetic MRI parameters such as the volume transfer constant (K(trans)), the extravascular-extracellular volume fraction (ν(e)), and the blood volume fraction (ν(p)) calculated with the Gd-DTPA AIF and the Gd-DTPA AIF converted from (18)F-FDG AIF normalized with or without blood sample were not statistically different. Similarly, the tumor metabolic rates of glucose (TMRGlc) calculated with (18) F-FDG AIF and with (18) F-FDG AIF obtained from Gd-DTPA AIF were also found not statistically different. In conclusion, only one accurate AIF would be needed for dual MRI-PET pharmacokinetic modeling in small animal models.
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Affiliation(s)
- Eric Poulin
- Centre d'Imagerie Moléculaire de Sherbrooke, Département de Médecine Nucléaire et Radiobiologie, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Quebec, Canada
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Lavini C, Verhoeff JJ, Majoie CB, Stalpers LJ, Richel DJ, Maas M. Model-based, semiquantitative and time intensity curve shape analysis of dynamic contrast-enhanced MRI: A comparison in patients undergoing antiangiogenic treatment for recurrent glioma. J Magn Reson Imaging 2011; 34:1303-12. [DOI: 10.1002/jmri.22742] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 07/18/2011] [Indexed: 11/07/2022] Open
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Gupta RK, Tomar V, Awasthi R, Yadav A, Husain N, Bharadwaj V, Ojha BK, Behari S, Prasad KN, Rathore RKS. T2*-weighted MR angiography substantially increases the detection of hemorrhage in the wall of brain abscess: implications in clinical interpretation. Neuroradiology 2011; 54:565-72. [PMID: 21915689 DOI: 10.1007/s00234-011-0952-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/27/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The purpose of the present study was to identify the true prevalence of hemorrhage in the abscess using T2*-weighted angiography (SWAN) imaging and to study its influence on diffusion tensor imaging (DTI) metrics. METHODS Fifteen patients of brain abscess underwent conventional, SWAN, and DT imaging on a 3-T MRI followed by its confirmation with histology. DTI metrics were quantified by region-of-interest analysis on hemorrhagic and non-hemorrhagic regions of the abscess wall. Prussian blue staining was performed on excised abscess walls to confirm hemorrhage on histology. RESULTS Eleven of 15 patients showed evidence of hemorrhage on both Prussian blue staining as well as SWAN imaging. Fractional anisotropy (FA) and linear anisotropy (CL) values were significantly higher, while spherical anisotropy was significantly lower in hemorrhagic compared to non-hemorrhagic regions of the abscess wall. CONCLUSION Hemorrhage in the abscess wall is a common feature and may not always indicate neoplasm. The presence of intracellular iron in addition to concentrically laid collagen fibers may have synergistic effect on FA and CL values in the abscess wall. Inclusion of SWAN to MRI protocol will define the true prevalence of hemorrhage in brain abscess.
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Affiliation(s)
- Rakesh Kumar Gupta
- MR Section, Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226014, India.
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Dujardin MI, Sourbron SP, Chaskis C, Verellen D, Stadnik T, de Mey J, Luypaert R. Quantification of cerebral tumour blood flow and permeability with T1-weighted dynamic contrast enhanced MRI: a feasibility study. J Neuroradiol 2011; 39:227-35. [PMID: 21840059 DOI: 10.1016/j.neurad.2011.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 06/27/2011] [Accepted: 07/01/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Recently, T1-weighted DCE-MRI was proposed as an alternative to T2*-weighted DSC-MRI for the quantification of perfusion and permeability in brain tumors. The aim of the present feasibility study was to explore the clinical potential of the technique in different tumor types using a case-based review of initial results. PATIENTS AND METHODS The method for data analysis was adapted from cerebral perfusion CT and applied in this study to a small group of patients with grade IV glioma and other brain tumors. The possible use of the proposed methodology was also explored for characterizing, following-up and planning the therapy of brain tumors. RESULTS Parametric maps clearly differentiated tumor from the surrounding brain tissue, and also distinguished areas within the tumor presenting with different characteristics, thereby allowing identification of significant target areas for biopsy and/or treatment. Differences in cerebral blood flow (CBF) and lower extraction fractions (E) were observed in various tumors. Progression from a grade II to grade IV glioma over the course of a year was characterized by an increase in CBF and a decrease in E. CONCLUSION DCE-MRI-based quantitative perfusion and permeability may be helpful for tumor-grade characterization, biopsy guidance, radiotherapy planning, radiotherapy monitoring and clinical follow-up, thereby improving the non-invasive characterization of brain tumors.
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Affiliation(s)
- Martine I Dujardin
- Department of Radiology/Befy, UZ Brussel, Laarbeeklaan, 101, 1090 Brussels, Belgium.
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Imaging findings in intracranial aspergillus infection in immunocompetent patients. World Neurosurg 2011; 74:661-70. [PMID: 21492637 DOI: 10.1016/j.wneu.2010.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 06/02/2010] [Indexed: 12/11/2022]
Abstract
AIM To study the neuroimaging features of craniocerebral aspergillosis infection in immunocompetent patients. MATERIALS AND METHODS The clinical and imaging data of 12 patients of aspergillus fungal infection were retrospectively reviewed. Diagnosis of fungal infection was confirmed by histopathologic examination of surgically excised specimen, stereotactic biopsy material, or endoscopic sinus biopsy. The radiologic studies were evaluated for anatomic distribution of lesions, signal intensity, contrast enhancement, presence of hemorrhage, diffusion restriction, perfusion, and spectroscopy characteristics. Medical records, biopsy reports, and autopsy findings were also reviewed. RESULTS Twelve cases of aspergillosis infections in immunocompetent patients were diagnosed at our hospital over a period of 10 years. Lesions could be classified based on imaging of lesions of sinonasal origin, intracranial mass lesion including both parenchymal or extraparenchymal meningeal based and stroke. Coexisting meningitis was also noted in one patient. Disease of sinonasal origin commonly showed invasion of the cavernous sinus and orbital apex resulting in visual symptoms and multiple cranial nerve palsies. Intracranial mass lesions without sinonasal involvement were seen in five cases that included isolated parenchymal lesion in two patients and dural-based mass lesions in three patients. Isolated intraparenchymal lesions included two cases of fungal cerebritis. Dural-based lesions were large granulomas with a significant mass effect. Infarcts were seen in three patients and angiography showed vessel narrowing or occlusion in all the three patients. CT demonstrated isodense to hyperdense attenuation of primary sinus disease with evidence of bone destruction in all the cases of sinonasal origin. Primary parenchymal lesions showed heterogenous attenuation with predominantly low-density areas. Dural-based lesions showed isodense to hyperdense attenuation. Magnetic resonance imaging revealed isointense to hypointense signal intensity on both T(1)-weighted (T1W) and T(2)-weighted (T2W) images in all lesions of sinonasal origin and isolated dural-based mass lesions. Primary parenchymal lesions showed heterogenous signal intensity pattern with predominantly hypointense signal on T1W and hyperintense signal on T2W images. Diffusion weighted imaging, magnetic resonance spectroscopy, and perfusion-weighted imaging gave valuable ancillary information in these cases. CONCLUSION Sinonasal disease with intracranial extension is the commonest pattern of aspergillus infection followed by intracranial mass lesions. Hyperdense sinonasal disease with bone destruction and intracranial extension on computed tomography, hypointense signal intensity of the lesions on T2W magnetic resonance images, presence of areas of restricted diffusion, decreased perfusion on perfusion-weighted imaging, and presence of hemorrhages are key to the imaging diagnosis of fungal infection.
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