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Jaafar N, Alsop DC. Arterial Spin Labeling: Key Concepts and Progress Towards Use as a Clinical Tool. Magn Reson Med Sci 2024; 23:352-366. [PMID: 38880616 PMCID: PMC11234948 DOI: 10.2463/mrms.rev.2024-0013] [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: 02/06/2024] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Arterial spin labeling (ASL), a non-invasive MRI technique, has emerged as a valuable tool for researchers that can measure blood flow and related parameters. This review aims to provide a qualitative overview of the technical principles and recent developments in ASL and to highlight its potential clinical applications. A growing literature demonstrates impressive ASL sensitivity to a range of neuropathologies and treatment responses. Despite its potential, challenges persist in the translation of ASL to widespread clinical use, including the lack of standardization and the limited availability of comprehensive training. As experience with ASL continues to grow, the final stage of translation will require moving beyond single site observational studies to multi-site experience and measurement of the added contribution of ASL to patient care and outcomes.
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Affiliation(s)
- Narjes Jaafar
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - David C. Alsop
- Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Bayraktar ES, Duygulu G, Çetinoğlu YK, Gelal MF, Apaydın M, Ellidokuz H. Comparison of ASL and DSC perfusion methods in the evaluation of response to treatment in patients with a history of treatment for malignant brain tumor. BMC Med Imaging 2024; 24:70. [PMID: 38519901 PMCID: PMC10958956 DOI: 10.1186/s12880-024-01249-w] [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: 11/28/2023] [Accepted: 03/15/2024] [Indexed: 03/25/2024] Open
Abstract
OBJECTIVE Perfusion MRI is of great benefit in the post-treatment evaluation of brain tumors. Interestingly, dynamic susceptibility contrast-enhanced (DSC) perfusion has taken its place in routine examination for this purpose. The use of arterial spin labeling (ASL), a perfusion technique that does not require exogenous contrast material injection, has gained popularity in recent years. The aim of the study was to compare two different perfusion techniques, ASL and DSC, using qualitative and quantitative measurements and to investigate the diagnostic effectiveness of both. The fact that the number of patients is higher than in studies conducted with 3D pseudo-continious ASL (pCASL), the study group is heterogeneous as it consists of patients with both metastases and glial tumors, the use of 3D Turbo Gradient Spin Echo (TGSE), and the inclusion of visual (qualitative) assessment make our study unique. METHODS Ninety patients, who were treated for malignant brain tumor, were enrolled in the retrospective study. DSC Cerebral Blood Volume (CBV), Cerebral Blood Flow (CBF) and ASL CBF maps of each case were obtained. In qualitative analysis, the lesions of the cases were visually classified as treatment-related changes (TRC) and relapse/residual mass (RRT). In the quantitative analysis, three regions of interest (ROI) measurements were taken from each case. The average of these measurements was compared with the ROI taken from the contralateral white matter and normalized values (n) were obtained. These normalized values were compared across events. RESULTS Uncorrected DSC normalized CBV (nCBV), DSC normalized CBF (nCBF) and ASL nCBF values of RRT cases were higher than those of TRC cases (p < 0.001). DSC nCBV values were correlated with DSC nCBF (r: 0.94, p < 0.001) and correlated with ASL nCBF (r: 0.75, p < 0.001). Similarly, ASL nCBF was positively correlated with DSC nCBF (r: 0.79 p < 0.01). When the ROC curve parameters were evaluated, the cut-off values were determined as 1.211 for DSC nCBV (AUC: 0.95, 93% sensitivity, 82% specificity), 0.896 for DSC nCBF (AUC; 0.95, 93% sensitivity, 82% specificity), and 0.829 for ASL nCBF (AUC: 0.84, 78% sensitivity, 75% specificity). For qualitative evaluation (visual evaluation), inter-observer agreement was found to be good for ASL CBF (0.714), good for DSC CBF (0.790), and excellent for DSC CBV (0.822). Intra-observer agreement was also evaluated. For the first observer, good agreement was found in ASL CBF (0.626, 70% sensitive, 93% specific), in DSC CBF (0.713, 76% sensitive, 95% specific), and in DSC CBV (0.755, 87% sensitive - 88% specific). In the second observer, moderate agreement was found in ASL CBF (0.584, 61% sensitive, 97% specific) and DSC CBF (0.649, 65% sensitive, 100% specific), and excellent agreement in DSC CBV (0.800, 89% sensitive, 90% specific). CONCLUSION It was observed that uncorrected DSC nCBV, DSC nCBF and ASL nCBF values were well correlated with each other. In qualitative evaluation, inter-observer and intra-observer agreement was higher in DSC CBV than DSC CBF and ASL CBF. In addition, DSC CBV is found more sensitive, ASL CBF and DSC CBF are found more specific for both observers. From a diagnostic perspective, all three parameters DSC CBV, DSC CBF and ASL CBF can be used, but it was observed that the highest rate belonged to DSC CBV.
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Affiliation(s)
- Ezgi Suat Bayraktar
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye
| | - Gokhan Duygulu
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye.
| | | | - Mustafa Fazıl Gelal
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye
| | - Melda Apaydın
- Department of Radiology, University of Izmir Katip Çelebi, Atatürk Training and Research Hospital, Izmir, 35360, Türkiye
| | - Hülya Ellidokuz
- Department of Biostatistics and Medical Informatics, University of Dokuz Eylül, İzmir, 35340, Türkiye
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Manning P, Srinivas S, Bolar DS, Rajaratnam MK, Piccioni DE, McDonald CR, Hattangadi-Gluth JA, Farid N. Arterial spin labeled perfusion MRI for the assessment of radiation-treated meningiomas. FRONTIERS IN RADIOLOGY 2024; 4:1345465. [PMID: 38562528 PMCID: PMC10982483 DOI: 10.3389/fradi.2024.1345465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/04/2024] [Indexed: 04/04/2024]
Abstract
Purpose Conventional contrast-enhanced MRI is currently the primary imaging technique used to evaluate radiation treatment response in meningiomas. However, newer perfusion-weighted MRI techniques, such as 3D pseudocontinuous arterial spin labeling (3D pCASL) MRI, capture physiologic information beyond the structural information provided by conventional MRI and may provide additional complementary treatment response information. The purpose of this study is to assess 3D pCASL for the evaluation of radiation-treated meningiomas. Methods Twenty patients with meningioma treated with surgical resection followed by radiation, or by radiation alone, were included in this retrospective single-institution study. Patients were evaluated with 3D pCASL and conventional contrast-enhanced MRI before and after radiation (median follow up 6.5 months). Maximum pre- and post-radiation ASL normalized cerebral blood flow (ASL-nCBF) was measured within each meningioma and radiation-treated meningioma (or residual resected and radiated meningioma), and the contrast-enhancing area was measured for each meningioma. Wilcoxon signed-rank tests were used to compare pre- and post-radiation ASL-nCBF and pre- and post-radiation area. Results All treated meningiomas demonstrated decreased ASL-nCBF following radiation (p < 0.001). Meningioma contrast-enhancing area also decreased after radiation (p = 0.008) but only for approximately half of the meningiomas (9), while half (10) remained stable. A larger effect size (Wilcoxon signed-rank effect size) was seen for ASL-nCBF measurements (r = 0.877) compared to contrast-enhanced area measurements (r = 0.597). Conclusions ASL perfusion may provide complementary treatment response information in radiation-treated meningiomas. This complementary information could aid clinical decision-making and provide an additional endpoint for clinical trials.
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Affiliation(s)
- Paul Manning
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, United States
| | - Shanmukha Srinivas
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, United States
| | - Divya S. Bolar
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Center for Functional Magnetic Resonance Imaging, University of California, San Diego, San Diego, CA, United States
| | - Matthew K. Rajaratnam
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, United States
| | - David E. Piccioni
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Carrie R. McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, United States
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Jona A. Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, San Diego, CA, United States
| | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, San Diego, CA, United States
- Center for Multimodal Imaging and Genetics, University of California, San Diego, San Diego, CA, United States
- Center for Functional Magnetic Resonance Imaging, University of California, San Diego, San Diego, CA, United States
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Yamashita K, Togao O, Kikuchi K, Kuga D, Sangatsuda Y, Fujioka Y, Yoshimoto K, Ishigami K. The cortical high-flow sign of oligodendroglioma, IDH-mutant and 1p/19q-codeleted: comparison between arterial spin labeling and dynamic susceptibility contrast methods. Neuroradiology 2024; 66:187-192. [PMID: 38127124 DOI: 10.1007/s00234-023-03267-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE The cortical high-flow sign with the non-enhancing area was reportedly found to be more frequent with oligodendroglioma, IDH-mutant and 1p/19q codeleted (ODG IDHm-codel) than with IDH-wildtype or astrocytoma, IDH-mutant on arterial spin labeling (ASL) in diffuse gliomas. This study aimed to compare the identification rate of the cortical high-flow sign on ASL in patients with ODG IDHm-codel to that on dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI). METHODS Participants consisted of 32 adult ODG IDHm-codel patients with pathologically confirmed. Subtraction images were generated from paired control and label images on ASL. For DSC, dynamic T2*-weighted perfusion weighted images were obtained after pre-bolus of gadolinium-based contrast agent. Regional cerebral blood flow/volume maps were generated based on the concentration-time curve and arterial input function. Tumor-affecting cortices without contrast enhancement on conventional MR imaging were targeted. The identification rate of the cortical high-flow sign was compared between ASL and DSC using the Pearson's Chi-Square test. RESULTS Frequency of the cortical high-flow sign was significantly higher on ASL (18/32, 56.3%; p < 0.001) than on DSC (5/32, 15.6%). All cases with the positive cortical high-flow sign on DSC were identified on ASL. CONCLUSION ASL effectively identifies the cortical high-flow sign in ODG IDHm-codel, surpassing DSC in identification rates.
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Affiliation(s)
- Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
| | - Osamu Togao
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kazufumi Kikuchi
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Daisuke Kuga
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yuhei Sangatsuda
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yutaka Fujioka
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
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Lambrecht S, Liu D, Dzaye O, Kamson DO, Reis J, Liebig T, Holdhoff M, Van Zijl P, Qin Q, Lin DDM. Velocity-Selective Arterial Spin Labeling Perfusion in Monitoring High Grade Gliomas Following Therapy: Clinical Feasibility at 1.5T and Comparison with Dynamic Susceptibility Contrast Perfusion. Brain Sci 2024; 14:126. [PMID: 38391701 PMCID: PMC10886779 DOI: 10.3390/brainsci14020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/24/2024] Open
Abstract
MR perfusion imaging is important in the clinical evaluation of primary brain tumors, particularly in differentiating between true progression and treatment-induced change. The utility of velocity-selective ASL (VSASL) compared to the more commonly utilized DSC perfusion technique was assessed in routine clinical surveillance MR exams of 28 patients with high-grade gliomas at 1.5T. Using RANO criteria, patients were assigned to two groups, one with detectable residual/recurrent tumor ("RT", n = 9), and the other with no detectable residual/recurrent tumor ("NRT", n = 19). An ROI was drawn to encompass the largest dimension of the lesion with measures normalized against normal gray matter to yield rCBF and tSNR from VSASL, as well as rCBF and leakage-corrected relative CBV (lc-rCBV) from DSC. VSASL (rCBF and tSNR) and DSC (rCBF and lc-rCBV) metrics were significantly higher in the RT group than the NRT group allowing adequate discrimination (p < 0.05, Mann-Whitney test). Lin's concordance analyses showed moderate to excellent concordance between the two methods, with a stronger, moderate correlation between VSASL rCBF and DSC lc-rCBV (r = 0.57, p = 0.002; Pearson's correlation). These results suggest that VSASL is clinically feasible at 1.5T and has the potential to offer a noninvasive alternative to DSC perfusion in monitoring high-grade gliomas following therapy.
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Affiliation(s)
- Sebastian Lambrecht
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Institute of Neuroradiology, University Hospital LMU Munich, 81377 Munich, Germany
| | - Dapeng Liu
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Omar Dzaye
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - David O Kamson
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jonas Reis
- Institute of Neuroradiology, University Hospital LMU Munich, 81377 Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital LMU Munich, 81377 Munich, Germany
| | - Matthias Holdhoff
- Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Peter Van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Qin Qin
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD 21205, USA
| | - Doris D M Lin
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Senger KPS, Kesavadas C, Thomas B, Singh A, Multani GS, AN D, Label M, Suchandrima B, Shin D. Experimenting with ASL-based arterialized cerebral blood volume as a novel imaging biomarker in grading glial neoplasms. Neuroradiol J 2023; 36:728-735. [PMID: 37548164 PMCID: PMC10649543 DOI: 10.1177/19714009231193163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Perfusion imaging is one of the methods used to grade glial neoplasms, and in this study we evaluated the role of ASL perfusion in grading brain glioma. PURPOSE The aim is to evaluate the role of arterialized cerebral blood volume (aCBV) of multi-delay ASL perfusion for grading glial neoplasm. MATERIALS AND METHODS This study is a prospective observational study of 56 patients with glial neoplasms of the brain who underwent surgery, and only cases with positive diagnosis of glioma are included to evaluate the novel diagnostic parameter. RESULTS In the study, ASL-derived normalized aCBV (naCBV) and T2*DSC-derived normalized CBV (nCBV) are showing very high correlation (Pearson's correlation coefficient value of 0.94) in grading glial neoplasms. naCBV and nCBF are also showing very high correlation (Pearson's correlation coefficient value of 0.876). The study also provides cutoff values for differentiating LGG from HGG for normalized aCBV(naCBV) of ASL, normalized CBV (nCBV), and normalized nCBF derived from T2* DCS as 1.12, 1.254, and 1.31, respectively. ASL-derived aCBV also shows better diagnostic accuracy than ASL-derived CBF. CONCLUSION This study is one of its kind to the best of our knowledge where multi-delay ASL perfusion-derived aCBV is used as a novel imaging biomarker for grading glial neoplasms, and it has shown high statistical correlation with T2* DSC-derived perfusion parameters.
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Affiliation(s)
- Krishna Pratap Singh Senger
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - C Kesavadas
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Bejoy Thomas
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Ankita Singh
- Department of Research, Army Hospital Research and Referral, New Delhi, India
| | - Gurpreet Singh Multani
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Deepti AN
- 1Department of Imaging Sciences and Interventional Radiology, Sree Chita Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Marc Label
- Department of Research and Development, GEHealthcare, Calgary, AB, Canada
| | | | - David Shin
- Department of Research and Development, GEHealthcare, Calgary, AB, Canada
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Wang X, Huang L, Guo W, Tang L, Wu A, Wu P, Zhao X, Lin Q, Yu L. Cerebral Microstructural and Microvascular Changes in Non-Neuropsychiatric Systemic Lupus Erythematosus: A Study Using Diffusion Kurtosis Imaging and 3D Pseudo-Continuous Arterial Spin Labeling. J Inflamm Res 2023; 16:5465-5475. [PMID: 38026250 PMCID: PMC10676653 DOI: 10.2147/jir.s429521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The purpose of this study was to observe cerebral microstructure and microcirculation features, as well as changes in white matter (WM) and gray matter (GM) among patients with non-neuropsychiatric systemic lupus erythematosus (non-NPSLE). Methods We compared 36 female patients with non-NPSLE and 20 age- and gender-matched healthy controls (HCs) who underwent 3.0T MRI imaging with diffusion kurtosis imaging (DKI) and 3D pseudo-continuous Arterial Spin Labeling (pCASL). Mean kurtosis (MK), mean kurtosis tensor (MKT), and cerebral blood flow (CBF) values were obtained from 25 brain regions, including WM and GM. We analyzed the correlation between imaging indicators and clinical data. Results When compared with HCs, patients with non-NPSLE had reduced MK and MKT values in regional WM, deep GM, and the left frontal lobe cortical GM, and increased CBF in the right parietal lobe WM and right semioval center (SOC). The MK and MKT values were weakly correlated with CBF in some regions, including WM and GM. Complement 3 (C3) and Complement 4 (C4) showed a weak positive correlation with MK and MKT in some regions, including WM and deep GM, while platelet (PLT) was positively correlated with MKT in the left frontal lobe WM; dsDNA antibody was correlated negatively with MK in the right occipital lobe WM; and erythrocyte sedimentation rate (ESR) was correlated negatively with CBF in the left SOC. Conclusion Our findings revealed the presence of brain microstructural and microvascular abnormalities in non-NPSLE patients, indicating microstructural damage in the cortical GM, which was less commonly reported. We found DKI and pCASL useful in detecting early brain lesions, and MK was a more sensitive and beneficial indicator.
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Affiliation(s)
- Xiaojuan Wang
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Lingling Huang
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Wenbin Guo
- Department of Pathology, Pingtan Comprehensive Experimental Area Hospital, Fuzhou, Fujian, 350400, People’s Republic of China
| | - Langlang Tang
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Aiyu Wu
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Peng Wu
- Philips Healthcare, Shanghai, 200000, People’s Republic of China
| | - Xiance Zhao
- Philips Healthcare, Shanghai, 200000, People’s Republic of China
| | - Qi Lin
- Department of Radiology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
| | - Lian Yu
- Department of Rheumatology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, Fujian, 364000, People’s Republic of China
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8
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Patil V, Malik R, Sarawagi R. Comparative study between dynamic susceptibility contrast magnetic resonance imaging and arterial spin labelling perfusion in differentiating low-grade from high-grade brain tumours. Pol J Radiol 2023; 88:e521-e528. [PMID: 38125817 PMCID: PMC10731442 DOI: 10.5114/pjr.2023.132889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Purpose Our aim was to distinguish between low-grade and high-grade brain tumours on the basis of dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) perfusion and arterial spin labelling (ASL) perfusion and to compare DSC and ASL techniques. Material and methods Forty-one patients with brain tumours were evaluated by 3-Tesla MRI. Conventional and perfusion MRI imaging with a 3D pseudo-continuous ASL (PCASL) and DSC perfusion maps were evaluated. Three ROIs were placed to obtain cerebral blood value (CBV) and cerebral blood flow (CBF) in areas of maximum perfusion in brain tumour and normal grey matter. Histopathological diagnosis was considered as the reference. ROC analysis was performed to compare the diagnostic performance and to obtain a feasible cut-off value of perfusion parameters to differentiate low-grade and high-grade brain tumours. Results Normalised perfusion parameters with grey matter (rCBF or rCBV lesion/NGM) of malignant lesions were significantly higher than those of benign lesions in both DSC (normalised rCBF of 2.16 and normalised rCBV of 2.63) and ASL (normalised rCBF of 2.22) perfusion imaging. The normalised cut-off values of DSC (rCBF of 1.1 and rCBV of 1.4) and ASL (rCBF of 1.3) showed similar specificity and near similar sensitivity in distinguishing low-grade and high-grade brain tumours. Conclusions Quantitative analysis of perfusion parameters obtained by both DSC and ASL perfusion techniques can be reliably used to distinguish low-grade and high-grade brain tumours. Normalisation of these values by grey matter gives us more reliable parameters, eliminating the different technical parameters involved in both the techniques.
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Affiliation(s)
- Vaibhav Patil
- All India Institute of Medical Sciences, Bhopal, India
| | - Rajesh Malik
- All India Institute of Medical Sciences, Bhopal, India
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9
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Cai L, Zhao E, Niu H, Liu Y, Zhang T, Liu D, Zhang Z, Li J, Qiao P, Lv H, Ren P, Zheng W, Wang Z. A machine learning approach to predict cerebral perfusion status based on internal carotid artery blood flow. Comput Biol Med 2023; 164:107264. [PMID: 37481951 DOI: 10.1016/j.compbiomed.2023.107264] [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: 04/18/2023] [Revised: 06/20/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND AND OBJECTIVE Cerebral blood flow (CBF), or perfusion, is a prerequisite for maintaining brain metabolism and normal physiological functions. Diagnosing and evaluating cerebral perfusion status is crucial to managing brain disease. However, cerebral perfusion imaging devices are complicated to operate, should be controlled by specialized technicians, are often large, and are usually installed in fixed places such as hospitals. It is significantly difficult for clinicians to obtain the cerebral perfusion status in time. Considering that CBF is mainly supplied by the internal carotid artery (ICA), this study proposes a cerebral perfusion status prediction model that can automatically quantify the level of cerebral perfusion in patients by modeling the association between ICA blood flow and cerebral perfusion. MATERIALS AND METHODS Forty-eight participants were enrolled in the study after screening. We collected participants' ICA ultrasound and brain magnetic resonance imaging (MRI) data before and after dobutamine injection based on a rigorous experimental paradigm and built an ICA-cerebral perfusion datasetdd. Support vector machine (SVM), k-nearest neighbor (KNN), decision tree (DT), random forest (RF), gradient boosting decision tree (GBDT), and extreme gradient boosting (XGBOOST) were used for early prediction of cerebral perfusion status. The SHAP analysis was adopted to reveal the impact of interpretable predictions for each feature. RESULTS The XGBOOST model demonstrated the best overall classification performance with an accuracy of 78.01%, sensitivity of 96.67%, specificity of 98.23%, F1 score of 74.57%, Matthews correlation coefficient (MCC) of 62.17%, and area under the receiver operating characteristic curve (AUC) of 87.08%. Accelerated speed, peak systolic flow velocity, and resistance index of ICA blood flow are important factors for cerebral perfusion prediction. CONCLUSIONS The proposed method paves a new avenue for the study of predicting cerebral perfusion status automatically and providesv a noninvasive, real-time, and low-cost alternative to brain perfusion imaging. Moreover, this analysis identifies highly predictive features for the cerebral perfusion status and gives clinicians an intuitive understanding of the influence of key features. The prediction models can serve as an early warning tool that offers sufficient time for clinicians to take early intervention measures.
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Affiliation(s)
- Linkun Cai
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China.
| | - Erwei Zhao
- National Space Science Center, Chinese Academy of Sciences, 100190, Beijing, China.
| | - Haijun Niu
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Yawen Liu
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Tingting Zhang
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China
| | - Dong Liu
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Zhe Zhang
- China Astronaut Research and Training Center, Beijing, China
| | - Jing Li
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Penggang Qiao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Han Lv
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China
| | - Pengling Ren
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China.
| | - Wei Zheng
- National Space Science Center, Chinese Academy of Sciences, 100190, Beijing, China.
| | - Zhenchang Wang
- School of Biological Science and Medical Engineering, Beihang University, 100191, Beijing, China; Department of Radiology, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, China.
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10
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Chatha G, Dhaliwal T, Castle-Kirszbaum MD, Amukotuwa S, Lai L, Kwan E. The utility of arterial spin labelled perfusion-weighted magnetic resonance imaging in measuring the vascularity of high grade gliomas - A prospective study. Heliyon 2023; 9:e17615. [PMID: 37519684 PMCID: PMC10372548 DOI: 10.1016/j.heliyon.2023.e17615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/13/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Background Dynamic susceptibility contrast (DSC) perfusion weighted imaging (PWI) currently remains the gold standard technique for measuring cerebral perfusion in glioma diagnosis and surveillance. Arterial spin labelling (ASL) PWI is a non-invasive alternative that does not require gadolinium contrast administration, although it is yet to be applied in widespread clinical practice. This study aims to assess the utility of measuring signal intensity in ASL PWI in predicting glioma vascularity by measuring maximal tumour signal intensity in patients based on pre-operative imaging and comparing this to maximal vessel density on histopathology. Methods Pseudocontinuous ASL (pCASL) and DSC images were acquired pre-operatively in 21 patients with high grade gliomas. The maximal signal intensity within the gliomas over a region of interest of 100 mm2 was measured and also normalised to the contralateral cerebral cortex (nTBF-C), and cerebellum (nTBF-Cb). Maximal vessel density per 1 mm2 was determined on histopathology using CD31 and CD34 immunostaining on all participants. Results Using ASL, statistically significant correlation was observed between maximal signal intensity (p < 0.05) and nTBF-C (p < 0.05) to maximal vessel density based on histopathology. Although a positive trend was also observed nTBF-Cb, this did not reach statistical significance. Using DSC, no statistically significant correlation was found between signal intensity, nTBF-C and nTBF-Cb. There was no correlation between maximal signal intensity between ASL and DSC. Average vessel density did not correlate with age, sex, previous treatment, or IDH status. Conclusions ASL PWI imaging is a reliable marker of evaluating the vascularity of high grade gliomas and may be used as an adjunct to DSC PWI.
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Affiliation(s)
- Gurkirat Chatha
- Department of Neurosurgery, Monash Health, Melbourne, Australia
| | | | - Mendel David Castle-Kirszbaum
- Department of Neurosurgery, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | | | - Leon Lai
- Department of Neurosurgery, Monash Health, Melbourne, Australia
- Department of Surgery, Monash University, Melbourne, Australia
| | - Edward Kwan
- Department of Pathology, Monash Health, Melbourne, Australia
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11
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Wang K, Guo H, Tian X, Miao Y, Han P, Jin F. Efficacy of three-dimensional arterial spin labeling and how it compares against that of contrast enhanced magnetic resonance imaging in preoperative grading of brain gliomas. ENVIRONMENTAL TOXICOLOGY 2023. [PMID: 37040330 DOI: 10.1002/tox.23800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To evaluate the efficacy of three-dimensional arterial spin labeling (3D-ASL) imaging in preoperative grading of brain gliomas, and compare the discrepancy between images obtained from 3D-ASL and contrast enhanced magnetic resonance imaging (CE-MRI) in grading of gliomas. METHODS Fifty-one patients with brain gliomas received plain MRI, CE-MRI and 3D-ASL scanning before surgery. In 3D-ASL images, the maximum tumor blood flow (TBF) of tumor parenchyma was measured, relative TBF-M and rTBF-WM were calculated. The cases were categorized into "ASL dominant" and "CE dominant" to compare the discrepancy between 3D-ASL and CE-MRI results. Independent samples t test, Mann-Whitney and U test and one-way analysis of variance (ANOVA) were performed to test the differences of TBF, rTBF-M and rTBF-WM values among brain gliomas with different grades. Spearman rank correlation analysis was performed to assess the correlation between TBF, rTBF-M, rTBF-WM and glioma grades respectively. To compare the discrepancy between 3D-ASL and CE-MRI results. RESULTS In high-grade gliomas (HGG) group, TBF, rTBF-M and rTBF-WM values were higher than those in low-grade gliomas (LGG) group (p < .05). Multiple comparison showed TBF and rTBF-WM values were different between grade I and IV gliomas, grade II and IV gliomas (both p < .05), the rTBF-M value was different between grade I and IV gliomas (p < .05). The values of all 3D-ASL derived parameters were positively correlated with gliomas grading (all p < .001). TBF showed highest specificity (89.3%) and rTBF-WM showed highest sensitivity (96.4%) when discriminating LGG and HGG using ROC curve. There were 29 CE dominant cases (23 cases were HGG), 9 ASL dominant cases (4 cases were HGG). CONCLUSION: 3D-ASL is of significance to preoperative grading of brain gliomas and might be more sensitive than CE-MRI in detection of tumor perfusion.
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Affiliation(s)
- Kai Wang
- Department of Neurosurgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Huanxuan Guo
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Xiaoyan Tian
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Yanping Miao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ping Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Jin
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
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12
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Rahman AU, Saeed M, Saeed MH, Zebari DA, Albahar M, Abdulkareem KH, Al-Waisy AS, Mohammed MA. A Framework for Susceptibility Analysis of Brain Tumours Based on Uncertain Analytical Cum Algorithmic Modeling. Bioengineering (Basel) 2023; 10:bioengineering10020147. [PMID: 36829641 PMCID: PMC9952481 DOI: 10.3390/bioengineering10020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023] Open
Abstract
Susceptibility analysis is an intelligent technique that not only assists decision makers in assessing the suspected severity of any sort of brain tumour in a patient but also helps them diagnose and cure these tumours. This technique has been proven more useful in those developing countries where the available health-based and funding-based resources are limited. By employing set-based operations of an arithmetical model, namely fuzzy parameterised complex intuitionistic fuzzy hypersoft set (FPCIFHSS), this study seeks to develop a robust multi-attribute decision support mechanism for appraising patients' susceptibility to brain tumours. The FPCIFHSS is regarded as more reliable and generalised for handling information-based uncertainties because its complex components and fuzzy parameterisation are designed to deal with the periodic nature of the data and dubious parameters (sub-parameters), respectively. In the proposed FPCIFHSS-susceptibility model, some suitable types of brain tumours are approximated with respect to the most relevant symptoms (parameters) based on the expert opinions of decision makers in terms of complex intuitionistic fuzzy numbers (CIFNs). After determining the fuzzy parameterised values of multi-argument-based tuples and converting the CIFNs into fuzzy values, the scores for such types of tumours are computed based on a core matrix which relates them with fuzzy parameterised multi-argument-based tuples. The sub-intervals within [0, 1] denote the susceptibility degrees of patients corresponding to these types of brain tumours. The susceptibility of patients is examined by observing the membership of score values in the sub-intervals.
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Affiliation(s)
- Atiqe Ur Rahman
- Department of Mathematics, University of Management and Technology, Lahore 54000, Pakistan
| | - Muhammad Saeed
- Department of Mathematics, University of Management and Technology, Lahore 54000, Pakistan
| | - Muhammad Haris Saeed
- Department of Chemistry, University of Management and Technology, Lahore 54000, Pakistan
| | - Dilovan Asaad Zebari
- Department of Computer Science, College of Science, Nawroz University, Duhok 42001, Iraq
| | - Marwan Albahar
- School of Computer Science, Umm Al Qura University, Mecca 24211, Saudi Arabia
- Correspondence: (M.A.); (M.A.M.)
| | | | - Alaa S. Al-Waisy
- Computer Technologies Engineering Department, Information Technology College, Imam Ja’afar Al-Sadiq University, Baghdad 10001, Iraq
| | - Mazin Abed Mohammed
- College of Computer Science and Information Technology, University of Anbar, Anbar 31001, Iraq
- Correspondence: (M.A.); (M.A.M.)
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13
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Alsulami TA, Hyare H, Thomas DL, Golay X. The value of arterial spin labelling (ASL) perfusion MRI in the assessment of post-treatment progression in adult glioma: A systematic review and meta-analysis. Neurooncol Adv 2023; 5:vdad122. [PMID: 37841694 PMCID: PMC10576519 DOI: 10.1093/noajnl/vdad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background The distinction between viable tumor and therapy-induced changes is crucial for the clinical management of patients with gliomas. This study aims to quantitatively assess the efficacy of arterial spin labeling (ASL) biomarkers, including relative cerebral blood flow (rCBF) and absolute cerebral blood flow (CBF), for the discrimination of progressive disease (PD) and treatment-related effects. Methods Eight articles were included in the synthesis after searching the literature systematically. Data have been extracted and a meta-analysis using the random-effect model was subsequently carried out. Diagnostic accuracy assessment was also performed. Results This study revealed that there is a significant difference in perfusion measurements between groups with PD and therapy-induced changes. The rCBF yielded a standardized mean difference (SMD) of 1.25 [95% CI 0.75, 1.75] (p < .00001). The maximum perfusion indices (rCBFmax and CBFmax) both showed equivalent discriminatory ability, with SMD of 1.35 [95% CI 0.78, 1.91] (p < .00001) and 1.56 [95% CI 0.79, 2.33] (p < .0001), respectively. Similarly, accuracy estimates were comparable among ASL-derived metrices. Pooled sensitivities [95% CI] were 0.85 [0.67, 0.94], 0.88 [0.71, 0.96], and 0.93 [0.73, 0.98], and pooled specificities [95% CI] were 0.83 [0.71, 0.91], 0.83 [0.67, 0.92], 0.84 [0.67, 0.93], for rCBF, rCBFmax and CBFmax, respectively. Corresponding HSROC area under curve (AUC) [95% CI] were 0.90 [0.87, 0.92], 0.92 [0.89, 0.94], and 0.93 [0.90, 0.95]. Conclusion These results suggest that ASL quantitative biomarkers, particularly rCBFmax and CBFmax, have the potential to discriminate between glioma progression and therapy-induced changes.
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Affiliation(s)
- Tamadur A Alsulami
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Harpreet Hyare
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
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14
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Qu B, Cao J, Qian C, Wu J, Lin J, Wang L, Ou-Yang L, Chen Y, Yan L, Hong Q, Zheng G, Qu X. Current development and prospects of deep learning in spine image analysis: a literature review. Quant Imaging Med Surg 2022; 12:3454-3479. [PMID: 35655825 PMCID: PMC9131328 DOI: 10.21037/qims-21-939] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 03/04/2022] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND OBJECTIVE As the spine is pivotal in the support and protection of human bodies, much attention is given to the understanding of spinal diseases. Quick, accurate, and automatic analysis of a spine image greatly enhances the efficiency with which spine conditions can be diagnosed. Deep learning (DL) is a representative artificial intelligence technology that has made encouraging progress in the last 6 years. However, it is still difficult for clinicians and technicians to fully understand this rapidly evolving field due to the diversity of applications, network structures, and evaluation criteria. This study aimed to provide clinicians and technicians with a comprehensive understanding of the development and prospects of DL spine image analysis by reviewing published literature. METHODS A systematic literature search was conducted in the PubMed and Web of Science databases using the keywords "deep learning" and "spine". Date ranges used to conduct the search were from 1 January, 2015 to 20 March, 2021. A total of 79 English articles were reviewed. KEY CONTENT AND FINDINGS The DL technology has been applied extensively to the segmentation, detection, diagnosis, and quantitative evaluation of spine images. It uses static or dynamic image information, as well as local or non-local information. The high accuracy of analysis is comparable to that achieved manually by doctors. However, further exploration is needed in terms of data sharing, functional information, and network interpretability. CONCLUSIONS The DL technique is a powerful method for spine image analysis. We believe that, with the joint efforts of researchers and clinicians, intelligent, interpretable, and reliable DL spine analysis methods will be widely applied in clinical practice in the future.
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Affiliation(s)
- Biao Qu
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Jianpeng Cao
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Chen Qian
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jinyu Wu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
| | - Jianzhong Lin
- Department of Radiology, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Liansheng Wang
- Department of Computer Science, School of Informatics, Xiamen University, Xiamen, China
| | - Lin Ou-Yang
- Department of Medical Imaging of Southeast Hospital, Medical College of Xiamen University, Zhangzhou, China
| | - Yongfa Chen
- Department of Pediatric Orthopedic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Liyue Yan
- Department of Information & Computational Mathematics, Xiamen University, Xiamen, China
| | - Qing Hong
- Biomedical Intelligent Cloud R&D Center, China Mobile Group, Xiamen, China
| | - Gaofeng Zheng
- Department of Instrumental and Electrical Engineering, Xiamen University, Xiamen, China
| | - Xiaobo Qu
- Department of Electronic Science, Biomedical Intelligent Cloud R&D Center, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, China
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15
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Solozhentseva K, Batalov A, Zakharova N, Goryaynov S, Pogosbekyan E, Pronin I. The Role of 3D-pCASL MRI in the Differential Diagnosis of Glioblastoma and Brain Metastases. Front Oncol 2022; 12:874924. [PMID: 35558515 PMCID: PMC9086561 DOI: 10.3389/fonc.2022.874924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/21/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The first aim of this study was to compare the intratumoral and peritumoral blood flow parameters in glioblastomas and brain metastases measured by pseudocontinuous arterial spin labeling MRI (3D pCASL). The second aim of this study was to determine whether pCASL could aid in identifying the source of brain metastases. Materials and Methods This study included 173 patients aged 12 to 83 years (median age—61 years), who were observed at the National Medical Research Center for Neurosurgery. All patients underwent preoperative MRI with pCASL perfusion. Thereafter patients were operated on and received histological diagnosis. No patients received preoperative chemo or radiotherapy. Results The values of maximum and normalized intratumoral blood flow were significantly higher in the group with gliblastoma than in the group with brain metastases: 168.98 + −91.96 versus 152.1 + −173.32 and 7.6 + −8.4 versus 9.3 + −5.33 respectively (p <0.01). However, ROC analysis showed low AUC specificity and sensitivity (0.64, 70%, 60% for mTBF and 0.66, 77%, 62% for nTBF). Peritumoral blood flow parameters were also higher in the glioblastoma group (29.61 + −22.89 versus 16.58 + −6.46 for mTBF and 1.63 + −1.14 versus 0.88 + −0.38 for nTBF, respectively; p <0.01). ROC analysis showed the following measurements of AUC, specificity, and sensitivity (0.75, 68%, 73% for mTBF and 0.77, 58%, 91% for nTBF). Regarding pCASL and various histological subsets of brain metastases, the study found statistically significant differences between the lung and melanoma metastases and the lung and kidney metastases. ROC analysis gave the following values for lung and melanoma metastases: AUC—0.76, specificity—75%, and sensitivity—73% for mTBF; 0.83, 67%, and 93% respectively, for nTBF. For lung and kidney metastases: AUC—0.74, specificity—70%, and sensitivity—93% for mTBF; 0.75, 70%, and 93% respectively, for nTBF. Conclusions pCASL could aid in differential diagnosis between glioblastoma and brain metastases. Measurement of peritumoral blood flow demonstrates higher specificity and sensitivity than with intratumoral blood flow. Moreover, pCASL provides the ability to distinguish lung metastases from kidney and melanoma metastases.
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Affiliation(s)
- Kristina Solozhentseva
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Artem Batalov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Natalia Zakharova
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Sergey Goryaynov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Eduard Pogosbekyan
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Igor Pronin
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
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Perfusion measurement in brain gliomas using velocity-selective arterial spin labeling: comparison with pseudo-continuous arterial spin labeling and dynamic susceptibility contrast MRI. Eur Radiol 2022; 32:2976-2987. [DOI: 10.1007/s00330-021-08406-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
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17
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Differentiating Glioblastomas from Solitary Brain Metastases: An Update on the Current Literature of Advanced Imaging Modalities. Cancers (Basel) 2021; 13:cancers13122960. [PMID: 34199151 PMCID: PMC8231515 DOI: 10.3390/cancers13122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Differentiating between glioblastomas and solitary brain metastases proves to be a challenging diagnosis for neuroradiologists, as both present with imaging patterns consisting of peritumoral hyperintensities with similar intratumoral texture on traditional magnetic resonance imaging sequences. Early diagnosis is paramount, as each pathology has completely different methods of clinical assessment. In the past decade, recent developments in advanced imaging modalities enabled providers to acquire a more accurate diagnosis earlier in the patient's clinical assessment, thus optimizing clinical outcome. Dynamic susceptibility contrast has been optimized for detecting relative cerebral blood flow and relative cerebral blood volume. Diffusion tensor imaging can be used to detect changes in mean diffusivity. Neurite orientation dispersion and density imaging is an innovative modality detecting changes in intracellular volume fraction, isotropic volume fraction, and extracellular volume fraction. Magnetic resonance spectroscopy is able to assist by providing a metabolic descriptor while detecting variable ratios of choline/N-acetylaspartate, choline/creatine, and N-acetylaspartate/creatine. Finally, radiomics and machine learning algorithms have been devised to assist in improving diagnostic accuracy while often utilizing more than one advanced imaging protocol per patient. In this review, we provide an update on all the current evidence regarding the identification and differentiation of glioblastomas from solitary brain metastases.
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Hatakeyama J, Ono T, Takahashi M, Oda M, Shimizu H. Differentiating between Primary Central Nervous System Lymphoma and Glioblastoma: The Diagnostic Value of Combining 18F-fluorodeoxyglucose Positron Emission Tomography with Arterial Spin Labeling. Neurol Med Chir (Tokyo) 2021; 61:367-375. [PMID: 33967177 PMCID: PMC8258004 DOI: 10.2176/nmc.oa.2020-0375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Using conventional magnetic resonance imaging (MRI) methods, the differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) is often difficult due to overlapping imaging characteristics. This study aimed to evaluate the diagnostic value of combining 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with arterial spin labeling (ASL) for differentiating PCNSL from GBM. In all, 20 patients with PCNSL and 55 with GBM were retrospectively examined. From the FDG-PET data, the maximum standardized uptake values (SUVmax) and the ratio of tumor to normal contralateral gray matter (T/N_SUVmax) were calculated. From the ASL data, the T/N ratio of the maximum tumor blood flow (relative TBFmax: rTBFmax) was obtained. Diagnostic performance of each parameter was analyzed using univariate and multivariate logistic regression analyses and receiver-operating characteristic (ROC) curve analyses. A generalized linear model was applied for comparing the performance of FDG-PET and ASL individually, and in combination. In univariate analysis, SUVmax and T/N_SUVmax were statistically higher in patients with PCNSL and rTBFmax was higher in patients with GBM. In the multivariate analysis, T/N_SUVmax and rTBFmax were statistically independent. The sensitivity, specificity, and area under the curve (AUC) for discriminating PCNSL from GBM were 100%, 87.3%, and 0.950 in T/N_SUVmax; 90%, 72.7%, and 0.824 in rTBFmax; and 95%, 96.4%, and 0.991 in the combined model, respectively. The combined use of T/N_SUVmax and rTBFmax may contribute to better differentiation between PCNSL and GBM.
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Affiliation(s)
- Junya Hatakeyama
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Takahiro Ono
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Masataka Takahashi
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Masaya Oda
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine
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Trinh A, Wintermark M, Iv M. Clinical Review of Computed Tomography and MR Perfusion Imaging in Neuro-Oncology. Radiol Clin North Am 2021; 59:323-334. [PMID: 33926680 DOI: 10.1016/j.rcl.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuroimaging plays an essential role in the initial diagnosis and continued surveillance of intracranial neoplasms. The advent of perfusion techniques with computed tomography and MR imaging have proven useful in neuro-oncology, offering enhanced approaches for tumor grading, guiding stereotactic biopsies, and monitoring treatment efficacy. Perfusion imaging can help to identify treatment-related processes, such as radiation necrosis, pseudoprogression, and pseudoregression, and can help to inform treatment-related decision making. Perfusion imaging is useful to differentiate between tumor types and between tumor and nonneoplastic conditions. This article reviews the clinical relevance and implications of perfusion imaging in neuro-oncology and highlights promising perfusion biomarkers.
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Affiliation(s)
- Austin Trinh
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University, 300 Pasteur Drive, Grant Building, Room S031, Stanford, CA 94305-5105, USA
| | - Max Wintermark
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University, 300 Pasteur Drive, Grant Building, Room S047, Stanford, CA 94305-5105, USA. https://twitter.com/mwNRAD
| | - Michael Iv
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University, 300 Pasteur Drive, Grant Building, Room S031E, Stanford, CA 94305-5105, USA.
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20
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Asai K, Nakamura H, Watanabe Y, Nishida T, Sakai M, Arisawa A, Takagaki M, Arita H, Ozaki T, Kagawa N, Fujimoto Y, Nakanishi K, Kinoshita M, Kishima H. Efficacy of endovascular intratumoral embolization for meningioma: assessment using dynamic susceptibility contrast-enhanced perfusion-weighted imaging. J Neurointerv Surg 2021; 13:1167-1171. [PMID: 33722964 DOI: 10.1136/neurintsurg-2020-017116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND In preoperative embolization for intracranial meningioma, endovascular intratumoral embolization is considered to be more effective for the reduction of tumorous vascularity than proximal feeder occlusion. In this study, we aimed to reveal different efficacies for reducing tumor blood flow in meningiomas by comparing endovascular intratumoral embolization and proximal feeder occlusion using dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI). METHODS 28 consecutive patients were included. DSC-PWI was performed before and after embolization for intracranial meningiomas. Normalized tumor blood volume (nTBV) of voxels of interest of whole tumors were measured from the DSC-PWI data before and after embolization. ΔnTBV% was compared between the cases that received intratumoral embolization and proximal feeder occlusion. RESULTS ΔnTBV% in the intratumoral embolization group (42.4±29.8%) was higher than that of the proximal feeder occlusion group (15.3±14.3%, p=0.0039). We used three types of embolic materials and ΔnTBV% did not differ between treatments with or without the use of each material: 42.8±42.4% vs 28.7±20.1% for microspheres (p=0.12), 36.1±20.6% vs 28.1±41.1% for n-butyl cyanoacrylate (p=0.33), and 32.3±37.3% vs 34.1±19.0% for bare platinum coils (p=0.77). CONCLUSIONS The flow reduction effect of intratumoral embolization was superior to that of proximal feeder occlusion in preoperative embolization for intracranial meningioma in an assessment using DSC-PWI.
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Affiliation(s)
- Katsunori Asai
- Neurosurgery, Osaka International Cancer Institute, Osaka, Japan .,Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan
| | - Hajime Nakamura
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | | | - Takeo Nishida
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Mio Sakai
- Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsuko Arisawa
- Diagnostic and Interventional Radiology, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Masatoshi Takagaki
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Hideyuki Arita
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Tomohiko Ozaki
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Naoki Kagawa
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Yasunori Fujimoto
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Katsuyuki Nakanishi
- Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
| | - Manabu Kinoshita
- Neurosurgery, Osaka International Cancer Institute, Osaka, Japan.,Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
| | - Haruhiko Kishima
- Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
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21
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Peñate Medina T, Kolb JP, Hüttmann G, Huber R, Peñate Medina O, Ha L, Ulloa P, Larsen N, Ferrari A, Rafecas M, Ellrichmann M, Pravdivtseva MS, Anikeeva M, Humbert J, Both M, Hundt JE, Hövener JB. Imaging Inflammation - From Whole Body Imaging to Cellular Resolution. Front Immunol 2021; 12:692222. [PMID: 34248987 PMCID: PMC8264453 DOI: 10.3389/fimmu.2021.692222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/12/2021] [Indexed: 01/31/2023] Open
Abstract
Imaging techniques have evolved impressively lately, allowing whole new concepts like multimodal imaging, personal medicine, theranostic therapies, and molecular imaging to increase general awareness of possiblities of imaging to medicine field. Here, we have collected the selected (3D) imaging modalities and evaluated the recent findings on preclinical and clinical inflammation imaging. The focus has been on the feasibility of imaging to aid in inflammation precision medicine, and the key challenges and opportunities of the imaging modalities are presented. Some examples of the current usage in clinics/close to clinics have been brought out as an example. This review evaluates the future prospects of the imaging technologies for clinical applications in precision medicine from the pre-clinical development point of view.
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Affiliation(s)
- Tuula Peñate Medina
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
- *Correspondence: Tuula Peñate Medina, ; Jan-Bernd Hövener,
| | - Jan Philip Kolb
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Gereon Hüttmann
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
- Airway Research Center North (ARCN), Member of the German Center of Lung Research (DZL), Gießen, Germany
| | - Robert Huber
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Oula Peñate Medina
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
- Institute for Experimental Cancer Research (IET), University of Kiel, Kiel, Germany
| | - Linh Ha
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein Lübeck (UKSH), Lübeck, Germany
| | - Patricia Ulloa
- Department of Radiology and Neuroradiology, University Medical Centers Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Naomi Larsen
- Department of Radiology and Neuroradiology, University Medical Centers Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Arianna Ferrari
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
| | - Magdalena Rafecas
- Institute of Medical Engineering (IMT), University of Lübeck, Lübeck, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department1, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Mariya S. Pravdivtseva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
- Department of Radiology and Neuroradiology, University Medical Centers Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Mariia Anikeeva
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
| | - Jana Humbert
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
- Department of Radiology and Neuroradiology, University Medical Centers Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Marcus Both
- Department of Radiology and Neuroradiology, University Medical Centers Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jennifer E. Hundt
- Lübeck Institute for Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center, Schleswig-Holstein Kiel University, Kiel, Germany
- *Correspondence: Tuula Peñate Medina, ; Jan-Bernd Hövener,
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22
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Pyatigorskaya N, Sgard B, Bertaux M, Yahia-Cherif L, Kas A. Can FDG-PET/MR help to overcome limitations of sequential MRI and PET-FDG for differential diagnosis between recurrence/progression and radionecrosis of high-grade gliomas? J Neuroradiol 2020; 48:189-194. [PMID: 32858062 DOI: 10.1016/j.neurad.2020.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023]
Abstract
The aim of our study was assessing the potential of FDG-PET-MRI to overcome limitations of separately performed MRI and PET-FDG and improving the performance of high-grade gliomas evaluation. Combined PET-MRI analysis allowed differentiating between recurrence/progression and radionecrosis with improved diagnostic accuracy (95% vs 63% for PET and 82% for MRI). FDG being a reliable, cost-saving tracer in this indication, combined FDG PET-MRI analysis could play a significant role in the follow-up of high-grade brain tumors.
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Affiliation(s)
- N Pyatigorskaya
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière -Charles Foix Hospital, Paris, France; Sorbonne Université, Univ Paris 6, UMR S 1127, CNRS UMR 722, Institut du Cerveau et de la Moelle épinière, F-75013 Paris, France.
| | - B Sgard
- Assistance Publique Hôpitaux de Paris, Nuclear Medicine Department, Pitié Salpêtrière-Charles Foix Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75651 Paris CEDEX 13, France
| | - M Bertaux
- Assistance Publique Hôpitaux de Paris, Nuclear Medicine Department, Pitié Salpêtrière-Charles Foix Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75651 Paris CEDEX 13, France
| | - L Yahia-Cherif
- Sorbonne Université, Univ Paris 6, UMR S 1127, CNRS UMR 722, Institut du Cerveau et de la Moelle épinière, F-75013 Paris, France
| | - A Kas
- Assistance Publique Hôpitaux de Paris, Nuclear Medicine Department, Pitié Salpêtrière-Charles Foix Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75651 Paris CEDEX 13, France; Sorbonne University, Laboratoire d'Imagerie Biomédicale, INSERM U1146, Paris, France
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23
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Luan J, Wu M, Wang X, Qiao L, Guo G, Zhang C. The diagnostic value of quantitative analysis of ASL, DSC-MRI and DKI in the grading of cerebral gliomas: a meta-analysis. Radiat Oncol 2020; 15:204. [PMID: 32831106 PMCID: PMC7444047 DOI: 10.1186/s13014-020-01643-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To perform quantitative analysis on the efficacy of using relative cerebral blood flow (rCBF) in arterial spin labeling (ASL), relative cerebral blood volume (rCBV) in dynamic magnetic sensitivity contrast-enhanced magnetic resonance imaging (DSC-MRI), and mean kurtosis (MK) in diffusion kurtosis imaging (DKI) to grade cerebral gliomas. METHODS Literature regarding ASL, DSC-MRI, or DKI in cerebral gliomas grading in both English and Chinese were searched from PubMed, Embase, Web of Science, CBM, China National Knowledge Infrastructure (CNKI), and Wanfang Database as of 2019. A meta-analysis was performed to evaluate the efficacy of ASL, DSC-MRI, and DKI in the grading of cerebral gliomas. RESULT A total of 54 articles (11 in Chinese and 43 in English) were included. Three quantitative parameters in the grading of cerebral gliomas, rCBF in ASL, rCBV in DSC-MRI, and MK in DKI had the pooled sensitivity of 0.88 [95% CI (0.83,0.92)], 0.92 [95% CI (0.83,0.96)], 0.88 [95% CI (0.82,0.92)], and the pooled specificity of 0.91 [95% CI (0.84,0.94)], 0.81 [95% CI (0.73,0.88)], 0.86 [95% CI (0.78,0.91)] respectively. The pooled area under the curve (AUC) were 0.95 [95% CI (0.93,0.97)], 0.91 [95% CI (0.89,0.94)], 0.93 [95% CI (0.91,0.95)] respectively. CONCLUSION Quantitative parameters rCBF, rCBV and MK have high diagnostic accuracy for preoperative grading of cerebral gliomas.
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Affiliation(s)
- Jixin Luan
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, 67, Dongchang West Road, Liaocheng District, 252000, Shandong Province, China
| | - Mingzhen Wu
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, 67, Dongchang West Road, Liaocheng District, 252000, Shandong Province, China
| | - Xiaohui Wang
- Department of Science and Education, Liaocheng People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, 67, Dongchang West Road, Liaocheng District, 252000, Shandong Province, China
| | - Lishan Qiao
- School of Mathematics, Liaocheng University, Liaocheng District, 252000, Shandong Province, China
| | - Guifang Guo
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, 67, Dongchang West Road, Liaocheng District, 252000, Shandong Province, China
| | - Chuanchen Zhang
- Department of Radiology, Liaocheng People's Hospital, Shandong First Medical University & Shandong Academy of Medical Sciences, 67, Dongchang West Road, Liaocheng District, 252000, Shandong Province, China.
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24
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Rahmat R, Saednia K, Haji Hosseini Khani MR, Rahmati M, Jena R, Price SJ. Multi-scale segmentation in GBM treatment using diffusion tensor imaging. Comput Biol Med 2020; 123:103815. [PMID: 32658776 PMCID: PMC7429988 DOI: 10.1016/j.compbiomed.2020.103815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 10/31/2022]
Abstract
Glioblastoma (GBM) is the commonest primary malignant brain tumor in adults, and despite advances in multi-modality therapy, the outlook for patients has changed little in the last 10 years. Local recurrence is the predominant pattern of treatment failure, hence improved local therapies (surgery and radiotherapy) are needed to improve patient outcomes. Currently segmentation of GBM for surgery or radiotherapy (RT) planning is labor intensive, especially for high-dimensional MR imaging methods that may provide more sensitive indicators of tumor phenotype. Automating processing and segmentation of these images will aid treatment planning. Diffusion tensor magnetic resonance imaging is a recently developed technique (DTI) that is exquisitely sensitive to the ordered diffusion of water in white matter tracts. Our group has shown that decomposition of the tensor information into the isotropic component (p - shown to represent tumor invasion) and the anisotropic component (q - shown to represent the tumor bulk) can provide valuable prognostic information regarding tumor infiltration and patient survival. However, tensor decomposition of DTI data is not commonly used for neurosurgery or radiotherapy treatment planning due to difficulties in segmenting the resultant image maps. For this reason, automated techniques for segmentation of tensor decomposition maps would have significant clinical utility. In this paper, we modified a well-established convolutional neural network architecture (CNN) for medical image segmentation and used it as an automatic multi-sequence GBM segmentation based on both DTI image maps (p and q maps) and conventional MRI sequences (T2-FLAIR and T1 weighted post contrast (T1c)). In this proof-of-concept work, we have used multiple MRI sequences, each with individually defined ground truths for better understanding of the contribution of each image sequence to the segmentation performance. The high accuracy and efficiency of our proposed model demonstrates the potential of utilizing diffusion MR images for target definition in precision radiation treatment planning and surgery in routine clinical practice.
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Affiliation(s)
- Roushanak Rahmat
- Department of Clinical Neuroscience, University of Cambridge, UK.
| | - Khadijeh Saednia
- Department of Computer Engineering, Amirkabir University of Technology, Iran; Department Electrical Engineering and Computer Science, York University, Canada
| | | | - Mohamad Rahmati
- Department of Computer Engineering, Amirkabir University of Technology, Iran
| | - Raj Jena
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - Stephen J Price
- Department of Clinical Neuroscience, University of Cambridge, UK
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25
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Parikh D, Afshari FT, Sherlala K, Ahmed S, Shad A. Utility of Arterial Spin Labeling Magnetic Resonance Imaging in Differentiating Sellar Region Meningiomas from Pituitary Adenomas. World Neurosurg 2020; 142:e407-e412. [PMID: 32673801 DOI: 10.1016/j.wneu.2020.07.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Differentiating sellar region meningiomas from pituitary adenomas on standard magnetic resonance imaging (MRI) sequences can be difficult. Arterial spin labeling (ASL) is a noninvasive technique of magnetic resonance perfusion imaging. The range of applications of ASL in neurosurgery has increased, and the information provided can be unique and complementary to other MRI sequences. Here we investigate the utility of ASL MRI in differentiating between sellar region meningiomas and pituitary adenomas. METHODS This was a retrospective comparison of quantitative assessments on absolute and normalized tumor blood flow in histologically proven meningiomas versus pituitary adenomas. RESULTS A total of 15 patients with sellar region lesions were identified, including 9 meningiomas and 6 pituitary adenomas. Mean absolute tumor blood flow and normalized tumor blood flow were significantly higher in meningiomas (131 mL/100 g/min and 2.22) than adenomas (47 mL/100 g/min and 0.92; P < 0.05). CONCLUSIONS ASL MRI is a useful adjunct sequence in differentiating sellar region meningiomas, which exhibit high perfusion, from pituitary adenomas, which exhibit relatively low perfusion.
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Affiliation(s)
- Dhruv Parikh
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Fardad T Afshari
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom.
| | - Khaled Sherlala
- Department of Radiology, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Shahzada Ahmed
- Department of Ear, Nose, and Throat, University Hospital Birmingham, Birmingham, United Kingdom
| | - Amjad Shad
- Department of Neurosurgery, University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
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26
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Xiao B, Wang P, Zhao Y, Liu Y, Ye Z. Nasopharyngeal carcinoma perfusion MRI: Comparison of arterial spin labeling and dynamic contrast-enhanced MRI. Medicine (Baltimore) 2020; 99:e20503. [PMID: 32481470 DOI: 10.1097/md.0000000000020503] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To investigate the feasibility of 3D arterial spin labeling (ASL) as an alternative to dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for the qualitative and quantitative evaluation of nasopharyngeal carcinoma (NPC) perfusion.Fifty-two newly diagnosed NPC patients underwent 3D ASL and DCE-MRI scans on a 3.0-T MRI system. The visual qualitative evaluation of the NPC perfusion level was scored from 0 to 3 (0 = no contrast to normal peripheral soft tissue, 3 = pronounced contrast to normal peripheral soft tissue). The visual evaluation of the NPC outline was scored from 0 to 2 (0 = very vague outline, 2 = clear outline). Comparisons of the ASL-derived blood flow (BF) with the DCE-MRI-derived positive enhancement integral, maximum slope of increase, maximum slope of decrease, and time to peak (TTP) were conducted between NPC and non-NPC areas with independent samples t-tests. The diagnostic performance of these parameters was assessed by receiver operating characteristic curve analysis. The correlations between ASL BF and DCE parameters were assessed by Spearman correlation analysis.There was no difference in the visual scores of the NPC perfusion level between the 2 perfusion methods (P= .963). ASL had a lower visual score for describing the outline of NPC than DCE-MRI (P < .001). The ASL and DCE parameters of the NPC areas were significantly different from those of the non-NPC areas (P < .001). The ASL BF showed the largest area under the receiver operating characteristic curve (AUC) of 0.936 for identifying NPC. When all NPC and non-NPC areas were taken into account, significant correlations were observed between the ASL BF and the DCE parameters positive enhancement integral (r = 0.503, P < .001), maximum slope of increase (r = 0.616, P < .001), maximum slope of decrease (r = 0.380, P < .001), and TTP (r = -0.601, P < .001).3D ASL could reveal the hyperperfusion of NPC in a qualitative and quantitative manner without using contrast agent. Additionally, the ASL BF correlated significantly with the semiquantitative DCE-MRI parameters.
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Affiliation(s)
| | - Peiguo Wang
- Department of Radiotherapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
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27
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Cebeci H, Durmaz MS, Arslan S, Arslan A, Tekin AF, Habibi HA, Koylu R. Diagnostic utility of arterial spin labeling in identifying changes in brain perfusion in patients with carbon monoxide poisoning. Clin Imaging 2020; 64:92-96. [PMID: 32388003 DOI: 10.1016/j.clinimag.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Carbon monoxide (CO) poisoning is one of the most common poisonings worldwide. The affinity of hemoglobin for CO is significantly higher than that for oxygen, and the formation of carboxy-hemoglobin leads to a decrease in the capacity of blood to transport oxygen to tissues, tissue hypoxia, and early perfusion changes in the affected tissue. This study aimed to investigate the utility of arterial spin labeling perfusion imaging (ASL-PI) in revealing cerebral vascular hemodynamic changes in patients presenting to the emergency room with CO poisoning and to compare findings with those from diffusion-weighted imaging (DWI). METHOD This study was conducted between November 2016 and May 2019 and was approved by the local ethics committee. DWI and ASL-PI examinations were performed in 83 patients who presented to the emergency room with CO poisoning. Four regions-the cerebral cortex, basal ganglia, cerebral white matter, and cerebellum-were evaluated for alterations in perfusion and diffusion, and findings from DWI and ASL-PI were compared. RESULTS The study group included 39 (50.6%) females and 38 (49.4%) males, with a mean (±SD) age of 40.08 ± 20.41 years (range, 7-86 years). DWI revealed restricted diffusion in 10 regions in 6 (7.8%) patients, including the basal ganglia (n = 2), cerebral white matter (n = 2), cerebral cortex (n = 3), and the cerebellum (n = 3). ASL-PI revealed hypo-perfusion in 64 regions in 36 (46.8%) patients, including the basal ganglia (n = 21), cerebral white matter (n = 12), cerebral cortex (n = 23), and cerebellum (n = 7). CONCLUSION ASL-PI provided additional information when used to identify perfusion changes in the brains of individuals who experienced CO poisoning and was superior to DWI as it revealed early changes in the brain. Considering its limitations, ASL-PI can be routinely used with DWI in cases of CO poisoning.
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Affiliation(s)
- Hakan Cebeci
- Department of Radiology, Selçuk University, Medical Faculty, Konya, Turkey.
| | | | - Serdar Arslan
- Departments of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Abdullah Arslan
- Department of Underwater and Hyperbaric Medicine, University of Health Science, Konya Training and Research Hospital, Konya, Turkey
| | - Ali Fuat Tekin
- Department of Radiology, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
| | - Hatice Arioz Habibi
- Departments of Radiology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Ramazan Koylu
- Department of Emergency Medicine, University of Health Sciences, Konya Training and Research Hospital, Konya, Turkey
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28
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Manning P, Daghighi S, Rajaratnam MK, Parthiban S, Bahrami N, Dale AM, Bolar D, Piccioni DE, McDonald CR, Farid N. Differentiation of progressive disease from pseudoprogression using 3D PCASL and DSC perfusion MRI in patients with glioblastoma. J Neurooncol 2020; 147:681-690. [PMID: 32239431 DOI: 10.1007/s11060-020-03475-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/24/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE To use 3D pseudocontinuous arterial spin labeling (3D PCASL) and dynamic susceptibility contrast-enhanced (DSC) perfusion MRI to differentiate progressive disease from pseudoprogression in patients with glioblastoma (GBM). METHODS Thirty-two patients with GBM who developed progressively enhancing lesions within the radiation field following resection and chemoradiation were included in this retrospective, single-institution study. The updated modified RANO criteria were used to establish progressive disease or pseudoprogression. Following 3D PCASL and DSC MR imaging, perfusion parameter estimates of cerebral blood flow (ASL-nCBF and DSC-nrCBF) and cerebral blood volume (DSC-nrCBV) were calculated. Additionally, contrast enhanced volumes were measured. Mann-Whitney U tests were used to compare groups. Linear discriminant analysis (LDA) and area under receiver operator characteristic curve (AUC) analyses were used to evaluate performance of each perfusion parameter and to determine optimal cut-off points. RESULTS All perfusion parameter measurements were higher in patients with progressive disease (mean, 95% CI ASL-nCBF 2.48, [2.03, 2.93]; DSC-nrCBF = 2.27, [1.85, 2.69]; DSC-nrCBV = 3.51, [2.37, 4.66]) compared to pseudoprogression (mean, 95% CI ASL-nCBF 0.99, [0.47, 1.52]; DSC-nrCBF = 1.05, [0.36, 1.74]; DSC-nCBV = 1.19, [0.34, 2.05]), and findings were significant at the p < 0.0125 level (p = 0.001, 0.003, 0.002; effect size: Cohen's d = 1.48, 1.27, and 0.92). Contrast enhanced volumes were not significantly different between groups (p > 0.447). All perfusion parameters demonstrated high AUC (0.954 for ASL-nCBF, 0.867 for DSC-nrCBF, and 0.891 for DSC-nrCBV), however, ASL-nCBF demonstrated the highest AUC and misclassified the fewest cases (N = 6). Lesions correctly classified by ASL but misclassified by DSC were located along the skull base or adjacent to large resection cavities with residual blood products, at areas of increased susceptibility. CONCLUSION Both 3D PCASL and DSC perfusion MRI techniques have nearly equivalent performance for the differentiation of progressive disease from pseudoprogression in patients with GBM. However, 3D PCASL is less sensitive to susceptibility artifact and may allow for improved classification in select cases.
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Affiliation(s)
- Paul Manning
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA. .,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA. .,Department of Radiology, University of California, San Diego, 200 West Arbor Drive, Mailbox # 8756, San Diego, CA, 92103, USA.
| | - Shadi Daghighi
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Matthew K Rajaratnam
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Sowmya Parthiban
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Naeim Bahrami
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA.,Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Divya Bolar
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Functional Magnetic Resonance Imaging, University of California, San Diego, La Jolla, CA, 92037, USA
| | - David E Piccioni
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Carrie R McDonald
- Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA.,Department of Neurosciences, University of California, San Diego, La Jolla, CA, 92037, USA.,Department of Psychiatry, University of California, San Diego, La Jolla, CA, 92037, USA
| | - Nikdokht Farid
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92037, USA.,Center for Multimodal Imaging and Genetics, University of California, San Diego, La Jolla, CA, 92037, USA
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29
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Pseudo-continuous arterial spin labelling shows high diagnostic performance in the detection of postoperative residual lesion in hyper-vascularised adult brain tumours. Eur Radiol 2020; 30:2809-2820. [PMID: 31965259 DOI: 10.1007/s00330-019-06474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/26/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Our aim was to evaluate the contribution of pseudo-continuous arterial spin labelling (pCASL) in the detection of a postoperative residual lesion in adult brain tumours. METHODS Seventy-five patients were prospectively included. Following the results of preoperative DSC-PWI assessment, intra-axial lesions, including high-grade gliomas (n = 43) and certain metastases (n = 14), were classified as hyper-vascular (HV+ group, n = 57); other lesions, including low-grade gliomas and certain metastases, were classified as non-hyper-vascular (HV- group, n = 18). To confirm the absence/presence of a residual lesion or disease progression, postoperative MRI including pCASL sequence and follow-up-MRI were performed within 72 h and 1-6 months after the resection, respectively. Two raters evaluated the images. Mean and maximal ASL cerebral blood flow (CBF) values were measured in the perioperative region and normalised to the contralateral tissue. The pCASL-CBF maps and post-contrast T1WI were visually assessed for residual lesion. Quantitative data were analysed with unpaired Student t and Mann-Whitney U tests and the visual diagnostic performance with the McNemar test. RESULTS In the HV+ group, the mean normalised CBF was 1.97 ± 0.59 and 0.97 ± 0.29 (p < 0.0001, AUC = 0.964, cut-off = 1.27) for patients with or without residual tumours, respectively. The mean normalised CBF was not discriminative for assessing residual tumours in the HV- group (p = 0.454). Visual CBF evaluation allowed 92.98% patients belonging to the HV+ group to be correctly classified (sensitivity 93.02%, specificity 92.86%, p < 0.001). Visual evaluation was correlated with contrast enhancement evaluation and with the mean normalised CBF values (r = 0.505, p < 0.0001 and 0.838, p < 0.0001, respectively). CONCLUSION Qualitative and quantitative ASL evaluation shows high diagnostic performance in postoperative assessment of hyper-perfused tumours. In this case, postoperative pCASL may be useful, especially if contrast injection cannot be performed or when contrast enhancement is doubtful. KEY POINTS • Evaluation of postoperative residual lesion in the case of brain tumours is an imaging challenge. • This prospective monocentric study showed that increased normalised cerebral blood flow assessed by pseudo-continuous arterial spin labelling (pCASL) correlates well with the presence of a residual tumour in the case of hyper-vascular tumour diagnosed on preoperative MRI. • Qualitative and quantitative pCASL is an informative sequence for hyper-vascular residual tumour, especially if acquired more than 48 h after brain tumour surgery, when contrast enhancement can give ambiguous results due to blood-brain barrier disruption.
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Geerts B, Law Ye B, Galanaud D, Dormont D, Pyatigorskaya N. Potential effect of fetal origin of posterior cerebral artery on the arterial spin labeling sequence. J Neuroradiol 2019; 47:238-241. [PMID: 31705918 DOI: 10.1016/j.neurad.2019.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 04/12/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Bert Geerts
- Department of Radiology, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000 Bruges, Belgium.
| | - Bruno Law Ye
- Service de neuroradiologie, hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, 75013 Paris, France
| | - Damien Galanaud
- Service de neuroradiologie, hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, 75013 Paris, France
| | - Didier Dormont
- Service de neuroradiologie, hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, 75013 Paris, France
| | - Nadya Pyatigorskaya
- Service de neuroradiologie, hôpital Pitié-Salpêtrière, Assistance publique Hôpitaux de Paris, 75013 Paris, France
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Ho CY, Supakul N, Patel PU, Seit V, Groswald M, Cardinal J, Lin C, Kralik SF. Differentiation of pilocytic and pilomyxoid astrocytomas using dynamic susceptibility contrast perfusion and diffusion weighted imaging. Neuroradiology 2019; 62:81-88. [PMID: 31676961 DOI: 10.1007/s00234-019-02310-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 10/15/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Pilocytic (PA) and pilomyxoid astrocytomas (PMA) are related low-grade tumors which occur predominantly in children. PMAs have a predilection for a supratentorial location in younger children with worse outcomes. However, the two have similar imaging characteristics. Quantitative MR sequences such as dynamic susceptibility contrast (DSC) perfusion and diffusion (DWI) were assessed for significant differences between the two tumor types and locations. METHODS A retrospective search for MRI with DSC and DWI on pathology-proven cases of PMA and PA in children was performed. Tumors were manually segmented on anatomic images registered to rCBV, K2, and ADC maps. Tumors were categorized as PA or PMA, with subclassification of supratentorial and infratentorial locations. Mean values were obtained for tumor groups and locations compared with Student's t test for significant differences with post hoc correction for multiple comparisons. ROC analysis for significant t test values was performed. Histogram evaluation was also performed. RESULTS A total of 49 patients met inclusion criteria. This included 30 patients with infratentorial PA, 8 with supratentorial PA, 6 with supratentorial PMA, and 5 with infratentorial PMA. Mean analysis showed significantly increased rCBV for infratentorial PMA (2.39 ± 1.1) vs PA (1.39 ± 0.16, p = 0.0006). ROC analysis for infratentorial PA vs PMA yielded AUC = 0.87 (p < 0.001). Histogram analysis also demonstrated a higher ADC peak location for PMA (1.8 ± 0.2) vs PA (1.56 ± 0.28). CONCLUSION PMA has a significantly higher rCBV than PA in the infratentorial space. DSC perfusion and diffusion MR imaging may be helpful to distinguish between the two tumor types in this location.
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Affiliation(s)
- Chang Y Ho
- Department of Radiology and Imaging Sciences, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.
| | - Nucharin Supakul
- Department of Radiology and Imaging Sciences, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Parth U Patel
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Vetana Seit
- Department of Radiology and Imaging Sciences, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Michael Groswald
- Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Jeremy Cardinal
- Department of Radiology and Imaging Sciences, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Chen Lin
- Department of Radiology and Imaging Sciences, MRI Department, Indiana University School of Medicine, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Stephen F Kralik
- Department of Radiology, Texas Children's Hospital, Houston, USA
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Park H, Lee J, Park SH, Choi SH. Evaluation of Tumor Blood Flow Using Alternate Ascending/Descending Directional Navigation in Primary Brain Tumors: A Comparison Study with Dynamic Susceptibility Contrast Magnetic Resonance Imaging. Korean J Radiol 2019; 20:275-282. [PMID: 30672167 PMCID: PMC6342753 DOI: 10.3348/kjr.2018.0300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/04/2018] [Indexed: 11/23/2022] Open
Abstract
Objective Alternate ascending/descending directional navigation (ALADDIN) is a novel arterial spin labeling technique that does not require a separate spin preparation pulse. We sought to compare the normalized cerebral blood flow (nCBF) values obtained by ALADDIN and dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) in patients with primary brain tumors. Materials and Methods Sixteen patients with primary brain tumors underwent MRI scans including contrast-enhanced T1-weighted imaging, DSC perfusion MRI, and ALADDIN. The nCBF values of normal gray matter (GM) and tumor areas were measured by both DSC perfusion MRI and ALADDIN, which were compared by the Wilcoxon signed rank test. Subgroup analyses according to pathology were performed with the Wilcoxon signed rank test. Results Higher mean nCBF values of GM regions in the bilateral frontal lobe, temporal lobe, and caudate were detected by ALADDIN than by DSC perfusion MRI (p <0.05). In terms of the mean or median nCBF values and the mean of the top 10% nCBF values from tumors, DSC perfusion MRI and ALADDIN did not statistically significantly differ either overall or in each tumor group. Conclusion ALADDIN tended to detect higher nCBF values in normal GM, as well as higher perfusion portions of primary brain tumors, than did DSC perfusion MRI. We believe that the high perfusion signal on ALADDIN can be beneficial in lesion detection and characterization.
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Affiliation(s)
- Hyeree Park
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joonhyuk Lee
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Hong Park
- Magnetic Resonance Imaging Laboratory, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Center for Nanoparticle Research, Institute for Basic Science (IBS), Seoul, Korea.
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Ji B, Wang S, Liu Z, Weinberg BD, Yang X, Liu T, Wang L, Mao H. Revealing hemodynamic heterogeneity of gliomas based on signal profile features of dynamic susceptibility contrast-enhanced MRI. NEUROIMAGE-CLINICAL 2019; 23:101864. [PMID: 31176951 PMCID: PMC6558214 DOI: 10.1016/j.nicl.2019.101864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 04/30/2019] [Accepted: 05/19/2019] [Indexed: 01/25/2023]
Abstract
Dynamic susceptibility contrast enhanced magnetic resonance imaging (DSC MRI) is widely used for studying blood perfusion in brain tumors. While the time-dependent change of MRI signals related to the concentration of the tracer is used to derive the hemodynamic parameters such as regional blood volume and flow into tumors, the tissue-specific information associated with variations in profiles of signal time course is often overlooked. We report a new approach of combining model free independent component analysis (ICA) identification of specific signal profiles of DSC MRI time course data and extraction of the features from those time course profiles to interrogate time course data followed by calculating the region specific blood volume based on selected individual time courses. Based on the retrospective analysis of DSC MRI data from 38 patients with pathology confirmed low (n = 18) and high (n = 20) grade gliomas, the results reveal the spatially defined intra-tumoral hemodynamic heterogeneity of brain tumors based on features of time course profiles. The hemodynamic heterogeneity as measured by the number of independent components of time course data is associated with the tumor grade. Using 8 selected signal profile features, machine-learning trained algorithm, e.g., logistic regression, was able to differentiate pathology confirmed low intra-tumoral and high grade gliomas with an accuracy of 86.7%. Furthermore, the new method can potentially extract more tumor physiological information from DSC MRI comparing to the traditional model-based analysis and morphological analysis of tumor heterogeneity, thus may improve the characterizations of gliomas for better diagnosis and treatment decisions. Signal profiles of dynamic susceptibility contrast MRI data of brain tumors reflect hemodynamic properties of tumor tissue. Features in signal profiles extracted by machine learning methods revealed the hemodynamic heterogeneity of the gliomas. The reported approach is a new strategy to characterize the intra-tumor heterogeneity and physiological properties of gliomas.
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Affiliation(s)
- Bing Ji
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Silun Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Zhou Liu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Medical College of Nanchang University, Nanchang, Jiangxi, China
| | - Brent D Weinberg
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Xiaofeng Yang
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Tianming Liu
- Department of Computer Sciences, University of Georgia, Athens, GA, United States of America
| | - Liya Wang
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America; Medical College of Nanchang University, Nanchang, Jiangxi, China; Department of Radiology, The People's Hospital of Longhua, Shenzhen, Guangdong, China.
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States of America.
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Kostenikov NA, Zhuikov BL, Chudakov VM, Iliuschenko YR, Shatik SV, Zaitsev VV, Sysoev DS, Stanzhevskiy AA. Application of 82 Sr/ 82 Rb generator in neurooncology. Brain Behav 2019; 9:e01212. [PMID: 30729720 PMCID: PMC6422714 DOI: 10.1002/brb3.1212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The applicability of "Rubidium Chloride, 82 Rb from Generator" radiopharmaceutical for brain tumors (BT) diagnostics is demonstrated on the basis of the application experience of the radiopharmaceutical in neurooncology. EXPERIMENTAL A total of 21 patients with various brain tumors and nonneoplastic abnormal brain masses were investigated. RESULTS AND DISCUSSIONS The results of the imaging and differential diagnostics of malignant and benign tumors, nonneoplastic abnormal brain masses and lesions revealed the prevalence of high uptake of the radiopharmaceutical in the malignant tumors in comparison with benign glioma and arteriovenous malformations in which 82 Rb-chloride accumulates in the vascular phase but does not linger further. The ultra-short half-life of radionuclide 82 Rb (76 s) along with a low absorbed radiation dose with 82 Rb-chloride by intravenous administration create a new possibility of successive use of two or more radiopharmaceuticals for the examination of the same patient. For instance, PET examination with 18 F-FDG, 11 C-methionine, 11 C-choline, or any other radiopharmaceutical can be carried out in just 7-15 min. after 82 Rb-chloride injection. CONCLUSION Research demonstrated an effectiveness of 82 Rb-chloride application as a diagnostic agent in neurooncology. A method of dosing and administration of the generator-produced radiopharmaceutical has been worked out. It is possible to do up to 600 PET sessions using one Russian 82 Rb generator GR-01. The generator is proved to be reliable and easy to use. The interest in 82 Rb-chloride as a tumor-seeking radiopharmaceutical rose due to the active application of the modern devices PET/CT in the routine clinical practice.
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Affiliation(s)
- Nikolay A. Kostenikov
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Boris L. Zhuikov
- Institute for Nuclear Research of Russian Academy of Sciences (INR RAS)MoscowRussia
| | - Valeriy M. Chudakov
- Institute for Nuclear Research of Russian Academy of Sciences (INR RAS)MoscowRussia
| | - Yuriy R. Iliuschenko
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Sergey V. Shatik
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Vadim V. Zaitsev
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Dmitriy S. Sysoev
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
| | - Andrey A. Stanzhevskiy
- Russian Research Center of Radiology and Surgical Technologies (RRCRST) of Ministry of Public HealthSaint‐PetersburgRussia
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Rebrikova VA, Sergeev NI, Padalko VV, Kotlyarov PM, Solodkiy VA. [The use of MR perfusion in assessing the efficacy of treatment for malignant brain tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:113-120. [PMID: 31577277 DOI: 10.17116/neiro201983041113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This literature review analyzes the capabilities of magnetic resonance imaging (MRI)-based cerebral perfusion for differentiation between post-radiation changes (e.g., radionecrosis) and continued growth. The technique is compared with other highly informative radiodiagnostic techniques used in neuroradiology. The use of MR perfusion is important in a comprehensive examination protocol. Trends in the technique development are analyzed.
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Affiliation(s)
- V A Rebrikova
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - N I Sergeev
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - V V Padalko
- Sechenov First Moscow Medical University, Moscow, Russia
| | - P M Kotlyarov
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - V A Solodkiy
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
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Vallatos A, Al-Mubarak HFI, Birch JL, Galllagher L, Mullin JM, Gilmour L, Holmes WM, Chalmers AJ. Quantitative histopathologic assessment of perfusion MRI as a marker of glioblastoma cell infiltration in and beyond the peritumoral edema region. J Magn Reson Imaging 2018; 50:529-540. [PMID: 30569620 DOI: 10.1002/jmri.26580] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Conventional MRI fails to detect regions of glioblastoma cell infiltration beyond the contrast-enhanced T1 solid tumor region, with infiltrating tumor cells often migrating along host blood vessels. PURPOSE To quantitatively and qualitatively analyze the correlation between perfusion MRI signal and tumor cell density in order to assess whether local perfusion perturbation could provide a useful biomarker of glioblastoma cell infiltration. STUDY TYPE Animal model. SUBJECTS Mice bearing orthotopic glioblastoma xenografts generated from a patient-derived glioblastoma cell line. FIELD STRENGTH/SEQUENCES 7T perfusion images acquired using a high signal-to-noise ratio (SNR) multiple boli arterial spin labeling sequence were compared with conventional MRI (T1 /T2 weighted, contrast-enhanced T1 , diffusion-weighted, and apparent diffusion coefficient). ASSESSMENT Immunohistochemistry sections were stained for human leukocyte antigen (probing human-derived tumor cells). To achieve quantitative MRI-tissue comparison, multiple histological slices cut in the MRI plane were stacked to produce tumor cell density maps acting as a "ground truth." STATISTICAL TESTS Sensitivity, specificity, accuracy, and Dice similarity indices were calculated and a two-tailed, paired t-test used for statistical analysis. RESULTS High comparison test results (Dice 0.62-0.72, Accuracy 0.86-0.88, Sensitivity 0.51-0.7, and Specificity 0.92-0.97) indicate a good segmentation for all imaging modalities and highlight the quality of the MRI tissue assessment protocol. Perfusion imaging exhibits higher sensitivity (0.7) than conventional MRI (0.51-0.61). MRI/histology voxel-to-voxel comparison revealed a negative correlation between tumor cell infiltration and perfusion at the tumor margins (P = 0.0004). DATA CONCLUSION These results demonstrate the ability of perfusion imaging to probe regions of low tumor cell infiltration while confirming the sensitivity limitations of conventional imaging modalities. The quantitative relationship between tumor cell density and perfusion identified in and beyond the edematous T2 hyperintensity region surrounding macroscopic tumor could be used to detect marginal tumor cell infiltration with greater accuracy. LEVEL OF EVIDENCE 1 Technical stage: 2 J. Magn. Reson. Imaging 2019;50:529-540.
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Affiliation(s)
- A Vallatos
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK.,Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - H F I Al-Mubarak
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK.,University of Misan, Iraq
| | - J L Birch
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| | - L Galllagher
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - J M Mullin
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - L Gilmour
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
| | - W M Holmes
- Glasgow Experimental MRI Centre, Institute of Neuroscience and Psychology, University of Glasgow, UK
| | - A J Chalmers
- Wolfson Wohl Translational Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, UK
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Di N, Cheng W, Chen H, Zhai F, Liu Y, Mu X, Chu Z, Lu N, Liu X, Wang B. Utility of arterial spin labelling MRI for discriminating atypical high-grade glioma from primary central nervous system lymphoma. Clin Radiol 2018; 74:165.e1-165.e9. [PMID: 30415766 DOI: 10.1016/j.crad.2018.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023]
Abstract
AIM To evaluate the ability of arterial spin labelling (ASL) magnetic resonance imaging (MRI) in differentiating primary central nervous system lymphoma (PCNSL) from atypical high-grade glioma (HGG), as well as exploring the underlying pathological mechanisms. METHODS AND MATERIALS Twenty-three patients with PCNSL and 17 patients with atypical HGG who underwent ASL-MRI were identified retrospectively. Absolute cerebral blood flow (aCBF) and normalised cerebral blood flow (nCBF) values were obtained, and were compared between PCNSL and atypical HGG using the Mann-Whitney U-test. The performance in discriminating between PCNSL and atypical HGG was evaluated using receiver-operating characteristics analysis and area-under-the-curve (AUC) values for aCBF and nCBF. The correlation between microvessel density (MVD) and aCBF was determined by Spearman's correlation analysis. RESULTS Atypical HGG demonstrated significantly higher aCBF, nCBF, and MVD values than PCNSL (p<0.05). The diagnostic accuracy of discriminating PCNSL from atypical HGG showed AUC=0.877 (95% confidence interval [CI] 0.735-0.959) for aCBF, and AUC=0.836 (95% confidence interval [CI] 0.685-0.934) for nCBF. There was a moderate positive correlation between aCBF values of region of interest (ROI >30 mm2) in the enhanced area and MVD values (rho=0.579, p=0.0001), and a strong positive correlation between aCBF values MVD based on "point-to-point biopsy" (rho=0.83, p=0.0029). Interobserver agreements for aCBF and nCBF were excellent (ICC >0.75). CONCLUSIONS ASL perfusion MRI is a useful imaging technique for the discrimination between atypical HGG and PCNSL, which may be determined by the difference of MVD between them.
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Affiliation(s)
- N Di
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China; Department of Radiology, Huashan Hospital Fudan University, 12 Wulumuqi Rd. Middle, 200040 Shanghai, China
| | - W Cheng
- Department of Pharmacy, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - H Chen
- Department of Radiology, Weifang Traditional Chinese Hospital, 1055 Weizhou Rd, 261000 Weifang, China
| | - F Zhai
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - Y Liu
- Department of Pediatrics, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - X Mu
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - Z Chu
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China
| | - N Lu
- Department of Radiology, Huashan Hospital Fudan University, 12 Wulumuqi Rd. Middle, 200040 Shanghai, China
| | - X Liu
- Department of Radiology, Binzhou Medical University Hospital, 661 Huanghe 2nd Rd, 256603 Binzhou, China.
| | - B Wang
- Department of Medical Imaging and Nuclear, Binzhou Medical University, 346 Guanhai Rd, 264000 Yantai, China.
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Chronic intracranial artery stenosis: Comparison of whole-brain arterial spin labeling with CT perfusion. Clin Imaging 2018; 52:252-259. [DOI: 10.1016/j.clinimag.2018.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/27/2018] [Accepted: 08/09/2018] [Indexed: 11/20/2022]
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Wong AMC, Yeh CH, Lin JJ, Liu HL, Chou IJ, Lin KL, Wang HS. Arterial spin-labeling perfusion imaging of childhood encephalitis: correlation with seizure and clinical outcome. Neuroradiology 2018; 60:961-970. [PMID: 30046856 DOI: 10.1007/s00234-018-2062-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/17/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE In childhood encephalitis, perfusion abnormalities have been infrequently reported to associate with clinical status. We investigated whether perfusion abnormalities correlated with seizure and clinical outcome in encephalitis. METHODS We retrospectively analyzed the MR studies of 77 pediatric patients with encephalitis. Pseudo-continuous arterial spin-labeling (ASL) imaging was performed on a 3-T scanner. The patients were divided into five groups according to ASL perfusion imaging pattern: normal perfusion (NP), focal hypoperfusion (Lf), extreme global hypoperfusion (LE), focal hyperperfusion (Hf), and extreme global hyperperfusion (HE). Clinical outcome at 3 weeks was dichotomized to unfavorable or favorable outcome according to the Glasgow outcome scale. Multivariate logistic regression was conducted to predict unfavorable outcome and presence of seizure separately, based on explanatory variables including age, sex, and ASL pattern. RESULTS Twenty-seven (35%) patients were designated as in group Hf, five (7%) in group Lf, 11 (14%) in group LE, none in group HE, and 34 (44%) in group NP. Multivariate logistic regression analysis showed that ASL pattern was significantly associated with unfavorable outcome (P = 0.005) and with presence of seizure (P = 0.005). For ASL pattern, group LE was 17.31 times as likely to have an unfavorable outcome as group NP (odds ratio confidence interval [CI] 3.084, 97.105; P = 0.001). Group Hf was 6.383 times as likely to have seizure as group NP (CI 1.765, 23.083; P = 0.005). CONCLUSIONS In childhood encephalitis, patients with extreme global hypoperfusion had poor neurological outcome and those with focal hypoperfusion were more likely to have seizure.
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Affiliation(s)
- Alex Mun-Ching Wong
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, 5 Fu-Hsing Street, Taoyuan, 333, Taiwan.
| | - Chih-Hua Yeh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung/Linkou, and Chang Gung University, 5 Fu-Hsing Street, Taoyuan, 333, Taiwan
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - I-Jun Chou
- Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung University, Linkou, Taiwan
| | - 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
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Liu M, Chen Z, Ma L. Test-retest reliability of perfusion of the precentral cortex and precentral subcortical white matter on three-dimensional pseudo-continuous arterial spin labeling. J Int Med Res 2018; 46:3788-3795. [PMID: 29926756 PMCID: PMC6136019 DOI: 10.1177/0300060518779716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective This study was performed to evaluate the test–retest reliability of perfusion
of the cortex and subcortical white matter on three-dimensional spiral fast
spin echo pseudo-continuous arterial spin labeling (3D-ASL). Methods Eight healthy subjects underwent 3D-ASL and structural imaging at the same
time each day for 1 week. ASL data acquisition was performed in the resting
state and right finger-tapping state. Cerebral blood flow (CBF) images were
calculated, and the CBF values of the precentral cortex (PCC) and precentral
subcortical white matter (PCSWM) were automatically extracted based on the
structural images and CBF images. Results In the resting state, the intraclass correlation coefficient (ICC) of the
bilateral PCC was 0.84 (left) and 0.81 (right) and that of the bilateral
SCWM was 0.89 (left) and 0.85 (right). In the finger-tapping state, the ICC
of the bilateral PCC was 0.91 (left) and 0.87 (right) and that of the
bilateral PCSWM was 0.87 (left) and 0.92 (right). The CBF value of the left
PCC and PCSWM was not significantly different between the resting state and
finger-tapping state on two ASL scans. Conclusion 3D-ASL provides reliable CBF measurement in the cortex and subcortical white
matter in the resting or controlled state.
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Affiliation(s)
- Mengqi Liu
- 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China.,2 Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Zhiye Chen
- 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China.,2 Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Lin Ma
- 1 Department of Radiology, Chinese PLA General Hospital, Beijing, China
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Perfusion Magnetic Resonance Imaging Changes in Normal Appearing Brain Tissue after Radiotherapy in Glioblastoma Patients may Confound Longitudinal Evaluation of Treatment Response. Radiol Oncol 2018; 52:143-151. [PMID: 30018517 PMCID: PMC6043875 DOI: 10.2478/raon-2018-0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/04/2018] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was assess acute and early delayed radiation-induced changes in normal-appearing brain tissue perfusion as measured with perfusion magnetic resonance imaging (MRI) and the dependence of these changes on the fractionated radiotherapy (FRT) dose level. Patients and methods Seventeen patients with glioma WHO grade III-IV treated with FRT were included in this prospective study, seven were excluded because of inconsistent FRT protocol or missing examinations. Dynamic susceptibility contrast MRI and contrast-enhanced 3D-T1-weighted (3D-T1w) images were acquired prior to and in average (standard deviation): 3.1 (3.3), 34.4 (9.5) and 103.3 (12.9) days after FRT. Pre-FRT 3D-T1w images were segmented into white- and grey matter. Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were calculated and co-registered patient-wise to pre-FRT 3D-T1w images. Seven radiation dose regions were created for each tissue type: 0-5 Gy, 5-10 Gy, 10-20 Gy, 20-30 Gy, 30-40 Gy, 40-50 Gy and 50-60 Gy. Mean CBV and CBF were calculated in each dose region and normalised (nCBV and nCBF) to the mean CBV and CBF in 0-5 Gy white- and grey matter reference regions, respectively. Results Regional and global nCBV and nCBF in white- and grey matter decreased after FRT, followed by a tendency to recover. The response of nCBV and nCBF was dose-dependent in white matter but not in grey matter. Conclusions Our data suggest that radiation-induced perfusion changes occur in normal-appearing brain tissue after FRT. This can cause an overestimation of relative tumour perfusion using dynamic susceptibility contrast MRI, and can thus confound tumour treatment evaluation.
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42
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Chen Z, Chen X, Liu M, Liu M, Ma L, Yu S. Evaluation of gray matter perfusion in episodic migraine using voxel-wise comparison of 3D pseudo-continuous arterial spin labeling. J Headache Pain 2018; 19:36. [PMID: 29796865 PMCID: PMC5966347 DOI: 10.1186/s10194-018-0866-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although previous studies have demonstrated that structural and functional abnormalities in episodic migraine (EM), less is known about altered brain perfusion in the EM. The aim of this study is to investigate altered gray matter perfusion in EM using a 3D volumetric perfusion imaging. METHODS Fifteen EM patients and 15 normal controls (NC) underwent structural and 3D pseudo-continuous arterial spin labeling (3D pc-ASL). The structural images were segmented using DARTEL methods and the generated normalized T1 tissue probability maps were used to coregister the cerebral blood flow (CBF) images, which would further be performed with standardization using Fisher Z Transformation. Voxel-wise analysis was applied to CBF map with Z standardization, and the Z value of the abnormal brain region was extracted and performed with correlation with the clinical variables. RESULTS The increased CBF value located in the left Brodmann 38 (BA38) and no significantly decreased CBF value were detected in EM. HAMD scores presented significantly positive correlation with the CBF value of the left BA38. CONCLUSION The current study indicated that the pattern of cerebral hyperperfusion may elucidate the neurogenic mechanism in the EM genesis, and 3D pc-ASL technique would non-invasively provide valuable cerebral perfusion information for the further pathophysiological and neuropsychological study in EM.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China.,Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mengyu Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mengqi Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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43
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Liu T, Cheng G, Kang X, Xi Y, Zhu Y, Wang K, Sun C, Ye J, Li P, Yin H. Noninvasively evaluating the grading and IDH1 mutation status of diffuse gliomas by three-dimensional pseudo-continuous arterial spin labeling and diffusion-weighted imaging. Neuroradiology 2018; 60:693-702. [PMID: 29777252 DOI: 10.1007/s00234-018-2021-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/02/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To noninvasively evaluate the value of three-dimensional pseudo-continuous arterial spin labeling (3D pCASL) and diffusion-weighted imaging (DWI) in diffuse gliomas grading as well as isocitrate dehydrogenase (IDH) 1 mutation status. METHODS Fifty-six patients with pathologically confirmed diffuse gliomas with preoperative 3D pCASL and DWI were enrolled in this study. The Student's t test and Mann-Whitney U test were used to evaluate differences in parameters of DWI and 3D pCASL between low and high grade as well as between mutant and wild-type IDH1 diffuse gliomas; receiver operator characteristic (ROC) analysis was used to assess the diagnostic performance. Subsequently, a multivariate stepwise logistic regression analysis was used to identify the independent parameters. Besides, Kruskal-Wallis H test was used to examine the differences among grades II, III, and IV diffuse gliomas. RESULTS All parameters but CBFmean showed significant differences between low- and high-grade diffuse gliomas. In ROC analysis, the AUC of CBFmax, rCBFmean, rCBFmax, ADCmean, and ADCmin were 0.701, 0.730, 0.746, 0.810, and 0.856 respectively. Only the value of ADCmin was identified as the independent parameter in the differentiation of low- from high-grade diffuse gliomas. All parameters but CBFmean showed significant differences among the three grades. And the values of CBFmean, CBFmax, rCBFmean, and ADCmean showed significant differences between mutant and wild-type IDH1 in grade II-III astrocytoma. CONCLUSION Both 3D pCASL and DWI could be useful tools for distinguishing low- from high-grade diffuse gliomas and have the potential to differentiate different IDH1 mutation statuses of astrocytoma.
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Affiliation(s)
- Tingting Liu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Guang Cheng
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xiaowei Kang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yibin Xi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yuanqiang Zhu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Kai Wang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Chao Sun
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jing Ye
- Department of Pathology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Ping Li
- Department of Radiology, Xi'an Mental Health Center, No. 15 Yanying Road, Xi'an, 710061, Shaanxi, China.
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Overview and Critical Appraisal of Arterial Spin Labelling Technique in Brain Perfusion Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:5360375. [PMID: 29853806 PMCID: PMC5964483 DOI: 10.1155/2018/5360375] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/11/2018] [Indexed: 12/02/2022]
Abstract
Arterial spin labelling (ASL) allows absolute quantification of CBF via a diffusible intrinsic tracer (magnetically labelled blood water) that disperses from the vascular system into neighbouring tissue. Thus, it can provide absolute CBF quantification, which eliminates the need for the contrast agent, and can be performed repeatedly. This review will focus on the common ASL acquisition techniques (continuous, pulsed, and pseudocontinuous ASL) and how ASL image quality might be affected by intrinsic factors that may bias the CBF measurements. We also provide suggestions to mitigate these risks, model appropriately the acquired signal, increase the image quality, and hence estimate the reliability of the CBF, which consists an important noninvasive biomarker. Emerging methodologies for extraction of new ASL-based biomarkers, such as arterial arrival time (AAT) and arterial blood volume (aBV), will be also briefly discussed.
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45
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Thust SC, van den Bent MJ, Smits M. Pseudoprogression of brain tumors. J Magn Reson Imaging 2018; 48:571-589. [PMID: 29734497 PMCID: PMC6175399 DOI: 10.1002/jmri.26171] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 04/07/2018] [Indexed: 12/11/2022] Open
Abstract
This review describes the definition, incidence, clinical implications, and magnetic resonance imaging (MRI) findings of pseudoprogression of brain tumors, in particular, but not limited to, high-grade glioma. Pseudoprogression is an important clinical problem after brain tumor treatment, interfering not only with day-to-day patient care but also the execution and interpretation of clinical trials. Radiologically, pseudoprogression is defined as a new or enlarging area(s) of contrast agent enhancement, in the absence of true tumor growth, which subsides or stabilizes without a change in therapy. The clinical definitions of pseudoprogression have been quite variable, which may explain some of the differences in reported incidences, which range from 9-30%. Conventional structural MRI is insufficient for distinguishing pseudoprogression from true progressive disease, and advanced imaging is needed to obtain higher levels of diagnostic certainty. Perfusion MRI is the most widely used imaging technique to diagnose pseudoprogression and has high reported diagnostic accuracy. Diagnostic performance of MR spectroscopy (MRS) appears to be somewhat higher, but MRS is less suitable for the routine and universal application in brain tumor follow-up. The combination of MRS and diffusion-weighted imaging and/or perfusion MRI seems to be particularly powerful, with diagnostic accuracy reaching up to or even greater than 90%. While diagnostic performance can be high with appropriate implementation and interpretation, even a combination of techniques, however, does not provide 100% accuracy. It should also be noted that most studies to date are small, heterogeneous, and retrospective in nature. Future improvements in diagnostic accuracy can be expected with harmonization of acquisition and postprocessing, quantitative MRI and computer-aided diagnostic technology, and meticulous evaluation with clinical and pathological data. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018.
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Affiliation(s)
- Stefanie C. Thust
- Lysholm Neuroradiology DepartmentNational Hospital for Neurology and NeurosurgeryLondonUK
- Department of Brain Rehabilitation and RepairUCL Institute of NeurologyLondonUK
- Imaging DepartmentUniversity College London HospitalLondonUK
| | - Martin J. van den Bent
- Department of NeurologyThe Brain Tumor Centre at Erasmus MC Cancer InstituteRotterdamThe Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MCUniversity Medical Centre RotterdamRotterdamThe Netherlands
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Luna A, Martín Noguerol T, Mata LA. Bases de la imagen funcional II: técnicas emergentes de resonancia magnética y nuevos métodos de análisis. RADIOLOGIA 2018. [DOI: 10.1016/j.rx.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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47
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Arisawa A, Watanabe Y, Tanaka H, Takahashi H, Matsuo C, Fujiwara T, Fujiwara M, Fujimoto Y, Tomiyama N. Comparative study of pulsed-continuous arterial spin labeling and dynamic susceptibility contrast imaging by histogram analysis in evaluation of glial tumors. Neuroradiology 2018; 60:599-608. [DOI: 10.1007/s00234-018-2024-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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48
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You SH, Yun TJ, Choi HJ, Yoo RE, Kang KM, Choi SH, Kim JH, Sohn CH. Differentiation between primary CNS lymphoma and glioblastoma: qualitative and quantitative analysis using arterial spin labeling MR imaging. Eur Radiol 2018; 28:3801-3810. [DOI: 10.1007/s00330-018-5359-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/19/2018] [Accepted: 01/29/2018] [Indexed: 10/17/2022]
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49
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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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50
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Wu B, Yang Y, Zhou S, Wang W, Wang Z, Hu G, He J, Wu X. Could Arterial Spin Labeling Distinguish Patients in Minimally Conscious State from Patients in Vegetative State? Front Neurol 2018; 9:110. [PMID: 29551989 PMCID: PMC5840257 DOI: 10.3389/fneur.2018.00110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/14/2018] [Indexed: 01/12/2023] Open
Abstract
Purpose Diagnostic error is common among patients with vegetative state (VS) and minimally conscious state (MCS). The purpose of this article is to use three-dimensional pseudo-continuous arterial spin labeling (pcASL) to compare cerebral blood flow (CBF) patterns in patients in MCS with those in VS. Methods Patients meeting MCS and VS criteria were identified. Two post-labeling delay (PLD) time pcASL on 3.0-Tesla magnetic resonance imaging scanner system were performed with patients in the resting awake state. After registration to T1WI structure imaging, multiple brain regions of interest of ASL CBF map were automatically separated. The average CBF value of every brain region was calculated and compared between the MCS and VS groups with t-tests. Results Fifteen patients with VS were identified, with ages ranging from 33 to 71 years. Eight patients who met the MCS criteria ranged in age from 23 to 61 years. Compared with VS, the regional CBF for MCS had a pattern of significantly increased CBF in the regions including the putamen, anterior cingulate gyrus, and medial frontal cortex. A left-lateralized pattern was observed to differentiate MCS from VS. CBF with PLD 2.5 s could find more regions of pattern differentiating MCS from VS than with PLD 1.5 s, except for the pallidum. Conclusion MCS might be differentiated from VS by different ranges of regional CBF as measured by ASL. Multi-PLD ASL may serve as an adjunct method to separate MCS from VS and assess functional reserve in patients recovering from severe brain injuries.
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Affiliation(s)
- Bing Wu
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Yi Yang
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Shuai Zhou
- Inner Mongolia Medical University, Hohhot, China
| | - Wei Wang
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Zizhen Wang
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Gang Hu
- Department of Radiology, PLA Army General Hospital, Beijing, China
| | - Jianghong He
- Department of Neurosurgery, PLA Army General Hospital, Beijing, China
| | - Xinhuai Wu
- Department of Radiology, PLA Army General Hospital, Beijing, China.,Inner Mongolia Medical University, Hohhot, China
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