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Lee DY, Choi KE, Han K, Choi SH, Lee N, Ahn SS, Chang JH, Kim SH, Lee SK, Park YW. Revisiting oligodendroglioma grading in the 2021 WHO classification: calcification and larger contrast-enhancing tumor volume may predict higher oligodendroglioma grade. Neuroradiology 2024:10.1007/s00234-024-03430-y. [PMID: 39014271 DOI: 10.1007/s00234-024-03430-y] [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: 05/23/2024] [Accepted: 07/09/2024] [Indexed: 07/18/2024]
Abstract
PURPOSE To investigate whether qualitative and quantitative imaging phenotypes can predict the grade of oligodendroglioma. METHODS Retrospective chart and imaging reviews were conducted on 180 adults with oligodendroglioma (IDH-mutant and 1p/19q codeleted) between 2005 and 2021. Qualitative imaging characteristics including tumor location, calcification, gliomatosis cerebri, cystic change, necrosis, and infiltrative pattern were analyzed. Quantitative imaging assessment was performed from the tumor mask via automatic segmentation to calculate total, contrast-enhancing (CE), non-enhancing (NE), and necrotic tumor volumes. Logistic analyses were conducted to determine predictors of oligodendroglioma grade. RESULTS This study included 180 patients (84 [46.7%] with grade 2 and 96 [53.3%] with grade 3 oligodendrogliomas), with a median age of 42 years (range 23-76 years), comprising 91 females and 89 males. On univariable analysis, calcification (odds ratio [OR] = 6.00, P < 0.001), necrosis (OR = 21.84, P = 0.003), presence of CE tumor (OR = 7.86, P < 0.001), larger total (OR = 1.01, P < 0.001), larger CE (OR = 2.22, P = 0.010), and larger NE (OR = 1.01, P < 0.001) tumor volumes were predictors of grade 3 oligodendroglioma. On multivariable analysis, calcification (OR = 3.79, P < 0.001) and larger CE tumor volume (OR = 2.70, P = 0.043) remained as independent predictors of grade 3 oligodendroglioma. The multivariable model exhibited an AUC, accuracy, sensitivity, specificity of 0.78 (95% confidence interval 0.72-0.84), 72.8%, 79.2%, 69.1%, respectively. CONCLUSION Presence of calcification and larger CE tumor volume may serve as useful imaging biomarkers for prediction of oligodendroglioma grade. CLINICAL RELEVANCE STATEMENT Assessment of intratumoral calcification and CE tumor volume may facilitate accurate preoperative estimation of oligodendroglioma grade. Presence of intratumoral calcification and larger contrast-enhancing tumor volume were the significant predictors of higher grade oligodendroglioma based on the 2021 WHO classification.
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Affiliation(s)
- Doo Young Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Ka Eum Choi
- Department of Statistics and Data Science, Yonsei University, Seoul, Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Seo Hee Choi
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Narae Lee
- Department of Nuclear Medicine, Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Martín-Noguerol T, Santos-Armentia E, Ramos A, Luna A. An update on susceptibility-weighted imaging in brain gliomas. Eur Radiol 2024:10.1007/s00330-024-10703-w. [PMID: 38581609 DOI: 10.1007/s00330-024-10703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
Susceptibility-weighted imaging (SWI) has become a standard component of most brain MRI protocols. While traditionally used for detecting and characterising brain hemorrhages typically associated with stroke or trauma, SWI has also shown promising results in glioma assessment. Numerous studies have highlighted SWI's role in differentiating gliomas from other brain lesions, such as primary central nervous system lymphomas or metastases. Additionally, SWI aids radiologists in non-invasively grading gliomas and predicting their phenotypic profiles. Various researchers have suggested incorporating SWI as an adjunct sequence for predicting treatment response and for post-treatment monitoring. A significant focus of these studies is on the detection of intratumoural susceptibility signals (ITSSs) in gliomas, which are indicative of microhemorrhages and vessels within the tumour. The quantity, distribution, and characteristics of these ITSSs can provide radiologists with more precise information for evaluating and characterising gliomas. Furthermore, the potential benefits and added value of performing SWI after the administration of gadolinium-based contrast agents (GBCAs) have been explored. This review offers a comprehensive, educational, and practical overview of the potential applications and future directions of SWI in the context of glioma assessment. CLINICAL RELEVANCE STATEMENT: SWI has proven effective in evaluating gliomas, especially through assessing intratumoural susceptibility signal changes, and is becoming a promising, easily integrated tool in MRI protocols for both pre- and post-treatment assessments. KEY POINTS: • Susceptibility-weighted imaging is the most sensitive sequence for detecting blood and calcium inside brain lesions. • This sequence, acquired with and without gadolinium, helps with glioma diagnosis, characterisation, and grading through the detection of intratumoural susceptibility signals. • There are ongoing challenges that must be faced to clarify the role of susceptibility-weighted imaging for glioma assessment.
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Affiliation(s)
| | | | - Ana Ramos
- Department of Neuroradiology, University Hospital, 12 de Octubre, Madrid, Spain
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain
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Jiang B, Zheng Y, She D, Xing Z, Cao D. MRI characteristics predict BRAF V600E status in gangliogliomas and pleomorphic xanthoastrocytomas and provide survival prognostication. Acta Radiol 2024; 65:33-40. [PMID: 37401109 DOI: 10.1177/02841851231183868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND BRAF V600E mutation is a common genomic alteration in gangliogliomas (GGs) and pleomorphic xanthoastrocytomas (PXAs) with prognostic and therapeutic implications. PURPOSE To investigate the ability of magnetic resonance imaging (MRI) features to predict BRAF V600E status in GGs and PXAs and their prognostic values. MATERIAL AND METHODS A cohort of 44 patients with histologically confirmed GGs and PXAs was reviewed retrospectively. BRAF V600E status was determined by immunohistochemistry (IHC) staining and fluorescence quantitative polymerase chain reaction (PCR). Demographics and MRI characteristics of the two groups were evaluated and compared. Univariate and multivariate Cox regression analyses were performed to identify MRI features that were prognostic for progression-free survival (PFS). RESULTS T1/FLAIR ratio, enhancing margin, and mean relative apparent diffusion coefficient (rADCmea) value showed significant differences between the BRAF V600E-mutant and BRAF V600E-wild groups (all P < 0.05). Binary logistic regression analysis revealed only rADCmea value was the independent predictive factor for BRAF V600E status (P = 0.027). Univariate Cox regression analysis showed age at diagnosis (P = 0.032), WHO grade (P = 0.020), enhancing margin (P = 0.029), and rADCmea value (P = 0.005) were significant prognostic factors for PFS. In multivariate Cox regression analysis, increasing age (P = 0.040, hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 1.002-1.079) and lower rADCmea values (P = 0.021, HR = 0.036, 95% CI = 0.002-0.602) were associated with poor PFS in GGs and PXAs. CONCLUSION Imaging features are potentially predictive of BRAF V600E status in GGs and PXAs. Furthermore, rADCmea value is a valuable prognostic factor for patients with GGs or PXAs.
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Affiliation(s)
- Bingqing Jiang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fujian, PR China
| | - Yingyan Zheng
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fujian, PR China
| | - Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fujian, PR China
| | - Zhen Xing
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fujian, PR China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fujian, PR China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fujian, PR China
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Naeem A, Aziz N, Nasir M, Rangwala HS, Fatima H, Mubarak F. Accuracy of MRI in Detecting 1p/19q Co-deletion Status of Gliomas: A Single-Center Retrospective Study. Cureus 2024; 16:e51863. [PMID: 38327950 PMCID: PMC10848880 DOI: 10.7759/cureus.51863] [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] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background Oligodendrogliomas, rare brain tumors in the frontal lobe's white matter, are reshaped by molecular markers like isocitrate dehydrogenase mutations and 1p/19q co-deletion, influencing treatment outcomes. Despite the initial indolence, these tumors pose a significant risk, with a median survival of 10-12 years. Non-invasive alternatives, such as magnetic resonance imaging (MRI) for assessing T2-fluid-attenuated inversion recovery (FLAIR) mismatch and calcifications, provide insights into molecular subtypes and aid prognosis. Our study explored these features to predict the oligodendroglioma status and refine patient management to improve outcomes. Methods In this retrospective study, patient data identified patients with suspected central nervous system tumors undergoing MRI, revealing low-grade gliomas. Surgical biopsy and 1p/19q fluorescence in situ hybridization confirmed the co-deletion status. MRI was used to assess various morphological features. Statistical analyses included x2 tests, Fisher's exact tests, Kruskal-Wallis tests, and binary logistic regression models, with significance set at p < 0.05. Results Seventy-three patients (median age, 37 years) were stratified according to 1p/19q co-deletion. Most (61.6%) were 18-40 years old and mostly male (67.1%). Co-deletion cases, primarily frontal lobe lesions (67.6%), were unilateral (88.2%), with 55.9% non-circumscribed margins and 58.8% ill-defined contours. Smooth contrast enhancement and no necrosis were observed in 48.1% of 1p/19q co-deletion cases. Logistic regression analysis showed a significant association between ill-defined/irregular contours and 1p/19q co-deletion. Fisher's exact test confirmed this but raised concerns about the small sample size influencing the conclusions. Conclusions This study established a significant link between glioma tumor contour characteristics, particularly irregular and ill-defined contours, and the likelihood of 1p/19q co-deletion. Our findings underscore the clinical relevance of using tumor contours in treatment decisions and prognosis assessments.
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Affiliation(s)
- Adnan Naeem
- Department of Radiology, Aga Khan University Hospital, Karachi, PAK
| | - Namrah Aziz
- Department of Radiology, Aga Khan Health Service, Karachi, PAK
| | - Manal Nasir
- Department of Radiology, Aga Khan University Hospital, Karachi, PAK
| | | | - Hareer Fatima
- Department of Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, PAK
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Doniselli FM, Pascuzzo R, Agrò M, Aquino D, Anghileri E, Farinotti M, Pollo B, Paterra R, Cuccarini V, Moscatelli M, DiMeco F, Sconfienza LM. Development of A Radiomic Model for MGMT Promoter Methylation Detection in Glioblastoma Using Conventional MRI. Int J Mol Sci 2023; 25:138. [PMID: 38203308 PMCID: PMC10778771 DOI: 10.3390/ijms25010138] [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: 11/20/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The methylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter is a molecular marker associated with a better response to chemotherapy in patients with glioblastoma (GB). Standard pre-operative magnetic resonance imaging (MRI) analysis is not adequate to detect MGMT promoter methylation. This study aims to evaluate whether the radiomic features extracted from multiple tumor subregions using multiparametric MRI can predict MGMT promoter methylation status in GB patients. This retrospective single-institution study included a cohort of 277 GB patients whose 3D post-contrast T1-weighted images and 3D fluid-attenuated inversion recovery (FLAIR) images were acquired using two MRI scanners. Three separate regions of interest (ROIs) showing tumor enhancement, necrosis, and FLAIR hyperintensities were manually segmented for each patient. Two machine learning algorithms (support vector machine (SVM) and random forest) were built for MGMT promoter methylation prediction from a training cohort (196 patients) and tested on a separate validation cohort (81 patients), based on a set of automatically selected radiomic features, with and without demographic variables (i.e., patients' age and sex). In the training set, SVM based on the selected radiomic features of the three separate ROIs achieved the best performances, with an average of 83.0% (standard deviation: 5.7%) for accuracy and 0.894 (0.056) for the area under the curve (AUC) computed through cross-validation. In the test set, all classification performances dropped: the best was obtained by SVM based on the selected features extracted from the whole tumor lesion constructed by merging the three ROIs, with 64.2% (95% confidence interval: 52.8-74.6%) accuracy and 0.572 (0.439-0.705) for AUC. The performances did not change when the patients' age and sex were included with the radiomic features into the models. Our study confirms the presence of a subtle association between imaging characteristics and MGMT promoter methylation status. However, further verification of the strength of this association is needed, as the low diagnostic performance obtained in this validation cohort is not sufficiently robust to allow clinically meaningful predictions.
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Affiliation(s)
- Fabio M. Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.M.D.); (D.A.); (V.C.)
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Riccardo Pascuzzo
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.M.D.); (D.A.); (V.C.)
| | - Massimiliano Agrò
- Post-Graduate School in Radiodiagnostics, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Domenico Aquino
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.M.D.); (D.A.); (V.C.)
| | - Elena Anghileri
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.)
| | - Mariangela Farinotti
- Neuroepidemiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy
| | - Rosina Paterra
- Neuro-Oncology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (E.A.)
| | - Valeria Cuccarini
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.M.D.); (D.A.); (V.C.)
| | - Marco Moscatelli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy; (F.M.D.); (D.A.); (V.C.)
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20133 Milan, Italy
| | - Francesco DiMeco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy;
- Department of Oncology and Hematology-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD 21205, USA
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, 20133 Milan, Italy
- Radiology Unit, IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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Ke X, Zhao J, Liu X, Zhou Q, Cheng W, Zhang P, Zhou J. Apparent diffusion coefficient values effectively predict cell proliferation and determine oligodendroglioma grade. Neurosurg Rev 2023; 46:83. [PMID: 37022533 DOI: 10.1007/s10143-023-01989-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023]
Abstract
This study aims to evaluate the value of conventional magnetic resonance imaging (MRI) features and apparent diffusion coefficient (ADC) values in differentiating oligodendroglioma of various grades and explore the correlation between ADC and Ki-67. The preoperative MRI data of 99 patients with World Health Organization (WHO) grades 2 (n = 42) and 3 (n = 57) oligodendroglioma confirmed by surgery and pathology were retrospectively analyzed. Conventional MRI features, ADCmean, ADCmin, and normalized ADC (nADC) were compared between the two groups. A receiver operating characteristic curve was used to evaluate each parameter's diagnostic efficacy in differentiating the two tumor types. Each tumor's Ki-67 proliferation index was also measured to explore its relationship with the ADC value. Compared with WHO2 grade tumors, WHO3 grade tumors had a larger maximum diameter and more significant cystic degeneration/necrosis, edema, and moderate/severe enhancement (all P < 0.05). The ADCmin, ADCmean, and nADC values of the WHO3 and WHO2 grade tumors were significantly different, and the ADCmin value most accurately distinguished the two tumor types, yielding an area under the curve value of 0.980. When 0.96 × 10-3 mm2/s was used as the differential diagnosis threshold, the sensitivity, specificity, and accuracy of the two groups were 100%, 93.00%, and 96.96%, respectively. The ADCmin (r = -0.596), ADCmean (r = - 0.590), nADC (r = - 0.577), and Ki-67 proliferation index values had significantly negative correlations (all P < 0.05). Conventional MRI features and ADC values are beneficial in the noninvasive prediction of the WHO grade and tumor proliferation rate of oligodendroglioma.
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Affiliation(s)
- Xiaoai Ke
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, Gansu, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Jun Zhao
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, Gansu, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
| | - Xianwang Liu
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, Gansu, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, Gansu, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
- Second Clinical School, Lanzhou University, Lanzhou, China
| | - Wen Cheng
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, Gansu, People's Republic of China
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China
| | - Peng Zhang
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Cuiyingmen No.82, Lanzhou, 730030, Gansu, People's Republic of China.
- Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, China.
- Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, China.
- Second Clinical School, Lanzhou University, Lanzhou, China.
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Cho NS, Hagiwara A, Sanvito F, Ellingson BM. A multi-reader comparison of normal-appearing white matter normalization techniques for perfusion and diffusion MRI in brain tumors. Neuroradiology 2023; 65:559-568. [PMID: 36301349 PMCID: PMC9905164 DOI: 10.1007/s00234-022-03072-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/14/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE There remains no consensus normal-appearing white matter (NAWM) normalization method to compute normalized relative cerebral blood volume (nrCBV) and apparent diffusion coefficient (nADC) in brain tumors. This reader study explored nrCBV and nADC differences using different NAWM normalization methods. METHODS Thirty-five newly diagnosed glioma patients were studied. For each patient, two readers created four NAWM regions of interests: (1) a single plane in the centrum semiovale (CSOp), (2) 3 spheres in the centrum semiovale (CSOs), (3) a single plane in the slice of the tumor center (TUMp), and (4) 3 spheres in the slice of the tumor center (TUMs). Readers repeated NAWM segmentations 1 month later. Differences in nrCBV and nADC of the FLAIR hyperintense tumor, inter-/intra-reader variability, and time to segment NAWM were assessed. As a validation step, the diagnostic performance of each method for IDH-status prediction was evaluated. RESULTS Both readers obtained significantly different nrCBV (P < .001), nADC (P < .001), and time to segment NAWM (P < .001) between the four normalization methods. nrCBV and nADC were significantly different between CSO and TUM methods, but not between planar and spherical methods in the same NAWM region. Broadly, CSO methods were quicker than TUM methods, and spherical methods were quicker than planar methods. For all normalization techniques, inter-reader reproducibility and intra-reader repeatability were excellent (intraclass correlation coefficient > 0.9), and the IDH-status predictive performance remained similar. CONCLUSION The selected NAWM region significantly impacts nrCBV and nADC values. CSO methods, particularly CSOs, may be preferred because of time reduction, similar reader variability, and similar diagnostic performance compared to TUM methods.
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Affiliation(s)
- Nicholas S Cho
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Francesco Sanvito
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
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Guo D, Jiang B. Noninvasively evaluating the grade and IDH mutation status of gliomas by using mono-exponential, bi-exponential diffusion-weighted imaging and three-dimensional pseudo-continuous arterial spin labeling. Eur J Radiol 2023; 160:110721. [PMID: 36738600 DOI: 10.1016/j.ejrad.2023.110721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To noninvasively assess the diagnostic performance of diffusion-weighted imaging (DWI), bi-exponential intravoxel incoherent motion imaging (IVIM) and three-dimensional pseudo-continuous arterial spin labeling (3D pCASL) in differentiating lower-grade gliomas (LGGs) from high-grade gliomas (HGGs), and predicting the isocitrate dehydrogenase (IDH) mutation status. MATERIALS AND METHODS Ninety-five patients with pathologically confirmed grade 2-4 gliomas with preoperative DWI, IVIM and 3D pCASL were enrolled in this study. The Student's t test and Mann-Whitney U test were used to evaluate differences in parameters of DWI, IVIM and 3D pCASL between LGG and HGG as well as between mutant and wild-type IDH in grade 2 and 3 diffusion astrocytoma; receiver operator characteristic (ROC) analysis was used to assess the diagnostic performance. RESULTS The value of ADCmean, ADCmin, Dmean and Dmin in HGGs were lower than in LGGs, while the value of CBFmean and CBFmax in HGGs were higher than in LGGs. In ROC analysis, the AUC values of Dmean, Dmin and CBFmax were 0.827, 0.878 and 0.839, respectively. The combination of CBFmax and Dmin displayed the highest diagnostic performance to distinguish LGGs from HGGs, with AUC 0.906, sensitivity 82.4 %, and specificity 86.4 %. In grades 2 and 3 diffusion astrocytoma patients, ADCmin, Dmean, Dmin, CBFmean and CBFmax showed significant differences between IDHmut and IDHwt group (p < 0.05, 0.001, 0.001, 0.01 and 0.001, respectively) and the AUC values were 0. 709, 0.849, 0.919, 0.755 and 0.873, respectively. Similarly, the combination of CBFmax and Dmin demonstrated the highest AUC value (0.938) in prediction IDH mutation status, with sensitivity 92.9 %, and specificity 95.5 %. CONCLUSION The combination of IVIM and 3D pCASL can be used in prediction histologic grade and IDH mutation status of glioma noninvasively.
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Affiliation(s)
- Da Guo
- Department of Radiology, The Sixth People's Hospital of Nanchong, Sichuan Province, People's Republic of China
| | - Binghu Jiang
- Department of Radiology, Nanchong Central Hospital, Sichuan Province, People's Republic of China.
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Ahn SH, Ahn SS, Park YW, Park CJ, Lee SK. Association of dynamic susceptibility contrast- and dynamic contrast-enhanced magnetic resonance imaging parameters with molecular marker status in lower-grade gliomas: A retrospective study. Neuroradiol J 2023; 36:49-58. [PMID: 35532193 PMCID: PMC9893160 DOI: 10.1177/19714009221098369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Molecular marker status is clinically relevant for treatment planning and predicting the prognosis of gliomas. This study aimed to assess whether quantitative imaging parameters from dynamic susceptibility contrast- (DSC-) and dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) can predict the molecular marker status of lower-grade gliomas (LGGs). MATERIALS AND METHODS Overall, 132 patients with LGGs who underwent DSC- and DCE-MRI were retrospectively enrolled. Statuses of relevant molecular markers including isocitrate dehydrogenase isoenzyme (IDH), 1p19q codeletion, epidermal growth factor receptor (EGFR), O6-methylguanine-DNA methyltransferase (MGMT), and telomerase reverse transcriptase (TERT) were collected. For each molecular marker, age, tumor diameter and location, and DSC- and DCE-MRI parameters, including the normalized cerebral blood volume (nCBV), volume transfer constant (Ktrans), rate transfer coefficient (Kep), extravascular extracellular volume fraction (Ve), and plasma volume fraction (Vp), were compared. Multivariable logistic regression analyses were performed. RESULTS The nCBV was significantly lower in LGGs with IDH mutation (p = .001) and TERT mutation (p = .027) than those without these mutations. Ktrans (p = .034), Ve (p = .023), and Vp (p = .044) values were significantly lower in MGMT methylated LGGs than in MGMT unmethylated LGGs. Perfusion parameters were not significantly associated with EGFR amplification and 1p19q codeletion. Young age (p < .001) and small diameter (p = .001) were significantly associated with IDH mutation. The nCBV was independently associated with IDH status (AUC, 0.817; 95% CI: 0.739-0.894). CONCLUSIONS DSC- and DCE-MRI parameters demonstrated correlations with molecular markers of LGGs. Especially, the nCBV can be helpful in predicting the IDH mutation status.
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Affiliation(s)
- Sung Hee Ahn
- Department of Radiology, Yonsei University College of
Medicine, Seoul, Korea
| | - Sung Soo Ahn
- Department of Radiology, Yonsei University College of
Medicine, Seoul, Korea
| | - Yae Won Park
- Department of Radiology, Yonsei University College of
Medicine, Seoul, Korea
| | - Chae Jung Park
- Department of Radiology, Yonsei University College of
Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology, Yonsei University College of
Medicine, Seoul, Korea
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10
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MRI features predict tumor grade in isocitrate dehydrogenase (IDH)-mutant astrocytoma and oligodendroglioma. Neuroradiology 2023; 65:121-129. [PMID: 35953567 DOI: 10.1007/s00234-022-03038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/07/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Nearly all literature for predicting tumor grade in astrocytoma and oligodendroglioma pre-dates the molecular classification system. We investigated the association between contrast enhancement, ADC, and rCBV with tumor grade separately for IDH-mutant astrocytomas and molecularly-defined oligodendrogliomas. METHODS For this retrospective study, 44 patients with IDH-mutant astrocytomas (WHO grades II, III, or IV) and 39 patients with oligodendrogliomas (IDH-mutant and 1p/19q codeleted) (WHO grade II or III) were enrolled. Two readers independently assessed preoperative MRI for contrast enhancement, ADC, and rCBV. Inter-reader agreement was calculated, and statistical associations between MRI metrics and WHO grade were determined per reader. RESULTS For IDH-mutant astrocytomas, both readers found a stepwise positive association between contrast enhancement and WHO grade (Reader A: OR 7.79 [1.97, 30.80], p = 0.003; Reader B: OR 6.62 [1.70, 25.82], p = 0.006); both readers found that ADC was negatively associated with WHO grade (Reader A: OR 0.74 [0.61, 0.90], p = 0.002); Reader B: OR 0.80 [0.66, 0.96], p = 0.017), and both readers found that rCBV was positively associated with WHO grade (Reader A: OR 2.33 [1.35, 4.00], p = 0.002; Reader B: OR 2.13 [1.30, 3.57], p = 0.003). For oligodendrogliomas, both readers found a positive association between contrast enhancement and WHO grade (Reader A: OR 15.33 [2.56, 91.95], p = 0.003; Reader B: OR 20.00 [2.19, 182.45], p = 0.008), but neither reader found an association between ADC or rCBV and WHO grade. CONCLUSIONS Contrast enhancement predicts WHO grade for IDH-mutant astrocytomas and oligodendrogliomas. ADC and rCBV predict WHO grade for IDH-mutant astrocytomas, but not for oligodendrogliomas.
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11
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Rincon-Torroella J, Rakovec M, Materi J, Raj D, Vivas-Buitrago T, Ferres A, Reyes Serpa W, Redmond KJ, Holdhoff M, Bettegowda C, González Sánchez JJ. Current and Future Frontiers of Molecularly Defined Oligodendrogliomas. Front Oncol 2022; 12:934426. [PMID: 35957904 PMCID: PMC9358027 DOI: 10.3389/fonc.2022.934426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Oligodendrogliomas are a subtype of adult diffuse glioma characterized by their better responsiveness to systemic chemotherapy than other high-grade glial tumors. The World Health Organization (WHO) 2021 brain tumor classification highlighted defining molecular markers, including 1p19q codeletion and IDH mutations which have become key in diagnosing and treating oligodendrogliomas. The management for patients with oligodendrogliomas includes observation or surgical resection potentially followed by radiation and chemotherapy with PCV (Procarbazine, Lomustine, and Vincristine) or Temozolomide. However, most of the available research about oligodendrogliomas includes a mix of histologically and molecularly diagnosed tumors. Even data driving our current management guidelines are based on post-hoc subgroup analyses of the 1p19q codeleted population in landmark prospective trials. Therefore, the optimal treatment paradigm for molecularly defined oligodendrogliomas is incompletely understood. Many questions remain open, such as the optimal timing of radiation and chemotherapy, the response to different chemotherapeutic agents, or what genetic factors influence responsiveness to these agents. Ultimately, oligodendrogliomas are still incurable and new therapies, such as targeting IDH mutations, are necessary. In this opinion piece, we present relevant literature in the field, discuss current challenges, and propose some studies that we think are necessary to answer these critical questions.
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Affiliation(s)
- Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Neurosurgery, Hospital Clínic i Provincial, Barcelona, Spain
| | - Maureen Rakovec
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Josh Materi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Divyaansh Raj
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Abel Ferres
- Department of Neurosurgery, Hospital Clínic i Provincial, Barcelona, Spain
| | | | - Kristin J. Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Matthias Holdhoff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- *Correspondence: Chetan Bettegowda, ; José Juan González Sánchez,
| | - José Juan González Sánchez
- Department of Neurosurgery, Hospital Clínic i Provincial, Barcelona, Spain
- *Correspondence: Chetan Bettegowda, ; José Juan González Sánchez,
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12
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Guarnaccia M, Guarnaccia L, La Cognata V, Navone SE, Campanella R, Ampollini A, Locatelli M, Miozzo M, Marfia G, Cavallaro S. A Targeted Next-Generation Sequencing Panel to Genotype Gliomas. LIFE (BASEL, SWITZERLAND) 2022; 12:life12070956. [PMID: 35888045 PMCID: PMC9320073 DOI: 10.3390/life12070956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/12/2022]
Abstract
Gliomas account for the majority of primary brain tumors. Glioblastoma is the most common and malignant type. Based on their extreme molecular heterogeneity, molecular markers can be used to classify gliomas and stratify patients into diagnostic, prognostic, and therapeutic clusters. In this work, we developed and validated a targeted next-generation sequencing (NGS) approach to analyze variants or chromosomal aberrations correlated with tumorigenesis and response to treatment in gliomas. Our targeted NGS analysis covered 13 glioma-related genes (ACVR1, ATRX, BRAF, CDKN2A, EGFR, H3F3A, HIST1H3B, HIST1H3C, IDH1, IDH2, P53, PDGFRA, PTEN), a 125 bp region of the TERT promoter, and 54 single nucleotide polymorphisms (SNPs) along chromosomes 1 and 19 for reliable assessment of their copy number alterations (CNAs). Our targeted NGS approach provided a portrait of gliomas’ molecular heterogeneity with high accuracy, specificity, and sensitivity in a single workflow, enabling the detection of variants associated with unfavorable outcomes, disease progression, and drug resistance. These preliminary results support its use in routine diagnostic neuropathology.
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Affiliation(s)
- Maria Guarnaccia
- Institute for Biomedical Research and Innovation, National Research Council, Via P. Gaifami 18, 95126 Catania, Italy; (M.G.); (V.L.C.)
| | - Laura Guarnaccia
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (L.G.); (S.E.N.); (R.C.); (A.A.); (M.L.); (G.M.)
- Department of Clinical Sciences and Community Health, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Valentina La Cognata
- Institute for Biomedical Research and Innovation, National Research Council, Via P. Gaifami 18, 95126 Catania, Italy; (M.G.); (V.L.C.)
| | - Stefania Elena Navone
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (L.G.); (S.E.N.); (R.C.); (A.A.); (M.L.); (G.M.)
| | - Rolando Campanella
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (L.G.); (S.E.N.); (R.C.); (A.A.); (M.L.); (G.M.)
| | - Antonella Ampollini
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (L.G.); (S.E.N.); (R.C.); (A.A.); (M.L.); (G.M.)
| | - Marco Locatelli
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (L.G.); (S.E.N.); (R.C.); (A.A.); (M.L.); (G.M.)
- “Aldo Ravelli” Research Center, Via Antonio di Rudinì 8, 20142 Milan, Italy
- Department of Medical-Surgical Physiopathology and Transplantation, University of Milan, Via Francesco Sforza 35, 20122 Milan, Italy
| | - Monica Miozzo
- Department of Health Sciences, University of Milan, 20122 Milan, Italy;
- Unit of Medical Genetics, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Giovanni Marfia
- Laboratory of Experimental Neurosurgery and Cell Therapy, Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy; (L.G.); (S.E.N.); (R.C.); (A.A.); (M.L.); (G.M.)
- Clinical Pathology Unit, Aerospace Medicine Institute “A. Mosso”, Italian Air Force, Viale dell’Aviazione 1, 20138 Milan, Italy
| | - Sebastiano Cavallaro
- Institute for Biomedical Research and Innovation, National Research Council, Via P. Gaifami 18, 95126 Catania, Italy; (M.G.); (V.L.C.)
- Correspondence: ; Tel.: +39-09-57338128
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13
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Aboud O, Shah R, Vera E, Burton E, Theeler B, Wu J, Boris L, Quezado M, Reyes J, Wall K, R Gilbert M, S Armstrong T, Penas-Prado M. Challenges of imaging interpretation to predict oligodendroglioma grade: a report from the Neuro-Oncology Branch. CNS Oncol 2022; 11:CNS83. [PMID: 35142534 PMCID: PMC8988255 DOI: 10.2217/cns-2021-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: To illustrate challenges of imaging interpretation in patients with oligodendroglioma seen at a referral center and evaluate interrater reliability. Methods: Two neuro-oncologists reviewed diagnostic preradiation MRIs of oligodendroglioma patients; interrater reliability was calculated with the kappa coefficient (k). A neuroradiologist measured presurgical apparent diffusion coefficient (ADC), if available. Results: Extensive enhancement was noted in four of 58 patients, k = 0.7; necrosis in seven of 58, k = 0.61; calcification in seven of 17, k = 1.0; diffusion restriction in two of 39 patients, k = 1.0 (all only in grade 3). ADC values with receiver operator characteristic analysis for area under the curve were 0.473, not significantly different from the null hypothesis (p = 0.14). Conclusions: Extensive enhancement, necrosis and calcification correlated with grade 3 oligodendroglioma in our sample. However, interrater variability is an important limitation when assessing radiographic features, supporting the need for standardization of imaging protocols and their interpretation.
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Affiliation(s)
- Orwa Aboud
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.,UC Davis Comprehensive Cancer Center, University of California Davis, Sacramento, CA 95817, USA
| | - Ritu Shah
- Department of Neuro radiology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20814, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Brett Theeler
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA.,Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Lisa Boris
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20814 USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Kathleen Wall
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA
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14
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Yeniçeri İÖ, Yıldız ME, Özduman K, Danyeli AE, Pamir MN, Dinçer A. The reliability and interobserver reproducibility of T2/FLAIR mismatch in the diagnosis of IDH-mutant astrocytomas. DIAGNOSTIC AND INTERVENTIONAL RADIOLOGY (ANKARA, TURKEY) 2021; 27:796-801. [PMID: 34792037 DOI: 10.5152/dir.2021.20624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The reliability and reproducibility of T2-weighted imaging/ fluid-attenuated inversion recovery (T2/FLAIR) mismatch were investigated in the diagnosis of isocitrate dehydrogenase (IDH) mutant astrocytoma between WHO grade II and III diffuse hemispheric gliomas. METHODS WHO grade II and grade III diffuse hemispheric gliomas (n=133) treated in our institute were included in the study. Pathological findings and molecular markers of the cases were reviewed with the criteria of WHO 2016. The finding of mismatch between T2-weighted and FLAIR images in preoperative magnetic resonance imaging (MRI) of the cases was evaluated by two different radiologists. The readers reviewed MRIs independently, blinded to the histopathologic diagnosis or molecular subset of tumors. The cases were classified as IDH-mutant astrocytoma, oligodendroglioma and IDH-wildtype (IDH-wt) astrocytoma according to molecular and genetic features. RESULTS T2/FLAIR mismatch positivity was observed in 46 patients (34.6%). T2/FLAIR mismatch positivity was observed in 42 of 75 IDH-mutant astrocytomas (56%) and 4 of 43 oligodendrogliomas (9.30%), while it was not seen among IDH-wt astrocytomas (0/15, 0%). The T2/FLAIR mismatch ratio was significantly different between IDH-mutant astrocytomas (WHO grade II and grade III) and oligodendrogliomas (chi-square, p <0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of T2/FLAIR mismatch in predicting IDH-mutant astrocytomas were 58.7%, 90.7%, 91.7%, 61.4%, and 70.3% respectively. Radiologist 1 diagnosed T2/FLAIR mismatch in 48 of 133 cases (36.1%) and Radiologist 2 in 66 of 133 cases (49.6%). The interrater agreement for the T2/FLAIR mismatch sign was 0.61 (p <0.05), 95% CI (0.55, 0.67). CONCLUSION T2/FLAIR mismatch appears to be an important MRI finding in distinguishing IDH-mutant astrocytomas from other diffuse hemispheric gliomas. However, it should be kept in mind that T2/FLAIR mismatch sign can be seen in a minority of oligodendrogliomas besides IDH-mutant astrocytomas.
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Affiliation(s)
- İbrahim Önder Yeniçeri
- Department of Radiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
| | - Mehmet Erdem Yıldız
- Department of Radiology Acıbadem University School of Medicine, İstanbul, Turkey
| | - Koray Özduman
- Department of Neurosurgery, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
| | - Ayça Erşen Danyeli
- Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, Acıbadem Altunizade Hospital, İstanbul, Turkey
| | - M Necmettin Pamir
- Departments of Neurosurgery Acıbadem University School of Medicine, İstanbul, Turkey
| | - Alp Dinçer
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University School of Medicine, İstanbul, Turkey
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15
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Pei L, Jones KA, Shboul ZA, Chen JY, Iftekharuddin KM. Deep Neural Network Analysis of Pathology Images With Integrated Molecular Data for Enhanced Glioma Classification and Grading. Front Oncol 2021; 11:668694. [PMID: 34277415 PMCID: PMC8282424 DOI: 10.3389/fonc.2021.668694] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/17/2021] [Indexed: 11/19/2022] Open
Abstract
Gliomas are primary brain tumors that originate from glial cells. Classification and grading of these tumors is critical to prognosis and treatment planning. The current criteria for glioma classification in central nervous system (CNS) was introduced by World Health Organization (WHO) in 2016. This criteria for glioma classification requires the integration of histology with genomics. In 2017, the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT-NOW) was established to provide up-to-date recommendations for CNS tumor classification, which in turn the WHO is expected to adopt in its upcoming edition. In this work, we propose a novel glioma analytical method that, for the first time in the literature, integrates a cellularity feature derived from the digital analysis of brain histopathology images integrated with molecular features following the latest WHO criteria. We first propose a novel over-segmentation strategy for region-of-interest (ROI) selection in large histopathology whole slide images (WSIs). A Deep Neural Network (DNN)-based classification method then fuses molecular features with cellularity features to improve tumor classification performance. We evaluate the proposed method with 549 patient cases from The Cancer Genome Atlas (TCGA) dataset for evaluation. The cross validated classification accuracies are 93.81% for lower-grade glioma (LGG) and high-grade glioma (HGG) using a regular DNN, and 73.95% for LGG II and LGG III using a residual neural network (ResNet) DNN, respectively. Our experiments suggest that the type of deep learning has a significant impact on tumor subtype discrimination between LGG II vs. LGG III. These results outperform state-of-the-art methods in classifying LGG II vs. LGG III and offer competitive performance in distinguishing LGG vs. HGG in the literature. In addition, we also investigate molecular subtype classification using pathology images and cellularity information. Finally, for the first time in literature this work shows promise for cellularity quantification to predict brain tumor grading for LGGs with IDH mutations.
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Affiliation(s)
- Linmin Pei
- Vision Lab, Department of Electrical & Computer Engineering, Old Dominion University, Norfolk, VA, United States
| | - Karra A. Jones
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, IA, United States
| | - Zeina A. Shboul
- Vision Lab, Department of Electrical & Computer Engineering, Old Dominion University, Norfolk, VA, United States
| | - James Y. Chen
- Department of Radiology, Division of Neuroradiology, San Diego VA Medical Center, La Jolla, CA, United States
- Department of Radiology, Division of Neuroradiology, UC San Diego Health System, San Diego, CA, United States
| | - Khan M. Iftekharuddin
- Vision Lab, Department of Electrical & Computer Engineering, Old Dominion University, Norfolk, VA, United States
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16
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Waqar M, Lewis D, Agushi E, Gittins M, Jackson A, Coope D. Cerebral and tumoral blood flow in adult gliomas: a systematic review of results from magnetic resonance imaging. Br J Radiol 2021; 94:20201450. [PMID: 34106749 PMCID: PMC9327770 DOI: 10.1259/bjr.20201450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Blood flow is the rate of blood movement and relevant to numerous processes, though understudied in gliomas. The aim of this review was to pool blood flow metrics obtained from MRI modalities in adult supratentorial gliomas. Methods: MEDLINE, EMBASE and the Cochrane database were queried 01/01/2000–31/12/2019. Studies measuring blood flow in adult Grade II–IV supratentorial gliomas using dynamic susceptibility contrast (DSC) MRI, dynamic contrast enhanced MRI (DCE-MRI) or arterial spin labelling (ASL) were included. Absolute and relative cerebral blood flow (CBF), peritumoral blood flow and tumoral blood flow (TBF) were reported. Results: 34 studies were included with 1415 patients and 1460 scans. The mean age was 52.4 ± 7.3 years. Most patients had glioblastoma (n = 880, 64.6%). The most common imaging modality was ASL (n = 765, 52.4%) followed by DSC (n = 538, 36.8%). Most studies were performed pre-operatively (n = 1268, 86.8%). With increasing glioma grade (II vs IV), TBF increased (70.8 vs 145.5 ml/100 g/min, p < 0.001) and CBF decreased (85.3 vs 49.6 ml/100 g/min, p < 0.001). In Grade IV gliomas, following treatment, CBF increased in ipsilateral (24.9 ± 1.2 vs 26.1 ± 0.0 ml/100 g/min, p < 0.001) and contralateral white matter (25.6 ± 0.2 vs 26.0± 0.0 ml/100 g/min, p < 0.001). Conclusion: Our findings demonstrate that increased mass effect from high-grade gliomas impairs blood flow within the surrounding brain that can improve with surgery. Advances in knowledge: This systematic review demonstrates how mass effect from brain tumours impairs blood flow in the surrounding brain parenchyma that can improve with treatment.
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Affiliation(s)
- Mueez Waqar
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Daniel Lewis
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Erjon Agushi
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Matthew Gittins
- Department of Biostatistics, Division of Population Health, Health Services Research& Primary Care, The University of Manchester, Manchester, UK
| | - Alan Jackson
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - David Coope
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, Manchester, UK
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17
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Taha B, Boley D, Sun J, Chen CC. State of Radiomics in Glioblastoma. Neurosurgery 2021; 89:177-184. [PMID: 33913492 DOI: 10.1093/neuros/nyab124] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 02/13/2021] [Indexed: 12/30/2022] Open
Abstract
Radiomics is an emerging discipline that aims to make intelligent predictions and derive medical insights based on quantitative features extracted from medical images as a means to improve clinical diagnosis or outcome. Pertaining to glioblastoma, radiomics has provided powerful, noninvasive tools for gaining insights into pathogenesis and therapeutic responses. Radiomic studies have yielded meaningful biological understandings of imaging features that are often taken for granted in clinical medicine, including contrast enhancement on glioblastoma magnetic resonance imaging, the distance of a tumor from the subventricular zone, and the extent of mass effect. They have also laid the groundwork for noninvasive detection of mutations and epigenetic events that influence clinical outcomes such as isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT). In this article, we review advances in the field of glioblastoma radiomics as they pertain to prediction of IDH mutation status and MGMT promoter methylation status, as well as the development of novel, higher order radiomic parameters.
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Affiliation(s)
- Birra Taha
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Boley
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ju Sun
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, Minnesota, USA
| | - Clark C Chen
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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18
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Gupta M, Gupta A, Yadav V, Parvaze SP, Singh A, Saini J, Patir R, Vaishya S, Ahlawat S, Gupta RK. Comparative evaluation of intracranial oligodendroglioma and astrocytoma of similar grades using conventional and T1-weighted DCE-MRI. Neuroradiology 2021; 63:1227-1239. [PMID: 33469693 DOI: 10.1007/s00234-021-02636-8] [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] [Received: 10/15/2020] [Accepted: 01/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This retrospective study was performed on a 3T MRI to determine the unique conventional MR imaging and T1-weighted DCE-MRI features of oligodendroglioma and astrocytoma and investigate the utility of machine learning algorithms in their differentiation. METHODS Histologically confirmed, 81 treatment-naïve patients were classified into two groups as per WHO 2016 classification: oligodendroglioma (n = 16; grade II, n = 25; grade III) and astrocytoma (n = 10; grade II, n = 30; grade III). The differences in tumor morphology characteristics were evaluated using Z-test. T1-weighted DCE-MRI data were analyzed using an in-house built MATLAB program. The mean 90th percentile of relative cerebral blood flow, relative cerebral blood volume corrected, volume transfer rate from plasma to extracellular extravascular space, and extravascular extracellular space volume values were evaluated using independent Student's t test. Support vector machine (SVM) classifier was constructed to differentiate two groups across grade II, grade III, and grade II+III based on statistically significant features. RESULTS Z-test signified only calcification among conventional MR features to categorize oligodendroglioma and astrocytoma across grade III and grade II+III tumors. No statistical significance was found in the perfusion parameters between two groups and its subtypes. SVM trained on calcification also provided moderate accuracy to differentiate oligodendroglioma from astrocytoma. CONCLUSION We conclude that conventional MR features except calcification and the quantitative T1-weighted DCE-MRI parameters fail to discriminate between oligodendroglioma and astrocytoma. The SVM could not further aid in their differentiation. The study also suggests that the presence of more than 50% T2-FLAIR mismatch may be considered as a more conclusive sign for differentiation of IDH mutant astrocytoma.
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Affiliation(s)
- Mamta Gupta
- Department of Radiology, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122002, India
| | - Abhinav Gupta
- Department of Radiology, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122002, India
| | - Virendra Yadav
- Centre for Biomedical Engineering, IIT Delhi, New Delhi, India
| | | | - Anup Singh
- Centre for Biomedical Engineering, IIT Delhi, New Delhi, India
| | - Jitender Saini
- National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rana Patir
- Department of Neurosurgery, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, India
| | - Sandeep Vaishya
- Department of Neurosurgery, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, India
| | - Sunita Ahlawat
- SRL Diagnostics, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, India
| | - Rakesh Kumar Gupta
- Department of Radiology, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122002, India.
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Guo L, Li X, Cao H, Hua J, Mei Y, Pillai JJ, Wu Y. Inflow-based vascular-space-occupancy (iVASO) might potentially predict IDH mutation status and tumor grade in diffuse cerebral gliomas. J Neuroradiol 2021; 49:267-274. [PMID: 33482231 DOI: 10.1016/j.neurad.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] [Received: 09/15/2020] [Revised: 12/13/2020] [Accepted: 01/11/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of the study is to assess the diagnostic performance of inflow-based vascular-space-occupancy (iVASO) MR imaging for differentiating glioblastomas (grade IV, GBM) and lower-grade diffuse gliomas (grade II and III, LGG) and its potential to predict IDH mutation status. METHODS One hundred and two patients with diffuse cerebral glioma (56 males; median age, 43.5 years) underwent iVASO and dynamic susceptibility contrast (DSC) MR imaging. The iVASO-derived arteriolar cerebral blood volume (CBVa), relative CBVa (rCBVa), and the DSC-derived relative cerebral blood volume (rCBV) were obtained, and these measurements were compared between the GBM group (n = 43) and the LGG group (n = 59) and between the IDH-mutation group (n = 54) and the IDH-wild group (n = 48). RESULTS Significant correlation was observed between rCBV and CBVa (P < 0.001) or rCBVa (P < 0.001). Both CBVa (P < 0.001) and rCBVa (P < 0.001) were higher in the GBM group. Both CBVa (P < 0.001) and rCBVa (P < 0.001) were lower in the IDH-mutation group compared to the IDH-wild group. Receiver operating characteristic analyses showed the area under curve (AUC) of 0.95 with CBVa and 0.97 with rCBVa in differentiating GBM from LGG. The AUCs were 0.82 and 0.85 for CBVa and rCBVa in predicting IDH gene status, respectively, which were lower than that of rCBV (AUC = 0.90). Combined rCBV and rCBVa significantly improved the diagnostic performance (AUC = 0.95). CONCLUSIONS iVASO MR imaging has the potential to predict IDH mutation and grade in glioma.
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Affiliation(s)
- Liuji Guo
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Xiaodan Li
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Haimei Cao
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Jun Hua
- Neurosection, Division of MRI Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Yingjie Mei
- China International Center, Philips Healthcare, Guangzhou, PR China
| | - Jay J Pillai
- Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yuankui Wu
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, PR China.
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20
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Lu D, Li Y, Lu H, Pillai JJ. Histogram-based analysis of cerebral blood flow using arterial spin labeling MRI in de novo brain gliomas: relationship to histopathologic grade and molecular markers. Neuroradiology 2021; 63:751-760. [PMID: 33392733 DOI: 10.1007/s00234-020-02625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE We developed multiple histogram-based CBF indices and evaluated their association with histopathologic grade in de novo brain tumor patients. Furthermore, the associations between these advanced CBF indices and molecular markers, including IDH1 mutation, ATRX loss, and 1p/19q co-deletion were also investigated. METHODS Thirteen de novo brain tumor patients (age 21-68 years, 9 M/4F) who were enrolled in our prospective study were scanned on 3 T MRI using a pCASL perfusion sequence following IRB-approved written informed consent. All patients have since undergone surgical intervention with tissue sampling for histopathologic tumor grading and molecular marker assessment. Tumor region of interest (ROI) were manually delineated on FLAIR images including the full extent of the tumor and peritumoral edema. Fourteen rCBF indices were derived from the histogram of the voxels with the ROI. Multi-linear regression was then used to compare rCBF indices with histopathologic tumor grade and molecular markers. RESULTS Averaged rCBF in top 10 and top 20 voxels (p < 0.004), but not the entire tumor ROI, was positively associated with WHO tumor grade. After accounting for tumor grade, the presence of 1p/19q co-deletion was associated with higher rCBF in top voxels, as well as with standard deviation of rCBF in the tumor ROI (p < 0.001). ATRX retention was related to higher rCBF, and this effect appears to be present in both higher-perfusion (p < 0.004) and low-perfusion (p < 0.05) voxels. IDH mutation was not significantly associated with any of the CBF indices investigated. CONCLUSION ASL MRI may provide useful supplemental noninvasive imaging assessment of brain tumor grade and molecular marker status.
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Affiliation(s)
- David Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yang Li
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, USA
| | - Jay J Pillai
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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21
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Zhang HW, Lyu GW, He WJ, Lei Y, Lin F, Wang MZ, Zhang H, Liang LH, Feng YN, Yang JH. DSC and DCE Histogram Analyses of Glioma Biomarkers, Including IDH, MGMT, and TERT, on Differentiation and Survival. Acad Radiol 2020; 27:e263-e271. [PMID: 31983532 DOI: 10.1016/j.acra.2019.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES The World Health Organization 2016 classification of central nervous system tumors added the molecular classification of gliomas and has guiding significance for the operation and prognosis of glioma patients. At present, the perfusion technique plays an important role in judging the malignant degree of glioma. To evaluate the performance of dynamic susceptibility contrast (DSC)- and dynamic contrast-enhanced (DCE)-magnetic resonance imaging (MRI) histogram analyses in discriminating the states of molecular biomarkers and survival in glioma patients. MATERIALS AND METHODS Forty-three glioma patients who underwent DCE- and DSC-MRI were enrolled. Relevant molecular test results, including those on isocitrate dehydrogenase (IDH), O6-methylguanine-DNA methyltransferase (MGMT) and telomere reverse transcriptase (TERT), were collected. The mean relative cerebral blood volume of DSC-MRI and histogram parameters derived from DCE-MRI (volume transfer coefficient (Ktrans), fractional volume of the extravascular extracellular space (Ve), fractional blood plasma volume (Vp), rate constant between the extravascular extracellular space and blood plasma (Kep) and area under the curve (AUC)) were calculated. Differences in each parameter between gliomas with different expression states (IDH, MGMT, and TERT) were evaluated. The diagnostic efficiency of each parameter was analyzed. The overall survival of all patients was assessed. RESULTS The 10th percentile AUC (AUC = 0.830, sensitivity = 0.78, specificity = 0.80), the 90th percentile Ve (AUC = 0.816, sensitivity = 0.84, specificity = 0.79), and the mean Kep (AUC = 0.818, sensitivity = 0.76, specificity = 0.78) provided the highest differential efficiency for IDH, MGMT, and TERT, respectively. Kaplan-Meier curves showed a significant difference between subjects with a 10th percentile AUC higher or lower than 0.028 (log-rank = 7.535; p = 0.006) for IDH and between subjects with different 90th percentile Ve values (log-rank = 6.532; p = 0.011) for MGMT. CONCLUSION Histogram DCE-MRI demonstrates good diagnostic performance in identifying different molecular types and for the prognostic assessment of glioma.
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Affiliation(s)
- Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Gui-Wen Lyu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Wen-Jie He
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China.
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Meng-Zhu Wang
- Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou, Guangdong Province, China
| | - Hong Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Li-Hong Liang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Yu-Ning Feng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, 3002 SunGangXi Road, Shenzhen 518035, China
| | - Ji-Hu Yang
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
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22
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Comparison of Conventional, Diffusion, and Perfusion MRI Between Low-Grade and Anaplastic Extraventricular Ependymoma. AJR Am J Roentgenol 2020; 215:978-984. [PMID: 32809860 DOI: 10.2214/ajr.20.22764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to investigate and compare conventional MRI, DWI, and dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI) characteristics between low-grade and anaplastic extraventricular ependymomas. MATERIALS AND METHODS. Twenty-six patients with extraventricular ependymomas (19 anaplastic and seven low-grade) who underwent preoperative MRI were enrolled in this retrospective study. Conventional MRI and DWI were performed in all patients; DSCPWI was performed in 15 patients (11 with anaplastic ependymoma and four with low-grade ependymoma). Demographics, conventional MRI features, minimum relative apparent diffusion coefficient (rADCmin), and maximum relative cerebral blood volume (rCBVmax) of the low-grade and anaplastic ependymomas were compared. Diagnostic performance with optimal cutoff values was determined. RESULTS. Anaplastic extraventricular ependymomas were more likely to be located in the superficial supratentorial cerebral hemisphere (p = 0.026) and to present with pial and cortical involvement (p = 0.028 and 0.013, respectively) and necrotic degeneration (p = 0.014). The mean rADCmin ± SD of anaplastic ependymoma was significantly lower than that of low-grade ependymoma (0.8 ± 0.2 vs 1.2 ± 0.3, p = 0.002). The mean rCBVmax of anaplastic ependymoma was significantly higher than that of low-grade ependymoma (15.7 ± 5.3 vs 9.0 ± 4.4, p = 0.042). The cutoff values in grading extraventricular ependymoma were 1.02 for rADCmin and 10.43 for rCBVmax. Combining conventional MRI, DWI, and DSC-PWI allowed the best differentiation of low-grade and anaplastic ependymoma (AUC = 1.00). CONCLUSION. Conventional MRI, DWI, and DSC-PWI techniques may aid in assessing and grading extraventricular ependymomas.
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Bulakbaşı N, Paksoy Y. Correction to: Advanced imaging in adult diffusely infiltrating low-grade gliomas. Insights Imaging 2020; 11:57. [PMID: 32323033 PMCID: PMC7176752 DOI: 10.1186/s13244-020-00862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The original article [1] contains errors in Table 1 in rows ktrans and Ve; the correct version of Table 1 can be viewed in this Correction article.
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Affiliation(s)
- Nail Bulakbaşı
- Medical Faculty, University of Kyrenia, Sehit Yahya Bakır Street, Karakum, Mersin-10, Kyrenia, Turkish Republic of Northern Cyprus, Turkey.
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Ding H, Huang Y, Li Z, Li S, Chen Q, Xie C, Zhong Y. Prediction of IDH Status Through MRI Features and Enlightened Reflection on the Delineation of Target Volume in Low-Grade Gliomas. Technol Cancer Res Treat 2020; 18:1533033819877167. [PMID: 31564237 PMCID: PMC6767744 DOI: 10.1177/1533033819877167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Isocitrate dehydrogenase mutational status defines distinct biologic behavior and
clinical outcomes in low-grade gliomas. We sought to determine magnetic resonance imaging
characteristics associated with isocitrate dehydrogenase mutational status to evaluate the
predictive roles of magnetic resonance imaging features in isocitrate dehydrogenase
mutational status and therefore their potential impact on the determination of clinical
target volume in radiotherapy. Forty-eight isocitrate dehydrogenase-mutant and 28
isocitrate dehydrogenase–wild-type low-grade gliomas were studied. Isocitrate
dehydrogenase mutation was related to more frequency of cortical involvement compared to
isocitrate dehydrogenase–wild-type group (34/46 vs 6/24, P = .0001).
Peritumoral edema was less frequent in isocitrate dehydrogenase–mutant tumors (32.6% vs
58.3% for isocitrate dehydrogenase–wild-type tumors, P = .0381).
Isocitrate dehydrogenase–wild-type tumors were more likely to have a nondefinable border,
while isocitrate dehydrogenase–mutant tumors had well-defined borders (66.7% vs 39.1%,
P = .0287). Only 8 (17.4%) of 46 of the isocitrate dehydrogenase–mutant
tumors demonstrated marked enhancement, while this was 66.7% in isocitrate–wild-type
tumors (P < .0001). Choline–creatinine ratio for isocitrate
dehydrogenase–wild-type tumors was significantly higher than that for isocitrate
dehydrogenase–mutant tumors. In conclusion, frontal location, well-defined border,
cortical involvement, less peritumoral edema, lack of enhancement, and low
choline–creatinine ratio were predictive for the definition of isocitrate
dehydrogenase–mutant low-grade gliomas. Magnetic resonance imaging can provide an
advantage in the detection of isocitrate dehydrogenase status indirectly and indicate the
need to explore new design for treatment planning in gliomas. Choline–creatinine ratio in
magnetic resonance spectroscopy could be a potential more reasonable reference for the new
design of delineation of target volume in low-grade gliomas.
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Affiliation(s)
- Haixia Ding
- Department of Chemotherapy and Radiation Therapy, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Wuchang District, Wuhan, China.,Hubei Cancer Clinical Study Center, Wuhan, China
| | - Yong Huang
- Department of Chemotherapy and Radiation Therapy, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Wuchang District, Wuhan, China.,Hubei Cancer Clinical Study Center, Wuhan, China
| | - Zhiqiang Li
- Department of Neurologic Surgery, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China
| | - Sirui Li
- Department of Radiology, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China
| | - Qiongrong Chen
- Department of Pathology, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China
| | - Conghua Xie
- Department of Chemotherapy and Radiation Therapy, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Wuchang District, Wuhan, China.,Hubei Cancer Clinical Study Center, Wuhan, China
| | - Yahua Zhong
- Department of Chemotherapy and Radiation Therapy, Zhongnan Hospital, Wuhan University, Wuchang District, Wuhan, China.,Hubei Key Laboratory of Tumor Biological Behaviors, Wuchang District, Wuhan, China.,Hubei Cancer Clinical Study Center, Wuhan, China
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25
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Bulakbaşı N, Paksoy Y. Advanced imaging in adult diffusely infiltrating low-grade gliomas. Insights Imaging 2019; 10:122. [PMID: 31853670 PMCID: PMC6920302 DOI: 10.1186/s13244-019-0793-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/25/2019] [Indexed: 02/09/2023] Open
Abstract
The adult diffusely infiltrating low-grade gliomas (LGGs) are typically IDH mutant and slow-growing gliomas having moderately increased cellularity generally without mitosis, necrosis, and microvascular proliferation. Supra-total resection of LGG significantly increases the overall survival by delaying malignant transformation compared with a simple debulking so accurate MR diagnosis is crucial for treatment planning. Data from meta-analysis support the addition of diffusion and perfusion-weighted MR imaging and MR spectroscopy in the diagnosis of suspected LGG. Typically, LGG has lower cellularity (ADCmin), angiogenesis (rCBVmax), capillary permeability (Ktrans), and mitotic activity (Cho/Cr ratio) compared to high-grade glioma. The identification of 2-hydroxyglutarate by MR spectroscopy can reflect the IDH status of the tumor. The initial low ADCmin, high rCBVmax, and Ktrans values are consistent with the poor prognosis. The gradual increase in intratumoral Cho/Cr ratio and rCBVmax values are well correlated with tumor progression. Besides MR-based technical artifacts, which are minimized by the voxel-based assessment of data obtained by histogram analysis, the problems derived from the diversity and the analysis of imaging data should be solved by using artificial intelligence techniques. The quantitative multiparametric MR imaging of LGG can either improve the diagnostic accuracy of their differential diagnosis or assess their prognosis.
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Affiliation(s)
- Nail Bulakbaşı
- Medical Faculty, University of Kyrenia, Sehit Yahya Bakır Street, Karakum, Mersin-10, Kyrenia, Turkish Republic of Northern Cyprus, Turkey.
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Zhang Y, Chen C, Cheng Y, Teng Y, Guo W, Xu H, Ou X, Wang J, Li H, Ma X, Xu J. Ability of Radiomics in Differentiation of Anaplastic Oligodendroglioma From Atypical Low-Grade Oligodendroglioma Using Machine-Learning Approach. Front Oncol 2019; 9:1371. [PMID: 31921635 PMCID: PMC6929242 DOI: 10.3389/fonc.2019.01371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/21/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives: To investigate the ability of radiomics features from MRI in differentiating anaplastic oligodendroglioma (AO) from atypical low-grade oligodendroglioma using machine-learning algorithms. Methods: A total number of 101 qualified patients (50 participants with AO and 51 with atypical low-grade oligodendroglioma) were enrolled in this retrospective, single-center study. Forty radiomics features of tumor images derived from six matrices were extracted from contrast-enhanced T1-weighted (T1C) images and fluid-attenuation inversion recovery (FLAIR) images. Three selection methods were performed to select the optimal features for classifiers, including distance correlation, least absolute shrinkage and selection operator (LASSO), and gradient boosting decision tree (GBDT). Then three machine-learning classifiers were adopted to generate discriminative models, including linear discriminant analysis, support vector machine, and random forest (RF). Receiver operating characteristic analysis was conducted to evaluate the discriminative performance of each model. Results: Nine predictive models were established based on radiomics features from T1C images and FLAIR images. All of the classifiers represented feasible ability in differentiation, with AUC more than 0.840 when combined with suitable selection method. For models based on T1C images, the combination of LASSO and RF classifier represented the highest AUC of 0.904 in the validation group. For models based on FLAIR images, the combination of GBDT and RF classifier showed the highest AUC of 0.861 in the validation group. Conclusion: Radiomics-based machine-learning approach could potentially serve as a feasible method in distinguishing AO from atypical low-grade oligodendroglioma.
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Affiliation(s)
- Yang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yangfan Cheng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yuen Teng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Guo
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Xu
- Radiology Department, West China Hospital, Sichuan University, Chengdu, China
| | - Xuejin Ou
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Wang
- School of Computer Science, Nanjing University of Science and Technology, Nanjing, China
| | - Hui Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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CT, conventional, and functional MRI features of skull lymphoma: a series of eight cases in a single institution. Skeletal Radiol 2019; 48:897-905. [PMID: 30310943 DOI: 10.1007/s00256-018-3085-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE With the hypothesis that the combination of CT, conventional, and functional MRI can indicate a possible diagnosis of skull lymphoma, this study aimed to systematically explore CT, conventional, and functional MRI features of this rare entity. MATERIALS AND METHODS This retrospective study included eight patients with pathologically confirmed skull lymphomas. CT and conventional MRI findings, including the location, size, attenuation/signal intensity, cystic/necrosis, hemorrhage, calcification, enhancement, skull change, brain parenchyma edema and adjacent structure invasion, were reviewed. We also reviewed multi-parametric functional MR imaging features obtained from diffusion-weighted imaging (DWI, n = 4), susceptibility-weighted imaging (SWI, n = 3) and dynamic susceptibility-weighted contrast-enhanced perfusion-weighted imaging (DSC-PWI, n = 1). RESULTS The eight patients in this series consisted of five males and three females, with a mean age of 51.1 years. All skull lymphomas showed the tumors extending to extra- and intra-cranial spaces with permeative destruction of the intervening skull. Intratumoral cystic/necrosis was seen in one case. Hemorrhage or calcification was absent. Dural mater infiltration was detected in all cases. Two clivus lymphomas encased internal carotid artery without narrowing the lumen. Three cases invaded brain parenchyma with moderate edema. The tumors demonstrated high signal on DWI with low ADC values comparing to muscles. SWI images showed little intratumoral hemorrhage and vessel. Low relative cerebral blood volume (rCBV) value was detected. CONCLUSIONS Skull lymphomas commonly presented as a homogenous solid tumor extending either intra- or extra-cranially with permeative bone destruction. Restricted diffusion, little intratumoral susceptibility signal, and lower perfusion may indicate a specific diagnosis. Multi-parametric functional MRI may be a promising tool for the diagnosis of skull lymphomas.
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Dynamic susceptibility contrast and diffusion MR imaging identify oligodendroglioma as defined by the 2016 WHO classification for brain tumors: histogram analysis approach. Neuroradiology 2019; 61:545-555. [PMID: 30712139 DOI: 10.1007/s00234-019-02173-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/16/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE According to the revised World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS) of 2016, oligodendrogliomas are now defined primarily by a specific molecular signature (presence of IDH mutation and 1p19q codeletion). The purpose of our study was to assess the value of dynamic susceptibility contrast MR imaging (DSC-MRI) and diffusion-weighted imaging (DWI) to characterize oligodendrogliomas and to distinguish them from astrocytomas. METHODS Seventy-one adult patients with untreated WHO grade II and grade III diffuse infiltrating gliomas and known 1p/19q codeletion status were retrospectively identified and analyzed using relative cerebral blood volume (rCBV) and apparent diffusion coefficient (ADC) maps based on whole-tumor volume histograms. The Mann-Whitney U test and logistic regression were used to assess the ability of rCBV and ADC to differentiate between oligodendrogliomas and astrocytomas both independently, but also related to the WHO grade. Prediction performance was evaluated in leave-one-out cross-validation (LOOCV). RESULTS Oligodendrogliomas showed significantly higher microvascularity (higher rCBVMean ≥ 0.80, p = 0.013) and higher vascular heterogeneity (lower rCBVPeak ≤ 0.044, p = 0.015) than astrocytomas. Diffuse gliomas with higher cellular density (lower ADCMean ≤ 1094 × 10-6 mm2/s, p = 0.009) were more likely to be oligodendrogliomas than astrocytomas. Histogram analysis of rCBV and ADC was able to differentiate between diffuse astrocytomas (WHO grade II) and anaplastic astrocytomas (WHO grade III). CONCLUSION Histogram-derived rCBV and ADC parameter may be used as biomarkers for identification of oligodendrogliomas and may help characterize diffuse gliomas based upon their genetic characteristics.
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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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Brendle C, Hempel JM, Schittenhelm J, Skardelly M, Reischl G, Bender B, Ernemann U, la Fougère C, Klose U. Glioma grading by dynamic susceptibility contrast perfusion and 11C-methionine positron emission tomography using different regions of interest. Neuroradiology 2018; 60:381-389. [PMID: 29464269 DOI: 10.1007/s00234-018-1993-5] [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: 11/20/2017] [Accepted: 02/06/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The use of dynamic susceptibility contrast (DSC) perfusion and 11C-methionine positron emission tomography (MET-PET) for glioma grading is currently not standardized. The purpose of this study was to identify regions of interest (ROIs) that enable the best performance and clinical applicability in both methods, as well as to evaluate the complementarity of DSC perfusion and MET-PET in spatial hotspot definition. METHODS In 41 patient PET/MRI datasets, different ROIs were drawn: in T2-hyperintense tumour, in T2-hyperintense tumour and adjacent oedema and in tumour areas with contrast enhancement, altered perfusion or pathological radiotracer uptake. The performance of DSC perfusion and MET-PET using the different ROIs to distinguish high- and low-grade gliomas was assessed. The spatial overlap of hotspots identified by DSC perfusion and MET-PET was assessed visually. RESULTS ROIs in T2 fluid attenuated inversion recovery (FLAIR) sequence-hyperintense tumour revealed the most significant differences between high- and low-grade gliomas and reached the highest diagnostic performance in both DSC perfusion (p = 0.046; area under the curve = 0.74) and MET-PET (p = 0.007; area under the curve = 0.80). The combination of methods yielded an area under the curve of 0.80. Hotspots were completely overlapped in one half of the patients, partially overlapped in one third of the patients and present in only one method in approximately 20% of the patients. CONCLUSIONS For multi-parametric examinations with DSC perfusion and MET-PET, we recommend an ROI definition based on T2-hyperintense tumour. DSC perfusion and MET-PET contain complementary information concerning the spatial hotspot definition.
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Affiliation(s)
- Cornelia Brendle
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany.
| | - Johann-Martin Hempel
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Jens Schittenhelm
- Neuropathology, Department of Pathology and Neuropathology, Eberhard Karls University, Liebermeistersstraße 8, 72076, Tuebingen, Germany
| | - Marco Skardelly
- University Hospital for Neurosurgery, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Gerald Reischl
- Preclinical Imaging and Radiopharmacy, Eberhard Karls University, Roentgenweg 13, 72076, Tuebingen, Germany
| | - Benjamin Bender
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Ulrike Ernemann
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
| | - Christian la Fougère
- Nuclear Nedicine and Clinical Molecular Imaging, Department of Radiology, Eberhard Karls University, Otfried-Mueller-Straße 14, 72076, Tuebingen, Germany
| | - Uwe Klose
- Diagnostic and Interventional Neuroradiology, Department of Radiology, Eberhard Karls University, Hoppe-Seyler-Straße 3, 72076, Tuebingen, Germany
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