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Azizova A, Wamelink IJHG, Prysiazhniuk Y, Cakmak M, Kaya E, Petr J, Barkhof F, Keil VC. Human performance in predicting enhancement quality of gliomas using gadolinium-free MRI sequences. J Neuroimaging 2024. [PMID: 39300683 DOI: 10.1111/jon.13233] [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: 06/17/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND AND PURPOSE To develop and test a decision tree for predicting contrast enhancement quality and shape using precontrast magnetic resonance imaging (MRI) sequences in a large adult-type diffuse glioma cohort. METHODS Preoperative MRI scans (development/optimization/test sets: n = 31/38/303, male = 17/22/189, mean age = 52/59/56.7 years, high-grade glioma = 22/33/249) were retrospectively evaluated, including pre- and postcontrast T1-weighted, T2-weighted, fluid-attenuated inversion recovery, and diffusion-weighted imaging sequences. Enhancement prediction decision tree (EPDT) was developed using development and optimization sets, incorporating four imaging features: necrosis, diffusion restriction, T2 inhomogeneity, and nonenhancing tumor margins. EPDT accuracy was assessed on a test set by three raters of variable experience. True enhancement features (gold standard) were evaluated using pre- and postcontrast T1-weighted images. Statistical analysis used confusion matrices, Cohen's/Fleiss' kappa, and Kendall's W. Significance threshold was p < .05. RESULTS Raters 1, 2, and 3 achieved overall accuracies of .86 (95% confidence interval [CI]: .81-.90), .89 (95% CI: .85-.92), and .92 (95% CI: .89-.95), respectively, in predicting enhancement quality (marked, mild, or no enhancement). Regarding shape, defined as the thickness of enhancing margin (solid, rim, or no enhancement), accuracies were .84 (95% CI: .79-.88), .88 (95% CI: .84-.92), and .89 (95% CI: .85-.92). Intrarater intergroup agreement comparing predicted and true enhancement features consistently reached substantial levels (≥.68 [95% CI: .61-.75]). Interrater comparison showed at least moderate agreement (group: ≥.42 [95% CI: .36-.48], pairwise: ≥.61 [95% CI: .50-.72]). Among the imaging features in the EPDT, necrosis assessment displayed the highest intra- and interrater consistency (≥.80 [95% CI: .73-.88]). CONCLUSION The proposed EPDT has high accuracy in predicting enhancement patterns of gliomas irrespective of rater experience.
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Affiliation(s)
- Aynur Azizova
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ivar J H G Wamelink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Yeva Prysiazhniuk
- Second Faculty of Medicine, Department of Pathophysiology, Charles University, Prague, Czech Republic
- Motol University Hospital, Prague, Czech Republic
| | - Marcus Cakmak
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elif Kaya
- Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Jan Petr
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Brain Imaging, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Center for Medical Image Computing, University College London, London, UK
| | - Vera C Keil
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Brain Imaging, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Roh TH, Kim SH. Supramaximal Resection for Glioblastoma: Redefining the Extent of Resection Criteria and Its Impact on Survival. Brain Tumor Res Treat 2023; 11:166-172. [PMID: 37550815 PMCID: PMC10409622 DOI: 10.14791/btrt.2023.0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 08/09/2023] Open
Abstract
Glioblastomas (GBMs) are the most common and aggressive primary brain tumors, and despite advances in treatment, prognosis remains poor. The extent of resection has been widely recognized as a key factor affecting survival outcomes in GBM patients. The surgical principle of "maximal safe resection" has been widely applied to balance tumor removal and neurological function preservation. Historically, T1-contrast enhanced (T1CE) extent of resection has been the focus of research; however, the "supramaximal resection" concept has emerged, advocating for even greater tumor resection while maintaining neurological function. Recent studies have demonstrated potential survival benefits associated with resection beyond T1CE extent in GBMs. This review explores the developing consensus and newly established criteria for "supramaximal resection" in GBMs, with a focus on T2-extent of resection. Systematic reviews and meta-analyses on supramaximal resection are summarized, and the Response Assessment in Neuro-Oncology (RANO) resect group classification for extent of resection is introduced. The evolving understanding of the role of supramaximal resection in GBMs may lead to improved patient outcomes and more objective criteria for evaluating the extent of tumor resection.
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Affiliation(s)
- Tae Hoon Roh
- Department of Neurosurgery, Brain Tumor Center, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Se-Hyuk Kim
- Department of Neurosurgery, Brain Tumor Center, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea.
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Contrast Enhancement Patterns in Pediatric Glioblastomas. J Comput Assist Tomogr 2023; 47:115-120. [PMID: 36112052 DOI: 10.1097/rct.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Brain tumors are the most common cause of cancer-related deaths among the pediatric population. Among these, pediatric glioblastomas (GBMs) comprise 2.9% of all central nervous system tumors and have a poor prognosis. The purpose of this study is to determine whether the imaging findings can be a prognostic factor for survival in children with GBMs. MATERIALS AND METHODS The imaging studies and clinical data from 64 pediatric patients with pathology-proven GBMs were evaluated. Contrast enhancement patterns were classified into focal, ring-like, and diffuse, based on preoperative postcontrast T1-weighted magnetic resonance images. We used the Kaplan-Meier method and Cox proportional hazard regression to evaluate the prognostic value of imaging findings. RESULTS Patients with ring-enhanced GBMs who underwent gross total resection or subtotal resection were found to have a significantly shorter progression-free survival ( P = 0.03) comparing with other enhancing and nonenhancing glioblastomas. CONCLUSIONS In this study, we analyzed survival factors in children with pediatric glioblastomas. In the group of patients who underwent gross total resection or subtotal resection, those patients with focal-enhanced GBMs had significantly longer progression-free survival ( P = 0.03) than did those with other types of enhancing GBMs (diffuse and ring-like).
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Hong JB, Roh TH, Kang SG, Kim SH, Moon JH, Kim EH, Ahn SS, Choi HJ, Cho J, Suh CO, Chang JH. Survival, Prognostic Factors, and Volumetric Analysis of Extent of Resection for Anaplastic Gliomas. Cancer Res Treat 2020; 52:1041-1049. [PMID: 32324987 PMCID: PMC7577820 DOI: 10.4143/crt.2020.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/22/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose The aim of this study is to evaluate the survival rate and prognostic factors of anaplastic gliomas according to the 2016 World Health Organization classification, including extent of resection (EOR) as measured by contrast-enhanced T1-weighted magnetic resonance imaging (MRI) and the T2-weighted MRI. Materials and Methods The records of 113 patients with anaplastic glioma who were newly diagnosed at our institute between 2000 and 2013 were retrospectively reviewed. There were 62 cases (54.9%) of anaplastic astrocytoma, isocitrate dehydrogenase (IDH) wild-type (AAw), 18 cases (16.0%) of anaplastic astrocytoma, IDH-mutant, and 33 cases (29.2%) of anaplastic oligodendroglioma, IDH-mutant and 1p/19q-codeleted. Results The median overall survival (OS) was 48.4 months in the whole anaplastic glioma group and 21.5 months in AAw group. In multivariate analysis, age, preoperative Karnofsky Performance Scale score, O6-methylguanine-DNA methyltransferase (MGMT) methylation status, postoperative tumor volume, and EOR measured from the T2 MRI sequence were significant prognostic factors. The EOR cut-off point for OS measured in contrast-enhanced T1-weighted MRI and T2-weighted MRI were 99.96% and 85.64%, respectively. Conclusion We found that complete resection of the contrast-enhanced portion (99.96%) and more than 85.64% resection of the non-enhanced portion of the tumor have prognostic impacts on patient survival from anaplastic glioma.
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Affiliation(s)
- Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Roh
- Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hyung Moon
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Jin Choi
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Division of Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeho Cho
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang-Ok Suh
- Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.,Brain Tumor Center, Severance Hospital, Yonsei University Health System, Seoul, Korea.,Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Costelloe CM, Amini B, Madewell JE. Risks and Benefits of Gadolinium-Based Contrast-Enhanced MRI. Semin Ultrasound CT MR 2020; 41:170-182. [DOI: 10.1053/j.sult.2019.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Costelloe CM, Amini B, Madewell JE. WITHDRAWN: Risks and Benefits of Gadolinium-Based Contrast Enhanced MRI. Semin Ultrasound CT MR 2020; 41:260-274. [PMID: 32446435 DOI: 10.1053/j.sult.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.1053/j.sult.2019.12.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Colleen M Costelloe
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Choi YS, Ahn SS, Chang JH, Kang SG, Kim EH, Kim SH, Jain R, Lee SK. Machine learning and radiomic phenotyping of lower grade gliomas: improving survival prediction. Eur Radiol 2020; 30:3834-3842. [PMID: 32162004 DOI: 10.1007/s00330-020-06737-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Recent studies have highlighted the importance of isocitrate dehydrogenase (IDH) mutational status in stratifying biologically distinct subgroups of gliomas. This study aimed to evaluate whether MRI-based radiomic features could improve the accuracy of survival predictions for lower grade gliomas over clinical and IDH status. MATERIALS AND METHODS Radiomic features (n = 250) were extracted from preoperative MRI data of 296 lower grade glioma patients from databases at our institutional (n = 205) and The Cancer Genome Atlas (TCGA)/The Cancer Imaging Archive (TCIA) (n = 91) datasets. For predicting overall survival, random survival forest models were trained with radiomic features; non-imaging prognostic factors including age, resection extent, WHO grade, and IDH status on the institutional dataset, and validated on the TCGA/TCIA dataset. The performance of the random survival forest (RSF) model and incremental value of radiomic features were assessed by time-dependent receiver operating characteristics. RESULTS The radiomics RSF model identified 71 radiomic features to predict overall survival, which were successfully validated on TCGA/TCIA dataset (iAUC, 0.620; 95% CI, 0.501-0.756). Relative to the RSF model from the non-imaging prognostic parameters, the addition of radiomic features significantly improved the overall survival prediction accuracy of the random survival forest model (iAUC, 0.627 vs. 0.709; difference, 0.097; 95% CI, 0.003-0.209). CONCLUSION Radiomic phenotyping with machine learning can improve survival prediction over clinical profile and genomic data for lower grade gliomas. KEY POINTS • Radiomics analysis with machine learning can improve survival prediction over the non-imaging factors (clinical and molecular profiles) for lower grade gliomas, across different institutions.
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Affiliation(s)
- Yoon Seong Choi
- Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.,Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea.
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Eui Hyun Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
| | - Rajan Jain
- Department of Radiology, Langone Medical Center, New York University School of Medicine, New York, NY, USA.,Department of Neurosurgery, Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science, College of Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea
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Li F, Zhang Y, Wang N, Song C, Gao Y, Diao X, Zhang H. Evaluation of the Prognosis of Neuroglioma Based on Dynamic Magnetic Resonance Enhancement. World Neurosurg 2020; 138:663-671. [PMID: 31981784 DOI: 10.1016/j.wneu.2020.01.087] [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: 12/27/2019] [Revised: 01/11/2020] [Accepted: 01/13/2020] [Indexed: 11/29/2022]
Abstract
This paper explores the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for the prognosis of glioma, and judges the relevant factors affecting the prognosis of glioma. This paper used a Cox proportional hazards model to retrospectively analyze clinical data of 81 patients with complete neuroglioma from the same neurosurgery medical team from January 2012 to November 2018, including DCE-MRI data. To determine the prognostic factors, P < 0.05 was used as the statistical standard, and the survival curve of statistically significant factors was drawn by Kaplan-Meier method. The Cox proportional hazard model analysis showed the preoperative Karnofsky Performance Status Scale (KPS) score, age, tumor pathologic grade, postoperative radiotherapy, temozolomide use, and Ki-67 expression had an impact on the prognosis of patients with neuroglioma. Multivariate analysis and DCE-MRI data showed that age, tumor grade, preoperative KPS score, postoperative radiotherapy, and Ki-67 expression were prognostic factors for patients with glioma. The older the age, the higher the pathologic grade, the higher the Ki-67 expression level, and the lower the KPS score before surgery, the worse the prognosis. Postoperative radiotherapy and appropriate temozolomide chemotherapy will help improve the prognosis of patients with neuroglioma.
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Affiliation(s)
- Fengjia Li
- Department of Neurosurgery, Jinan City People's Hospital (Jinan People's Hospital Affiliated to Shandong First Medical University), Jinan, Shandong Province, China
| | - Yue Zhang
- Department of Neurosurgery, Zouping People's Hospital of Shandong Province, Zouping, Shandong Province, China
| | - Naiwu Wang
- Department of Radiology, Jinan City People's Hospital (Jinan People's Hospital Affiliated to Shandong First Medical University), Jinan, Shandong Province, China
| | - Chunyu Song
- Department of Neurosurgery, Jinan City People's Hospital (Jinan People's Hospital Affiliated to Shandong First Medical University), Jinan, Shandong Province, China
| | - Yong Gao
- Department of Neurosurgery, Jinan City People's Hospital (Jinan People's Hospital Affiliated to Shandong First Medical University), Jinan, Shandong Province, China
| | - Xingtao Diao
- Department of Neurosurgery, Jinan City People's Hospital (Jinan People's Hospital Affiliated to Shandong First Medical University), Jinan, Shandong Province, China
| | - Hui Zhang
- Department of Radiology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
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Prognostic value of magnetic resonance imaging features in low-grade gliomas. Biosci Rep 2019; 39:BSR20190544. [PMID: 31092699 PMCID: PMC6549082 DOI: 10.1042/bsr20190544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction: The treatment strategy for low-grade gliomas (LGGs) is still controversial, and there are no standardized criteria to predict the prognosis of patients with LGGs. Magnetic resonance imaging (MRI) is a routine test for preoperative diagnosis for LGG and can reflect the destructive features for the tumor. In the present study, we aimed to explore the relationship between the MRI features and prognosis in patients with LGG.Methods: Clinical data of 80 patients with pathologically proved LGGs between January 2010 and December 2016 were analyzed retrospectively. MRI features were classified as contrast enhancement pattern (focal enhancement, diffuse enhancement and ring-like enhancement), necrosis and cysts based on the preoperative MR images. Kaplan-Meier method and multivariate analysis were performed on the data by SPSS software to explore the prognostic significance of MRI features.Results: Patients with cystic LGG had a significantly longer 5-year progression-free survival (PFS) than that with no cyst (90.9 ± 8.7 vs 65.7 ± 9.1%, P=0.045). Multivariate analysis further verified cyst as an independent prognosis factor for PFS (P=0.027, hazard ratio [HR] = 0.084). Additionally, patients with ring-like enhancement exhibited significantly longer 5-year PFS time in the Kaplan-Meier survival curves (100 vs 67.2 ± 7.7%, P=0.049). There was no significant difference in PFS and overall survival (OS) between patients with or without necrosis.Conclusion: Our study suggests that cyst formation and ring-like enhancement on preoperative MR images can be useful to predict a favorable prognosis in patients with LGGs.
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Juan W, Yin-Sheng C, Xiao-Bing J, Fu-Hua L, Zheng-He C, Jian W, Wei-Heng Z. The mediating role of extent of resection in the relationship between the tumor characteristics and survival outcome of glioma. J Cancer 2019; 10:3232-3238. [PMID: 31289594 PMCID: PMC6603369 DOI: 10.7150/jca.30159] [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: 09/24/2018] [Accepted: 04/26/2019] [Indexed: 01/08/2023] Open
Abstract
The prognostic value of tumor characteristics for glioma has been controversial, partly because of a lack of knowledge about how these associations develop. Extent of resection may be factors that mediate the relationship between tumor characteristics and the hazard of death from glioma. Patients and Methods: This consecutive study retrospectively included a group of 393 treatment-naive patients with newly, pathologically confirmed glioma between January 2004 and December 2014. Information on patient age, gender, Karnofsky Performance Status (KPS), tumor grade, tumor size, tumor location, presence or absence of contrast enhancement on MRI and extent of tumor resection have all been collected. The discrete-time survival model integrating survival outcomes within structural equation models was employed to develop and evaluate a comprehensive hypothesis regarding the direct and indirect impact of tumor characteristics on the hazard of death from glioma, mediated by the extent of resection. Results: Except for tumor location, the indirect effects of tumor grade, contrast enhancement, and tumor size on PFS of glioma through extent of resection were found significant in the model. Conclusion: This study provides a better understanding of the process through which tumor characteristics is associated with hazard of death from glioma.
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Affiliation(s)
- Wang Juan
- School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Chen Yin-Sheng
- Department of Neurosurgery/Neuro-oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Jiang Xiao-Bing
- Department of Neurosurgery/Neuro-oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Lin Fu-Hua
- Department of Neurosurgery/Neuro-oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Chen Zheng-He
- Department of Neurosurgery/Neuro-oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wang Jian
- Department of Neurosurgery/Neuro-oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Zhu Wei-Heng
- College of information science and technology, Jinan University, Guangzhou, China
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Lee M, Han K, Ahn SS, Bae S, Choi YS, Hong JB, Chang JH, Kim SH, Lee SK. The added prognostic value of radiological phenotype combined with clinical features and molecular subtype in anaplastic gliomas. J Neurooncol 2019; 142:129-138. [PMID: 30604396 DOI: 10.1007/s11060-018-03072-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/03/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE To determine whether radiological phenotype can improve the predictive performance of the risk model based on molecular subtype and clinical risk factors in anaplastic glioma patients. METHODS This retrospective study was approved by our institutional review board with waiver of informed consent. MR images of 86 patients with pathologically diagnosed anaplastic glioma (WHO grade III) between January 2007 and February 2016 were analyzed according to the Visually Accessible Rembrandt Images (VASARI) features set. Significant imaging findings were selected to generate a radiological risk score (RRS) for overall survival (OS) and progression-free survival (PFS) using the least absolute shrinkage and selection operator (LASSO) Cox regression model. The prognostic value of RRS was evaluated with multivariate Cox regression including molecular subtype and clinical risk factors. The C-indices of multivariate models with and without RRS were compared by bootstrapping. RESULTS Eight VASARI features contributed to RRS for OS and six contributed to PFS. Multifocality or multicentricity was the most influential feature, followed by restricted diffusion. RRS was significantly associated with OS and PFS (P < .001), as well as age and molecular subtype. The multivariate model with RRS demonstrated a significantly higher predictive performance than the model without (C-index difference: 0.074, 95% confidence interval [CI]: 0.031, 0.148 for OS; C-index difference: 0.054, 95% CI: 0.014, 0.123 for PFS). CONCLUSION RRS derived from VASARI features was an independent predictor of survival in patients with anaplastic gliomas. The addition of RRS significantly improved the predictive performance of the molecular feature based model.
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Affiliation(s)
- Minsu Lee
- Department of Radiology, Aerospace Medical Center, Republic of Korea Air Force, Chungcheongbuk-do, Cheongju-si, Republic of Korea
| | - Kyunghwa Han
- Departments of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Sung Soo Ahn
- Departments of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Sohi Bae
- Departments of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Yoon Seong Choi
- Departments of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Je Beom Hong
- Department of Neurosurgery, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam, Republic of Korea
| | - Jong Hee Chang
- Neurosurgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Pathology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Koo Lee
- Departments of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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Niu J, Zhang S, Ma S, Diao J, Zhou W, Tian J, Zang Y, Jia W. Preoperative prediction of cavernous sinus invasion by pituitary adenomas using a radiomics method based on magnetic resonance images. Eur Radiol 2018; 29:1625-1634. [PMID: 30255254 PMCID: PMC6510860 DOI: 10.1007/s00330-018-5725-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/20/2018] [Accepted: 08/17/2018] [Indexed: 12/31/2022]
Abstract
Objectives To predict cavernous sinus (CS) invasion by pituitary adenomas (PAs) pre-operatively using a radiomics method based on contrast-enhanced T1 (CE-T1) and T2-weighted magnetic resonance (MR) imaging. Methods A total of 194 patients with Knosp grade two and three PAs (training set: n = 97; test set: n = 97) were enrolled in this retrospective study. From CE-T1 and T2 MR images, 2553 quantitative imaging features were extracted. To select the most informative features, least absolute shrinkage and selection operator (LASSO) was performed. Subsequently, a linear support vector machine (SVM) was used to fit the predictive model. Furthermore, a nomogram was constructed by incorporating clinico-radiological risk factors and radiomics signature, and the clinical usefulness of the nomogram was validated using decision curve analysis (DCA). Results Three imaging features were selected in the training set, based on which the radiomics model yielded area under the curve (AUC) values of 0.852 and 0.826 for the training and test sets. The nomogram based on the radiomics signature and the clinico-radiological risk factors yielded an AUC of 0.899 in the training set and 0.871 in the test set. Conclusions The nomogram developed in this study might aid neurosurgeons in the pre-operative prediction of CS invasion by Knosp grade two and three PAs, which might contribute to creating surgical strategies. Key Points • Pre-operative diagnosis of CS invasion by PAs might affect creating surgical strategies • MRI might help for diagnosis of CS invasion by PAs before surgery • Radiomics might improve the CS invasion detection by MR images. Electronic supplementary material The online version of this article (10.1007/s00330-018-5725-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jianxing Niu
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Shuaitong Zhang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Shunchang Ma
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jinfu Diao
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Wenjianlong Zhou
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China.,CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Yali Zang
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100080, China.
| | - Wang Jia
- Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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13
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Berberich A, Hielscher T, Kickingereder P, Winkler F, Drüschler K, Riedemann L, Arzt M, Kessler T, Platten M, von Deimling A, Wick W, Sahm F, Bendszus M, Wick A. Nonmeasurable Speckled Contrast-Enhancing Lesions Appearing During Course of Disease Are Associated With IDH Mutation in High-Grade Astrocytoma Patients. Int J Radiat Oncol Biol Phys 2018; 102:1472-1480. [PMID: 30071292 DOI: 10.1016/j.ijrobp.2018.07.2004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/17/2018] [Accepted: 07/21/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Because treatment options at progression are limited for patients with glioma, accuracy in definition of progression is pivotal. Clinically asymptomatic, newly detected, nonmeasurable, speckled contrast-enhancing lesions (SCEs) without immediate relation to prior immune therapy or radiation therapy appear relatively frequently during the course of disease in patients with glioma and challenge the definition of progression based on Response Assessment in Neuro-oncology criteria. Therefore, data characterizing these SCEs are needed for recommendations of subsequent clinical management. MATERIALS AND METHODS Magnetic resonance imaging of 746 patients with glioma included in this study were retrospectively revised for appearance of newly detected SCEs during the course of disease. Associations with molecular and clinical baseline parameters and their prognostic impact were statistically analyzed, and frequency, natural course, and location of SCEs were described. RESULTS SCEs occurred more frequently in World Health Organization grade 2 and 3 astrocytoma and oligodendroglial tumors and were significantly associated with isocitrate dehydrogenase mutation in World Health Organization grade 3 astrocytoma and glioblastoma. SCEs mostly remained stable or dissolved in follow-up magnetic resonance imaging, even if no new treatment was initiated. SCEs were frequently located within the tumor or tumor-associated fluid-attenuated inversion recovery abnormalities, but distant appearance also occurred. In patients with glioblastoma, SCEs were associated with a favorable prognosis, which was also observed in the subgroup of patients with glioblastoma with isocitrate dehydrogenase wildtype status. CONCLUSIONS The data demonstrate a predominantly benign course of SCEs after their appearance and emphasize cautious definitions of progression and regular clinical and radiographic follow-up rather than premature initiation of new antitumor therapies until progression is confirmed.
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Affiliation(s)
- Anne Berberich
- Clinical Cooperation Unit, Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Frank Winkler
- Clinical Cooperation Unit, Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Katharina Drüschler
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Lars Riedemann
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Marlene Arzt
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Tobias Kessler
- Clinical Cooperation Unit, Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Platten
- Clinical Cooperation Unit, Neuroimmunology and Brain Tumor Immunology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit, Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany
| | - Antje Wick
- Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.
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14
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Fujii Y, Muragaki Y, Maruyama T, Nitta M, Saito T, Ikuta S, Iseki H, Hongo K, Kawamata T. Threshold of the extent of resection for WHO Grade III gliomas: retrospective volumetric analysis of 122 cases using intraoperative MRI. J Neurosurg 2017; 129:1-9. [PMID: 28885120 DOI: 10.3171/2017.3.jns162383] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%-100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 ( IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.
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Affiliation(s)
- Yu Fujii
- 1Department of Neurosurgery and.,3Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshihiro Muragaki
- 1Department of Neurosurgery and.,2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Takashi Maruyama
- 1Department of Neurosurgery and.,2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Masayuki Nitta
- 1Department of Neurosurgery and.,2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | | | - Soko Ikuta
- 2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Hiroshi Iseki
- 2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Kazuhiro Hongo
- 3Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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15
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Association of MRI-classified subventricular regions with survival outcomes in patients with anaplastic glioma. Clin Radiol 2017; 72:426.e1-426.e6. [DOI: 10.1016/j.crad.2016.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/17/2016] [Accepted: 11/21/2016] [Indexed: 11/18/2022]
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16
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Shi X, Liu K, Wang T, Zheng S, Gu W, Ye L. Formation mechanism of dysprosium-doped manganese carbonate nanoparticles by thermal decomposition. RSC Adv 2016. [DOI: 10.1039/c6ra20347g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The formation mechanism of Dy-doped MnCO3 NPs through the thermal decomposition method was elucidated and the potential of Dy-doped MnCO3 NPs as an efficient MR contrast agent was demonstrated in the brain glioma-bearing mice.
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Affiliation(s)
- Xin Shi
- School of Chemical Biology and Pharmaceutical Sciences
- Capital Medical University
- Beijing 100069
- P. R. China
| | - Kang Liu
- School of Chemical Biology and Pharmaceutical Sciences
- Capital Medical University
- Beijing 100069
- P. R. China
| | - Tingjian Wang
- Department of Neurosurgery
- Beijing Sanbo Brain Hospital
- Capital Medical University
- Beijing 100093
- P. R. China
| | - Shunjia Zheng
- School of Chemical Biology and Pharmaceutical Sciences
- Capital Medical University
- Beijing 100069
- P. R. China
| | - Wei Gu
- School of Chemical Biology and Pharmaceutical Sciences
- Capital Medical University
- Beijing 100069
- P. R. China
| | - Ling Ye
- School of Chemical Biology and Pharmaceutical Sciences
- Capital Medical University
- Beijing 100069
- P. R. China
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