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Wangaryattawanich P, Rutman AM, Petcharunpaisan S, Mossa-Basha M. Incidental findings on brain magnetic resonance imaging (MRI) in adults: a review of imaging spectrum, clinical significance, and management. Br J Radiol 2023; 96:20220108. [PMID: 35522780 PMCID: PMC9975529 DOI: 10.1259/bjr.20220108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 01/27/2023] Open
Abstract
Utilization of brain MRI has dramatically increased in recent decades due to rapid advancement in imaging technology and improving accessibility. As a result, radiologists increasingly encounter findings incidentally discovered on brain MRIs which are performed for unrelated indications. Some of these findings are clinically significant, necessitating further investigation or treatment and resulting in increased costs to healthcare systems as well as increased patient anxiety. Moreover, management of these incidental findings poses a significant challenge for referring physicians. Therefore, it is important for interpreting radiologists to know the prevalence, clinical consequences, and appropriate management of these findings. There is a wide spectrum of incidental findings on brain MRI such as asymptomatic brain infarct, age-related white matter changes, microhemorrhages, intracranial tumors, intracranial cystic lesions, and anatomic variants. This article provides a narrative review of important incidental findings encountered on brain MRI in adults with a focus on prevalence, clinical implications, and recommendations on management of these findings based on current available data.
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Affiliation(s)
| | | | | | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina, Chapel Hill, NC, United States
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Sultana N, Sun C, Katsube T, Wang B. Biomarkers of Brain Damage Induced by Radiotherapy. Dose Response 2020; 18:1559325820938279. [PMID: 32694960 PMCID: PMC7350401 DOI: 10.1177/1559325820938279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/26/2020] [Accepted: 06/05/2020] [Indexed: 12/18/2022] Open
Abstract
Radiotherapy remains currently a critical component for both primary and metastatic brain tumors either alone or in combination with surgery, chemotherapy, and molecularly targeted agents, while it could cause simultaneously normal brain tissue injury leading to serious health consequences, that is, development of cognitive impairments following cranial radiotherapy is considered as a critical clinical disadvantage especially for the whole brain radiotherapy. Biomarkers can help to detect the accurate physiology or conditions of patients with brain tumor and develop effective treatment procedures for these patients. In the near future, biomarkers will become one of the prime driving forces of cancer treatment. In this minireview, we analyze the documented work on the acute brain damage and late consequences induced by radiotherapy, identify the biomarkers, in particular, the predictive biomarkers for the damage, and summarize the biological significance of the biomarkers. It is expected that translation of these research advance to radiotherapy would assist stratifying patients for optimized treatment and improving therapeutic efficacy and the quality of life.
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Affiliation(s)
- Nahida Sultana
- Institute of Food and Radiation Biology, Atomic Energy Research Establishment, Bangladesh Atomic Energy Commission, Dhaka, People’s Republic of Bangladesh
| | - Chao Sun
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou, People’s Republic of China
| | - Takanori Katsube
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Bing Wang
- National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
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Yu Y, Zhang H, Xiao Z, She D, Xing Z, Yang X, Cao D. Diffusion-weighted MRI combined with susceptibility-weighted MRI: added diagnostic value for four common lateral ventricular tumors. Acta Radiol 2018; 59:980-987. [PMID: 29065704 DOI: 10.1177/0284185117738562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Diffusion-weighted imaging (DWI) and susceptibility-weighted imaging (SWI) are reliable imaging modalities for brain tumors. However, the role of DWI and SWI in the diagnosis of common lateral ventricular tumors has not been systematically evaluated. Purpose To evaluate the diagnostic performance of DWI and SWI in common lateral ventricular tumors. Material and Methods Fifty-two patients with histopathologically confirmed lateral ventricular tumors were included in this study (18 with central neurocytomas, nine with ependymomas, seven with high-grade gliomas, and 18 with meningiomas). The relative minimum apparent diffusion coefficient (rADCmin) and relative average apparent diffusion coefficient (rADCave) measured by DWI and the intratumoral susceptibility signal intensity (ITSS) of hemorrhage acquired by SWI were calculated. These quantitative parameters were evaluated using the Mann-Whitney U test, receiver operating characteristic curve, and logistic regression analyses. Results The rADCmin and rADCave ratios of central neurocytomas were significantly lower than those of the other neoplasms. The rADCmin and rADCave ratios of ependymomas and the rADCave ratio of high-grade gliomas were significantly higher than those of meningiomas. The ITSS score of meningiomas was significantly lower than those of the other tumors, while the score of central neurocytomas was obviously lower than those of ependymomas and high-grade gliomas. The combination of the rADC ratio with the ITSS showed no significant difference, except in discriminating between meningiomas and high-grade glioma-ependymomas. Conclusion The rADC ratios and ITSS may be useful for differentiating common lateral ventricular tumors. The diagnostic performance may be improved with the use of the rADC ratios and ITSS scores.
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Affiliation(s)
- Yuanlin Yu
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Hua Zhang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Zebin Xiao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Dejun She
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Zhen Xing
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Xiefeng Yang
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
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Ueda F, Aburano H, Ryu Y, Yoshie Y, Nakada M, Hayashi Y, Matsui O, Gabata T. MR Spectroscopy to Distinguish between Supratentorial Intraventricular Subependymoma and Central Neurocytoma. Magn Reson Med Sci 2017; 16:223-230. [PMID: 27941295 PMCID: PMC5600029 DOI: 10.2463/mrms.mp.2015-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to discriminate supratentorial intraventricular subependymoma (SIS) from central neurocytoma (CNC) using magnetic resonance spectroscopy (MRS). METHODS Single-voxel proton MRS using a 1.5T or 3T MR scanner from five SISs, five CNCs, and normal controls were evaluated. They were examined using a point-resolved spectroscopy. Automatically calculated ratios comparing choline (Cho), N-acetylaspartate (NAA), myoinositol (MI), and/or glycine (Gly) to creatine (Cr) were determined. Evaluation of Cr to unsuppressed water (USW) was also performed. Mann-Whitney U test was carried out to test the significance of differences in the metabolite ratios. Detectability of lactate (Lac) and alanine (Ala) was evaluated. RESULTS Although a statistically significant difference (P < 0.0001) was observed in Cho/Cr among SIS, control spectra, and CNC, no statistical difference was noted between SIS and control spectra (P = 0.11). Statistically significant differences were observed in NAA/Cr between SIS and CNC (P = 0.04) or control spectra (P < 0.0001). A statistically significant difference was observed in MI and/or Gly to Cr between SIS and control spectra (P = 0.03), and CNC and control spectra (P < 0.0006). There were no statistical differences between SIS and CNC for MI and/or Gly to Cr (P = 0.32). Significant statistical differences were found between SIS and control spectra (P < 0.0053), control spectra and CNC (P < 0.0016), and SIS and CNC (P < 0.0083) for Cr to USW. Lac inverted doublets were confirmed in two SISs. Triplets of Lac and Ala were detected in four spectra of CNC. CONCLUSION The present study showed that MRS can be useful in discriminating SIS from CNC.
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Affiliation(s)
- Fumiaki Ueda
- Department of Advanced Medical Imaging, Graduate School of Medical Science, Kanazawa University
| | | | - Yasuji Ryu
- Department of Radiology, Tonami General Hospital
| | | | | | | | - Osamu Matsui
- Department of Advanced Medical Imaging, Graduate School of Medical Science, Kanazawa University
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Brandão LA, Castillo M. Adult Brain Tumors: Clinical Applications of Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2017; 24:781-809. [PMID: 27742117 DOI: 10.1016/j.mric.2016.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.
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Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Av. Das Américas 700, sala 320, Barra da Tijuca, Rio de Janeiro 30112011, Brazil; Clínica IRM- Ressonância Magnética, Rua Capitão Salomão 44 Humaitá, Rio de Janeiro 22271040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
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Abstract
Pediatric brain tumors are the leading cause of death from solid tumors in childhood. The most common posterior fossa tumors in children are medulloblastoma, atypical teratoid/rhabdoid tumor, cerebellar pilocytic astrocytoma, ependymoma, and brainstem glioma. Location, and imaging findings on computed tomography (CT) and conventional MR (cMR) imaging may provide important clues to the most likely diagnosis. Moreover, information obtained from advanced MR imaging techniques increase diagnostic confidence and help distinguish between different histologic tumor types. Here we discuss the most common posterior fossa tumors in children, including typical imaging findings on CT, cMR imaging, and advanced MR imaging studies.
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Affiliation(s)
- Lara A Brandão
- Radiologic Department, Clínica Felippe Mattoso, Fleury Medicina Diagnóstica, Avenida das Américas 700, sala 320, Barra Da Tijuca, Rio De Janeiro, Rio De Janeiro CEP 22640-100, Brazil; Department of Radiology, Clínica IRM- Ressonância Magnética, Rua Capitão Salomão, Humaitá, Rio De Janeiro, Rio De Janeiro CEP 22271-040, Brazil.
| | - Tina Young Poussaint
- Division of Neuroradiology, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
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Kimura M, da Cruz LCH. Multiparametric MR Imaging in the Assessment of Brain Tumors. Magn Reson Imaging Clin N Am 2016; 24:87-122. [PMID: 26613877 DOI: 10.1016/j.mric.2015.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Functional MR imaging methods make possible the quantification of dynamic physiologic processes that occur in the brain. Moreover, the use of these advanced imaging techniques in the setting of oncologic treatment of the brain is widely accepted and has found worldwide routine clinical use.
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Affiliation(s)
- Margareth Kimura
- Magnetic Resonance Department of Clínica de Diagnóstico por Imagem (CDPI), Centro Médico Barrashopping, Av. das Américas, 4666, grupo 325, Barra da Tijuca, Rio de Janeiro, RJ, CEP: 22649-900, Brazil.
| | - L Celso Hygino da Cruz
- Magnetic Resonance Department of Clínica de Diagnóstico por Imagem (CDPI), IRM Ressonância Magnética, Av. das Américas, 4666, grupo 325, Barra da Tijuca, Rio de Janeiro, RJ, CEP: 22649-900, Brazil
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Yang Y, Tian KB, Hao SY, Wu Z, Li D, Zhang JT. Primary Intracranial Extra-Axial Anaplastic Ependymomas. World Neurosurg 2016; 90:704.e1-704.e9. [PMID: 26947725 DOI: 10.1016/j.wneu.2016.02.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Ependymomas are usually located in the ventricular system or in the central canal of the spinal cord; intracranial extra-axial ependymomas (IEAEs) are rare. To date, only 17 cases of IEAEs have been reported. CASE DESCRIPTION We report 2 cases with 3 IEAEs (anaplastic) that were initially misdiagnosed. In Case 1 (47-year-old male), the para-falcine lesion was initially refractory to radiosurgery and gross total resection (GTR) was required due to relentless growth. The lesion had adhered to the falx and was well demarcated from the surrounding cortex. It was then correctly diagnosed as an anaplastic ependymoma on the basis of histopathology, and the patient received radiotherapy. No recurrence was observed after the 53-month follow-up. In Case 2 (30-year-old male), 2 IEAEs underwent staged surgeries and were identified as extra-axial lesions without connection to the ventricular system. Near total resection (NTR) and GTR were achieved in the right temporal and right occipital lesions, respectively, but the patient declined radiotherapy. The residual tumor after NTR regrew rapidly, and aggressive resection was performed followed by radiotherapy. No further recurrence was observed after 28 months. The previous 17 cases were male predominant (76.5%) without correct preoperative diagnoses; no recurrence was observed after total resection in the 9 patients reported in the literature. CONCLUSIONS IEAEs are rare and have a wide spectrum of clinical and radiological phenotypes. Preoperative diagnosis is difficult. Favorable outcomes for IEAEs can be achieved by GTR plus radiotherapy. Multiple IEAEs benefit from tailored staged surgical resection plus radiotherapy.
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Affiliation(s)
- Yang Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Kai-Bing Tian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Shu-Yu Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor.
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China; China National Clinical Research Center for Neurological Diseases; Center of Brain Tumor, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Brian Tumor.
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Dou W, Zhang M, Zhang X, Li Y, Chen H, Li S, Lu M, Dai J, Constans JM. Convex-Envelope Based Automated Quantitative Approach to Multi-Voxel 1H-MRS Applied to Brain Tumor Analysis. PLoS One 2015; 10:e0137850. [PMID: 26367871 PMCID: PMC4569259 DOI: 10.1371/journal.pone.0137850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/23/2015] [Indexed: 11/26/2022] Open
Abstract
Background Magnetic Resonance Spectroscopy (MRS) can measure in vivo brain tissue metabolism that exhibits unique biochemical characteristics in brain tumors. For clinical application, an efficient and versatile quantification method of MRS would be an important tool for medical research, particularly for exploring the scientific problem of tumor monitoring. The objective of our study is to propose an automated MRS quantitative approach and assess the feasibility of this approach for glioma grading, prognosis and boundary detection. Methods An automated quantitative approach based on a convex envelope (AQoCE) is proposed in this paper, including preprocessing, convex-envelope based baseline fitting, bias correction, sectional baseline removal, and peak detection, in a total of 5 steps. Some metabolic ratios acquired by this quantification are selected for statistical analysis. An independent sample t-test and the Kruskal-Wallis test are used for distinguishing low-grade gliomas (LGG) and high-grade gliomas (HGG) and for detecting the tumor, peritumoral and contralateral areas, respectively. Seventy-eight cases of pre-operative brain gliomas with pathological reports are included in this study. Results Cho/NAA, Cho/Cr and Lip-Lac/Cr (LL/Cr) calculated by AQoCE in the tumor area differ significantly between LGG and HGG, with p≤0.005. Using logistic regression combining Cho/NAA, Cho/Cr and LL/Cr to generate a ROC curve, AQoCE achieves a sensitivity of 92.9%, a specificity of 72.2%, and an area under ROC curve (AUC) of 0.860. Moreover, both Cho/NAA and Cho/Cr in the AQoCE approach show a significant difference (p≤0.019) between tumoral, peritumoral, and contralateral areas. The comparison between the results of AQoCE and Siemens MRS processing software are also discussed in this paper. Conclusions The AQoCE approach is an automated method of residual water removal and metabolite quantification. It can be applied to multi-voxel 1H-MRS for evaluating brain glioma grading and demonstrating characteristics of brain glioma metabolism. It can also detect infiltration in the peritumoral area. Under the limited clinical data used, AQoCE is significantly more versatile and efficient compared to the reference approach of Siemens.
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Affiliation(s)
- Weibei Dou
- Department of Electronic Engineering, Tsinghua University, Beijing, China
- * E-mail: (WD); (JD)
| | - Mingyu Zhang
- Radiology Department of Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing, China
| | - Xiaojie Zhang
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Yuan Li
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Hongyan Chen
- Radiology Department of Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Shaowu Li
- Beijing Neurosurgical Institute, Beijing, China
| | - Min Lu
- Department of Electronic Engineering, Tsinghua University, Beijing, China
| | - Jianping Dai
- Radiology Department of Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing, China
- * E-mail: (WD); (JD)
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Nachimuthu DS, Baladhandapani A. Multidimensional texture characterization: on analysis for brain tumor tissues using MRS and MRI. J Digit Imaging 2015; 27:496-506. [PMID: 24496552 DOI: 10.1007/s10278-013-9669-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper investigates the efficacy of automated pattern recognition methods on magnetic resonance data with the objective of assisting radiologists in the clinical diagnosis of brain tissue tumors. In this paper, the sciences of magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) are combined to improve the accuracy of the classifier, based on the multidimensional co-occurrence matrices to assess the detection of pathological tissues (tumor and edema), normal tissues (white matter - WM and gray matter - GM), and fluid (cerebrospinal fluid - CSF). The results show the ability of the classifier with iterative training to automatically and simultaneously recover tissue-specific spectral and structural patterns and achieve segmentation of tumor and edema and grading of high and low glioma tumor. Here, extreme learning machine - improved particle swarm optimization (ELM-IPSO) neural network classifier is trained with the feature descriptions in brain magnetic resonance (MR) spectra. This has the characteristics of varying the normal spectral pattern associated with tumor patterns along with imaging features. Validation was performed considering 35 clinical studies. The volumetric features extracted from the vectors of this matrix articulate some important elementary structures, which along with spectroscopic metabolite ratios discriminate the tumor grades and tissue classes. The quantitative 3D analysis reveals significant improvement in terms of global accuracy rate for automatic classification in brain tissues and discriminating pathological tumor tissue from structural healthy brain tissue.
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Abstract
Neuroimaging plays a crucial role in diagnosis of brain tumors and in the decision-making process for therapy. Functional imaging techniques can reflect cellular density (diffusion imaging), capillary density (perfusion techniques), and tissue biochemistry (magnetic resonance [MR] spectroscopy). In addition, cortical activation imaging (functional MR imaging) can identify various loci of eloquent cerebral cortical function. Combining these new tools can increase diagnostic specificity and confidence. Familiarity with conventional and advanced imaging findings facilitates accurate diagnosis, differentiation from other processes, and optimal patient treatment. This article is a practical synopsis of pathologic, clinical, and imaging spectra of most common brain tumors.
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Affiliation(s)
- Danai Chourmouzi
- Diagnostic Radiology Department, Interbalcan Medical Centre, Asklipiou 10, Thessaloniki 57001, Greece.
| | - Elissabet Papadopoulou
- Diagnostic Radiology Department, Interbalcan Medical Centre, Asklipiou 10, Thessaloniki 57001, Greece
| | - Kostantinos Marias
- Computational Medicine Laboratory, Institute of Computer Science, Plastira 100 Vasilika Vouton, FORTH, Heraklion, Greece
| | - Antonios Drevelegas
- Diagnostic Radiology Department, Interbalcan Medical Centre, Asklipiou 10, Thessaloniki 57001, Greece
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Tsolaki E, Svolos P, Kousi E, Kapsalaki E, Fezoulidis I, Fountas K, Theodorou K, Kappas C, Tsougos I. Fast spectroscopic multiple analysis (FASMA) for brain tumor classification: a clinical decision support system utilizing multi-parametric 3T MR data. Int J Comput Assist Radiol Surg 2014; 10:1149-66. [PMID: 25024116 DOI: 10.1007/s11548-014-1088-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 05/05/2014] [Indexed: 01/14/2023]
Abstract
INTRODUCTION A clinical decision support system (CDSS) for brain tumor classification can be used to assist in the diagnosis and grading of brain tumors. A Fast Spectroscopic Multiple Analysis (FASMA) system that uses combinations of multiparametric MRI data sets was developed as a CDSS for brain tumor classification. METHODS MRI metabolic ratios and spectra, from long and short TE, respectively, as well as diffusion and perfusion data were acquired from the intratumoral and peritumoral area of 126 patients with untreated intracranial tumors. These data were categorized based on the pathology, and different machine learning methods were evaluated regarding their classification performance for glioma grading and differentiation of infiltrating versus non-infiltrating lesions. Additional databases were embedded to the system, including updated literature values of the related MR parameters and typical tumor characteristics (imaging and histological), for further comparisons. Custom Graphical User Interface (GUI) layouts were developed to facilitate classification of the unknown cases based on the user's available MR data. RESULTS The highest classification performance was achieved with a support vector machine (SVM) using the combination of all MR features. FASMA correctly classified 89 and 79% in the intratumoral and peritumoral area, respectively, for cases from an independent test set. FASMA produced the correct diagnosis, even in the misclassified cases, since discrimination between infiltrative versus non-infiltrative cases was possible. CONCLUSIONS FASMA is a prototype CDSS, which integrates complex quantitative MR data for brain tumor characterization. FASMA was developed as a diagnostic assistant that provides fast analysis, representation and classification for a set of MR parameters. This software may serve as a teaching tool on advanced MRI techniques, as it incorporates additional information regarding typical tumor characteristics derived from the literature.
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Affiliation(s)
- Evangelia Tsolaki
- Medical Physics Department, Medical School, University of Thessaly, 41110 , Biopolis, Larissa, Greece
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Diffusion weighted MR imaging and proton MR spectroscopy findings of central neurocytoma with pathological correlation. J Neuroradiol 2013; 41:243-50. [PMID: 24238840 DOI: 10.1016/j.neurad.2013.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 09/22/2013] [Accepted: 09/23/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE Three cases of histopathologically confirmed central neurocytoma (CN) are presented, emphasizing diagnostic imaging issues: conventional magnetic resonance imaging with Proton magnetic resonance spectroscopy (MRS) and diffusion-weighted imaging (DWI) findings of CN. MATERIALS AND METHODS Patients age ranged from 17 to 32 years, Imaging include a CT scan and MR examination with DWI and proton MRS on a 1.5-T system. DWI and subsequent apparent diffusion coefficient (ADC) were obtained in all. Single voxel MRS was performed prior to surgery using a point resolved spectroscopy sequence (PRESS) with short 35 ms and long echotime (TE) 144 ms, associated with a two-dimensional chemical Shift Imaging (2D-CSI) with 144 ms TE (one case). Histopathological examination included immunostaining with synaptophysin. RESULTS With the long TE, a variable amount of glycine with markedly increased choline, very small to almost complete loss of N-acetylaspartate and creatine, and inverted triplet of alanine-lactate were observed in all three patients. Increased glutamate and glutamine complex (Glx) was also observed in all with short TE. DWI demonstrated variable low ADC which appeared well correlated with the tumor signal intensity and cell density: the most homogeneous and highly dense cellular tumor with increased nucleus to cytoplasm ratio demonstrated the lower ADC. Histological pattern was typical in two cases and demonstrated an oligodendroglioma-like pattern in one case. Positivity for synaptophysin confirmed the neuronal origin in all. CONCLUSION The demonstration within an intraventricular tumor of both glycine and alanine on MRS along with high choline, bulky Glx and restricted diffusion appear diagnostic of CN.
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Hingwala DR, Radhakrishnan N, Kesavadas C, Thomas B, Kapilamoorthy TR, Radhakrishnan VV. Neuroenteric cysts of the brain-comprehensive magnetic resonance imaging. Indian J Radiol Imaging 2013; 23:155-63. [PMID: 24082482 PMCID: PMC3777327 DOI: 10.4103/0971-3026.116579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neuroenteric cysts are developmental cysts that should be differentiated from other, more common non-neoplastic cysts as well as cystic neoplasms. While these lesions may have varied imaging findings, T1 hyperintense prepontine lesion due to mucinous/proteinaceous content is characteristic. Location and imaging characteristics aid in formulating the correct diagnosis of neuroepithelial/neuroenteric cysts. Magnetic resonance spectroscopy (MRS) has the specific finding of N-Acetyl Aspartate (NAA)-like peak at 2.02 ppm which is not seen in other cystic lesions. In this study, we aim to discuss the imaging findings of these lesions on conventional and advanced MRI findings and provide radiologic-pathologic correlation. We also briefly describe the pathogenesis, embryology and radiological differential diagnoses of these cysts.
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Affiliation(s)
- Divyata R Hingwala
- Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Imaging findings of intraventricular and ependymal lesions. J Neuroradiol 2013; 40:229-44. [DOI: 10.1016/j.neurad.2013.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/24/2013] [Accepted: 06/24/2013] [Indexed: 11/15/2022]
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The Outline of Prognosis and New Advances in Diagnosis of Oral Squamous Cell Carcinoma (OSCC): Review of the Literature. ACTA ACUST UNITED AC 2013. [DOI: 10.1155/2013/519312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective. Oral squamous cell carcinoma (OSCC) has a remarkable incidence over the world and a fairly strenuous prognosis, encouraging further research on the prognostic factors and new techniques for diagnosis that might modify disease outcome. Data Sources. A web-based search for all types of articles published was initiated using Medline/Pub Med, with the key words such as oral cancer, prognostic factors of oral cancer, diagnostic method of oral cancer, and imaging techniques for diagnosis of oral cancer. The search was restricted to articles published in English, with no publication date restriction (last update April, 2013). Review Methods. In this paper, I approach the factors of prognosis of OSCC and the new advances in diagnostic technologies as well. I also reviewed available studies of the tissue fluorescence spectroscopy and other noninvasive diagnostic aids for OSCC. Results. The outcome is greatly influenced by the stage of the disease (especially TNM). Prognosis also depends or varies with tumour primary site, nodal involvement, tumour thickness, and the status of the surgical margins. Conclusion. Tumour diameter is not the most accurate when compared to tumour thickness or depth of invasion, which can be related directly to prognosis. There is a wide agreement on using ultrasound guided fine needle aspiration biopsies in the evaluation of lymph node metastasis.
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Abstract
Pediatric brain tumors are the most common solid tumor of childhood. This article focuses on the metabolic signature of common pediatric brain tumors using MR spectroscopic analyses.
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Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Barra Da Tijuca, Rio De Janeiro, Brazil.
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Liu M, Yue Q, Isobe T, Matsumura A, Li J, Yang Z, Quan H, Xing H, Gong Q. Proton MR spectroscopy of central neurocytoma using short and long echo time: new proofs for the existence of glycine and glutamate. Acad Radiol 2012; 19:779-84. [PMID: 22503892 DOI: 10.1016/j.acra.2012.02.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 02/12/2012] [Accepted: 02/13/2012] [Indexed: 12/28/2022]
Abstract
RATIONALE AND OBJECTIVES Central neurocytomas (CNCs) are rare benign tumors typically located in the lateral ventricle of the central nervous system. The authors report five patients with CNCs and review 16 previously published studies that included 52 patients with CNCs to explore the magnetic resonance spectroscopic features of CNCs. MATERIALS AND METHODS Five patients with CNCs were retrospectively reviewed. They were examined using point-resolved spectroscopic series with short and/or long echo times. The integrals of choline, creatine, and the 3.55-ppm peak were determined using Magnetic Resonance User Interface software, and the metabolite ratios relative to creatine were obtained. In two cases, T2 relaxation times of choline and the metabolite resonance at 3.55 ppm were calculated using data points acquired with different echo times and an exponential decay model. RESULTS Consistent with previously published studies, all five patients showed highly increased choline and reduced N-acetylaspartate and creatine. Four patients in the present study and 35 in published data demonstrated prominent peaks at 3.55 ppm, which were assigned to glycine because of its relaxation pattern and long T2 relaxation time. In addition, increased in vivo glutamate and glutamine was also confirmed in three patients examined with short echo times. Alanine and lactate peaks were observed in three and two patients, respectively. CONCLUSIONS The present study shows that the 3.55-ppm peak characteristic of CNC should be assigned to glycine according to its T2 relaxation time. Besides increased glycine and choline, the presence of glutamate or glutamine, which appears on series with short echo times, may further confirm the diagnosis of CNC.
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MRI findings in patients with central neurocytomas with special reference to differential diagnosis from other ventricular tumours near the foramen of Monro. J Clin Neurosci 2012; 19:681-6. [DOI: 10.1016/j.jocn.2011.06.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 06/23/2011] [Accepted: 06/26/2011] [Indexed: 11/18/2022]
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Shah T, Jayasundar R, Singh VP, Sarkar C. MRS characterization of central neurocytomas using glycine. NMR IN BIOMEDICINE 2011; 24:1408-1413. [PMID: 21465595 DOI: 10.1002/nbm.1705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Revised: 01/10/2011] [Accepted: 02/14/2011] [Indexed: 05/30/2023]
Abstract
This study reports in vivo MRS findings in 11 patients with histologically diagnosed central neurocytomas, which are rare intraventricular tumors of neuronal origin. Single-voxel (1)H MRS was carried out prior to surgery using a point-resolved spectroscopy sequence with TR=6 s, TE=135 ms and 128 scans. In vitro high-resolution (1)H spectroscopy was also carried out on two surgically excised samples. The striking features of the spectra from the central neurocytomas were the presence of high glycine, decreased N-acetylaspartate, increased choline and alanine. Retrospective, blind analysis of the spectra by two independent observers correctly identified all but one central neurocytoma based on the presence of glycine. The presence of glycine and prominent choline in the (1)H MR spectrum is a characteristic feature of the central neurocytomas, and could be used to characterize and differentiate them from other brain tumors.
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Affiliation(s)
- Tariq Shah
- Department of NMR, All India Institute of Medical Sciences, New Delhi, India.
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Shah T, Jayasundar R, Singh VP, Sarkar C. In vivo MRS study of intraventricular tumors. J Magn Reson Imaging 2011; 34:1053-9. [DOI: 10.1002/jmri.22711] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 06/07/2011] [Indexed: 11/05/2022] Open
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Cerebral metabolic changes in neurologically presymptomatic patients undergoing haemodialysis: in vivo proton MR spectroscopic findings. Eur Radiol 2009; 20:1502-7. [PMID: 19997847 DOI: 10.1007/s00330-009-1673-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 09/09/2009] [Accepted: 10/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To prospectively investigate and detect early cerebral metabolic changes in patients with end-stage renal disease (ESRD) by using in vivo proton MR spectroscopy (MRS). METHODS We enrolled 32 patients with ESRD and 32 healthy controls between the ages of 26 and 50 years. Short echo time single-voxel proton MRS was acquired from volumes of interest (VOIs) located in the frontal grey and white matter, temporal white matter and basal ganglia. The choline/phospatidylcholine (Cho), myo-inositol (mI), N-acetylaspartate (NAA) and total creatine (tCr) peaks were measured and the metabolic ratios with respect to tCr were calculated. RESULTS In the ESRD group, significant elevations of the Cho/tCr and mI/tCr ratios were observed for the frontal grey matter, frontal white matter, temporal white matter and basal ganglia as compared with controls. There was no significant difference in the NAA/tCr ratios at all VOIs between the ESRD patients and the healthy controls. CONCLUSIONS Proton MRS is a useful and non-invasive imaging tool for the detection of early cerebral metabolic changes in neurologically presymptomatic ESRD patients.
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