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Negroni D, Bono R, Soligo E, Longo V, Cossandi C, Carriero A, Stecco A. T1-Weighted Contrast Enhancement, Apparent Diffusion Coefficient, and Cerebral-Blood-Volume Changes after Glioblastoma Resection: MRI within 48 Hours vs. beyond 48 Hours. Tomography 2023; 9:342-351. [PMID: 36828379 PMCID: PMC9967426 DOI: 10.3390/tomography9010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of the study is to identify the advantages, if any, of post-operative MRIs performed at 48 h compared to MRIs performed after 48 h in glioblastoma surgery. MATERIALS AND METHODS To assess the presence of a residual tumor, the T1-weighted Contrast Enhancement (CE), Apparent Diffusion Coefficient (ADC), and Cerebral Blood Volume (rCBV) in the proximity of the surgical cavity were considered. The rCBV ratio was calculated by comparing the rCBV with the contralateral normal white matter. After the blind image examinations by the two radiologists, the patients were divided into two groups according to time window after surgery: ≤48 h (group 1) and >48 h (group 2). RESULTS A total of 145 patients were enrolled; at the 6-month follow-up MRI, disease recurrence was 89.9% (125/139), with a mean patient survival of 8.5 months (SD 7.8). The mean ADC and rCBV ratio values presented statistical differences between the two groups (p < 0.05). Of these 40 patients in whom an ADC value was not obtained, the rCBV values could not be calculated in 52.5% (21/40) due to artifacts (p < 0.05). CONCLUSION The study showed differences in CE, rCBV, and ADC values between the groups of patients undergoing MRIs before and after 48 h. An MRI performed within 48 h may increase the ability of detecting GBM by the perfusion technique with the calculation of the rCBV ratio.
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Affiliation(s)
- Davide Negroni
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
- Correspondence:
| | - Romina Bono
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Eleonora Soligo
- Radiology Department, San Andrea Hospital of Vercelli, 13100 Vercelli, Italy
| | - Vittorio Longo
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Christian Cossandi
- Neurosurgery Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Alessandro Carriero
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Alessandro Stecco
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
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The new era of bio-molecular imaging with O-(2-18F-fluoroethyl)-L-tyrosine (18F-FET) in neurosurgery of gliomas. Clin Transl Imaging 2022. [DOI: 10.1007/s40336-022-00509-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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3
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Chi X, Wang Y, Li C, Huang X, Gao H, Zhang Y, Ji N. Resection of Noncontrast-Enhancing Regions Deteriorated the Immunotherapeutic Efficacy of HSPPC-96 Vaccination in Treating Glioblastoma. Front Oncol 2022; 12:877190. [PMID: 35664765 PMCID: PMC9158124 DOI: 10.3389/fonc.2022.877190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Surgical resection remains a first-line therapy for glioblastoma multiforme (GBM). Increased extent of resection (EOR) of noncontrast-enhancing regions in T2-weighted MRI images (T2-EOR) provides a survival benefit for GBM patients receiving standard radio/chemotherapy. However, whether it also improves immunotherapeutic outcomes remains unclear. We calculated the T2-EOR by comparing the preoperative and postoperative MRI T2 hyperintensity outside the enhancing tumour and correlated the T2-EOR with immunological and clinical outcomes from our published early-phase trial of heat shock protein peptide complex-96 (HSPPC-96) vaccination in treating a cohort of 19 patients with newly diagnosed GBMs (NCT02122822). Patients with higher T2-EOR exhibited shorter progression-free survival (PFS) (HR 11.29, p=0.002) and overall survival (OS) (HR 6.5, p=0.003) times than patients with lower T2-EOR. T2-EOR was negatively correlated with the levels of tumour specific immune response (TSIR) post-vaccination (R=-0.725, p<0.001) and absolute TSIR increase from pre- to post-vaccination (R=-0.679, p=0.001). Multivariate Cox regression models revealed that higher T2-EOR represented an independent risk factor for PFS (HR 19.85, p=0.0068) and OS (HR 21.24, p=0.0185) in this patient cohort. Taken together, increased T2-EOR deteriorated immunotherapeutic outcomes by suppressing TSIR, suggesting the potential of T2-EOR as an early biomarker for predicting the immunotherapeutic efficacy of HSPPC-96 vaccination.
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Affiliation(s)
- Xiaohan Chi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chunzhao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - Hua Gao
- Cure & Sure Biotech Co., LTD, Shenzhen, China
| | - Yang Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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4
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Ruiz-Garcia H, Middlebrooks EH, Trifiletti DM, Chaichana KL, Quinones-Hinojosa A, Sheehan JP. The Extent of Resection in Gliomas-Evidence-Based Recommendations on Methodological Aspects of Research Design. World Neurosurg 2022; 161:382-395.e3. [PMID: 35505558 DOI: 10.1016/j.wneu.2021.08.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Modern neurosurgery has established maximal safe resection as a cornerstone in the management of diffuse gliomas. Evaluation of the extent of resection (EOR), and its association with certain outcomes or interventions, heavily depends on an adequate methodology to draw strong conclusions. We aim to identify weaknesses and limitations that may threaten the internal validity and generalizability of studies involving the EOR in patients with glioma and to suggest methodological recommendations that may help mitigate these threats. METHODS A systematic search was performed by querying PubMed, Web of Science, and Scopus since inception to April 30, 2021 using PICOS/PRISMA guidelines. Articles were then screened to identify high-impact studies evaluating the EOR in patients diagnosed with diffuse gliomas in accordance with predefined criteria. We identify common weakness and limitations during the evaluation of the EOR in the selected studies and then delineate potential methodological recommendations for future endeavors dealing with the EOR. RESULTS We identified 31 high-impact studies and found several research design issues including inconsistencies regarding EOR terminology, measurement, data collection, analysis, and reporting. Although some of these issues were related to now outdated reporting standards, many were still present in recent publications and deserve attention in contemporary and future research. CONCLUSIONS There is a current need to focus more attention to the methodological aspects of glioma research. Methodological inconsistencies may introduce weaknesses into the internal validity of the studies and hamper comparative analysis of cohorts from different institutions. We hope our recommendations will eventually help develop stronger methodological designs in future research endeavors.
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Affiliation(s)
- Henry Ruiz-Garcia
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Daniel M Trifiletti
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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5
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Silva AHD, Constantinides M, Valetopoulou A, Sgardelis P, Mankad K, D'Arco F, Jankovic I, Thompson D. Paediatric spinal cord low-grade gliomas-evaluation and management of post-surgical residual disease. Childs Nerv Syst 2022; 38:577-586. [PMID: 34855000 DOI: 10.1007/s00381-021-05412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/06/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the evaluation and management of post-surgical residual disease for low-grade intramedullary spinal cord tumours (IMSCT) in childhood. METHODS A single-centre retrospective review of low-grade IMSCTs treated between 2000 and 2019. All surgeries were performed with intent of safe maximal resection guided by intra-operative neurophysiological monitoring (IONM). Pre- and post-operative MRIs were reviewed to assess the extent of resection (EOR), recorded as follows: gross total resection (GTR), near total resection (NTR), sub-total resection (STR) and partial resection (PR). Outcome measures were time to recurrence, need for and modality of additional therapy and ambulatory status at last follow-up. RESULTS Thirty patients underwent surgery for IMSCT (median age 6.9 years). EOR was GTR = 8, NTR = 4, STR = 9, PR = 9. All patients were alive at last follow-up (median follow-up 73 months [IQR 93 months]). Eighteen patients (60%) remained radiologically stable. Twelve patients (40%) developed recurrence during surveillance. Progression free survival was significantly better in cases with GTR + NTR in comparison to either STR or PR (p = 0.039). 10/30 (33%) patients were treated with additional therapy. At last follow-up, 26/30 patients were independently mobile. CONCLUSION Survival rates for low-grade IMSCT are excellent. Radical micro-surgical resection, guided by IONM provides effective means of balancing the objectives of maximal safe resection, functional outcome and tumour control. Whilst evidence of 'residual disease' was identified in over 2/3 of immediate post-operative MRI scans, additional treatment was required in only 1/3 of cases. Critical appraisal of post-operative imaging findings is required to better define 'residual disease'. Small volume residual disease (< 5%) does not compromise progression-free survival.
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Affiliation(s)
- A H D Silva
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - M Constantinides
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - A Valetopoulou
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - P Sgardelis
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - K Mankad
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - F D'Arco
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - I Jankovic
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK
| | - D Thompson
- Department of Paediatric Neurosurgery, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
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Huntoon K, Makary MS, Damante M, Giglio P, Slone W, Elder JB. Intraoperative 3 T MRI is more correlative to residual disease extent than early postoperative MRI. J Neurooncol 2021; 154:345-351. [PMID: 34417709 DOI: 10.1007/s11060-021-03833-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/18/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Extent of resection of low grade glioma (LGG) is an important prognostic variable, and may influence decisions regarding adjuvant therapy in certain patient populations. Immediate postoperative magnetic resonance image (MRI) is the mainstay for assessing residual tumor. However, previous studies have suggested that early postoperative MRI fluid-attenuated inversion recovery (FLAIR) (within 48 h) may overestimate residual tumor volume in LGG. Intraoperative magnetic resonance imaging (iMRI) without subsequent resection may more accurately assess residual tumor. Consistency in MRI techniques and utilization of higher magnet strengths may further improve both comparisons between MRI studies performed at different time points as well as the specificity of MRI findings to identify residual tumor. To evaluate the utility of 3 T iMRI in the imaging of LGG, we volumetrically analyzed intraoperative, early, and late (~ 3 months after surgery) postoperative MRIs after resection of LGG. METHODS A total of 32 patients with LGG were assessed retrospectively. Residual tumor was defined as hyperintense T2 signal on FLAIR. Volumetric assessment was performed with intraoperative, early, and late postoperative FLAIR via TeraRecon iNtuition. RESULTS Perilesional FLAIR parenchymal abnormality volumes were significantly different comparing intraoperative and early postoperative MRI (2.17 ± 0.45 cm3 vs. 5.47 ± 1.07 cm3, respectively (p = 0.0002)). A significant difference of perilesional FLAIR parenchymal abnormality volumes was also found comparing early and late postoperative MRI (5.47 ± 1.07 cm3 vs. 3.22 ± 0.64 cm3, respectively (p = 0.0001)). There was no significant difference between intraoperative and late postoperative Perilesional FLAIR parenchymal abnormality volumes. CONCLUSIONS Intraoperative 3 T MRI without further resection appears to better reflect the volume of residual tumor in LGG compared with early postoperative 3 T MRI. Early postoperative MRI may overestimate residual tumor. As such, intraoperative MRI performed after completion of tumor resection may be more useful for making decisions regarding adjuvant therapy.
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Affiliation(s)
- Kristin Huntoon
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA. .,Department of Neurological Surgery, MD Anderson Cancer Center, University of Texas, 1515 Holcombe, Houston, TX, 77030, USA.
| | - Mina S Makary
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Damante
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Pierre Giglio
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wayne Slone
- Department of Radiology, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - J Bradley Elder
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, Columbus, OH, USA
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Rykkje AM, Li D, Skjøth-Rasmussen J, Larsen VA, Nielsen MB, Hansen AE, Carlsen JF. Surgically Induced Contrast Enhancements on Intraoperative and Early Postoperative MRI Following High-Grade Glioma Surgery: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11081344. [PMID: 34441279 PMCID: PMC8392564 DOI: 10.3390/diagnostics11081344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
For the radiological assessment of resection of high-grade gliomas, a 72-h diagnostic window is recommended to limit surgically induced contrast enhancements. However, such enhancements may occur earlier than 72 h post-surgery. This systematic review aimed to assess the evidence on the timing of the postsurgical MRI. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles describing surgically induced contrast enhancements on MRI after resection for high-grade gliomas were included and analysed. The frequency of different contrast enhancement patterns on intraoperative MRI (iMRI) and early postoperative MRI (epMRI) was recorded. The search resulted in 1443 studies after removing duplicates, and a total of 12 studies were chosen for final review. Surgically induced contrast enhancements were reported at all time points after surgery, including on iMRI, but their type and frequency vary. Thin linear contrast enhancements were commonly found to be surgically induced and were less frequently recorded on postoperative days 1 and 2. This suggests that the optimal time to scan may be at or before this time. However, the evidence is limited, and higher-quality studies using larger and consecutively sampled populations are needed.
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Affiliation(s)
- Alexander Malcolm Rykkje
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Dana Li
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Vibeke Andrée Larsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jonathan Frederik Carlsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
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8
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Sipos D, László Z, Tóth Z, Kovács P, Tollár J, Gulybán A, Lakosi F, Repa I, Kovács A. Additional Value of 18F-FDOPA Amino Acid Analog Radiotracer to Irradiation Planning Process of Patients With Glioblastoma Multiforme. Front Oncol 2021; 11:699360. [PMID: 34295825 PMCID: PMC8290215 DOI: 10.3389/fonc.2021.699360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/11/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE To investigate the added value of 6-(18F]-fluoro-L-3,4-dihydroxyphenylalanine (FDOPA) PET to radiotherapy planning in glioblastoma multiforme (GBM). METHODS From September 2017 to December 2020, 17 patients with GBM received external beam radiotherapy up to 60 Gy with concurrent and adjuvant temozolamide. Target volume delineations followed the European guideline with a 2-cm safety margin clinical target volume (CTV) around the contrast-enhanced lesion+resection cavity on MRI gross tumor volume (GTV). All patients had FDOPA hybrid PET/MRI followed by PET/CT before radiotherapy planning. PET segmentation followed international recommendation: T/N 1.7 (BTV1.7) and T/N 2 (BTV2.0) SUV thresholds were used for biological target volume (BTV) delineation. For GTV-BTVs agreements, 95% of the Hausdorff distance (HD95%) from GTV to the BTVs were calculated, additionally, BTV portions outside of the GTV and coverage by the 95% isodose contours were also determined. In case of recurrence, the latest MR images were co-registered to planning CT to evaluate its location relative to BTVs and 95% isodose contours. RESULTS Average (range) GTV, BTV1.7, and BTV2.0 were 46.58 (6-182.5), 68.68 (9.6-204.1), 42.89 (3.8-147.6) cm3, respectively. HD95% from GTV were 15.5 mm (7.9-30.7 mm) and 10.5 mm (4.3-21.4 mm) for BTV1.7 and BTV2.0, respectively. Based on volumetric assessment, 58.8% (28-100%) of BTV1.7 and 45.7% of BTV2.0 (14-100%) were outside of the standard GTV, still all BTVs were encompassed by the 95% dose. All recurrences were confirmed by follow-up imaging, all occurred within PTV, with an additional outfield recurrence in a single case, which was not DOPA-positive at the beginning of treatment. Good correlation was found between the mean and median values of PET/CT and PET/MRI segmented volumes relative to corresponding brain-accumulated enhancement (r = 0.75; r = 0.72). CONCLUSION 18FFDOPA PET resulted in substantial larger tumor volumes compared to MRI; however, its added value is unclear as vast majority of recurrences occurred within the prescribed dose level. Use of PET/CT signals proved to be feasible in the absence of direct segmentation possibilities of PET/MR in TPS. The added value of 18FFDOPA may be better exploited in the context of integrated dose escalation.
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Affiliation(s)
- David Sipos
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Zoltan László
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
| | - Zoltan Tóth
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
- MEDICOPUS Healthcare Provider and Public Nonprofit Ltd., Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Peter Kovács
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Jozsef Tollár
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Neurology, Somogy County Moritz Kaposi Teaching Hospital, Kaposvár, Hungary
| | - Akos Gulybán
- Medical Physics Department, Institut Jules Bordet, Bruxelles, Belgium
| | - Ferenc Lakosi
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Imre Repa
- Dr. József Baka Diagnostic, Radiation Oncology, Research and Teaching Center, “Moritz Kaposi” Teaching Hospital, Kaposvár, Hungary
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
| | - Arpad Kovács
- Doctoral School of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Medical Imaging, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
- Department of Oncoradiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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9
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Pala A, Durner G, Braun M, Schmitz B, Wirtz CR, Coburger J. The Impact of an Ultra-Early Postoperative MRI on Treatment of Lower Grade Glioma. Cancers (Basel) 2021; 13:cancers13122914. [PMID: 34200923 PMCID: PMC8230433 DOI: 10.3390/cancers13122914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022] Open
Abstract
The timing of MRI imaging after surgical resection may have an important role in assessing the extent of resection (EoR) and in determining further treatment. The aim of our study was to evaluate the time dependency of T2 and FLAIR changes after surgery for LGG. The Log-Glio database of patients treated at our hospital from 2016 to 2021 was searched for patients >18a and non-enhancing intra-axial lesion with complete MR-imaging protocol. A total of 16 patients matched the inclusion criteria and were thus selected for volumetric analysis. All patients received an intraoperative scan (iMRI) after complete tumor removal, an ultra-early postoperative scan after skin closure, an early MRI within 48 h and a late follow up MRI after 3-4 mo. Detailed volumetric analysis of FLAIR and T2 abnormalities was conducted. Demographic data and basic characteristics were also analyzed. An ultra-early postoperative MRI was performed within a median time of 30 min after skin closure and showed significantly lower FLAIR (p = 0.003) and T2 (p = 0.003) abnormalities when compared to early postoperative MRI (median 23.5 h), though no significant difference was found between ultra-early and late postoperative FLAIR (p = 0.422) and T2 (p = 0.575) images. A significant difference was calculated between early and late postoperative FLAIR (p = 0.005) and T2 (p = 0.019) MRI scans. Additionally, we found no significant difference between intraoperative and ultra-early FLAIR/T2 (p = 0.919 and 0.499), but we found a significant difference between iMRI and early MRI FLAIR/T2 (p = 0.027 and p = 0.035). Therefore, a postoperative MRI performed 24 h or 48 h might lead to false positive findings. An MRI scan in the first hour after surgery (ultra-early) correlated best with residual tumor at 3 months follow up. An iMRI with open skull, at the end of resection, was similar to an ultra-early MRI with regard to residual tumor.
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Affiliation(s)
- Andrej Pala
- Department of Neurosurgery, University of Ulm, 89312 Günzburg, Germany; (G.D.); (C.R.W.); (J.C.)
- Correspondence: ; Tel.: +49-82-219-628-866
| | - Gregor Durner
- Department of Neurosurgery, University of Ulm, 89312 Günzburg, Germany; (G.D.); (C.R.W.); (J.C.)
| | - Michael Braun
- Department of Neuroradiology, University of Ulm, 89312 Günzburg, Germany; (M.B.); (B.S.)
| | - Bernd Schmitz
- Department of Neuroradiology, University of Ulm, 89312 Günzburg, Germany; (M.B.); (B.S.)
| | - Christian Rainer Wirtz
- Department of Neurosurgery, University of Ulm, 89312 Günzburg, Germany; (G.D.); (C.R.W.); (J.C.)
| | - Jan Coburger
- Department of Neurosurgery, University of Ulm, 89312 Günzburg, Germany; (G.D.); (C.R.W.); (J.C.)
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10
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Kavouridis VK, Boaro A, Dorr J, Cho EY, Iorgulescu JB, Reardon DA, Arnaout O, Smith TR. Contemporary assessment of extent of resection in molecularly defined categories of diffuse low-grade glioma: a volumetric analysis. J Neurosurg 2020; 133:1291-1301. [PMID: 31653812 PMCID: PMC7348099 DOI: 10.3171/2019.6.jns19972] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While the effect of increased extent of resection (EOR) on survival in diffuse infiltrating low-grade glioma (LGG) patients is well established, there is still uncertainty about the influence of the new WHO molecular subtypes. The authors designed a retrospective analysis to assess the interplay between EOR and molecular classes. METHODS The authors retrospectively reviewed the records of 326 patients treated surgically for hemispheric WHO grade II LGG at Brigham and Women's Hospital and Massachusetts General Hospital (2000-2017). EOR was calculated volumetrically and Cox proportional hazards models were built to assess for predictive factors of overall survival (OS), progression-free survival (PFS), and malignant progression-free survival (MPFS). RESULTS There were 43 deaths (13.2%; median follow-up 5.4 years) among 326 LGG patients. Median preoperative tumor volume was 31.2 cm3 (IQR 12.9-66.0), and median postoperative residual tumor volume was 5.8 cm3 (IQR 1.1-20.5). On multivariable Cox regression, increasing postoperative volume was associated with worse OS (HR 1.02 per cm3; 95% CI 1.00-1.03; p = 0.016), PFS (HR 1.01 per cm3; 95% CI 1.00-1.02; p = 0.001), and MPFS (HR 1.01 per cm3; 95% CI 1.00-1.02; p = 0.035). This result was more pronounced in the worse prognosis subtypes of IDH-mutant and IDH-wildtype astrocytoma, for which differences in survival manifested in cases with residual tumor volume of only 1 cm3. In oligodendroglioma patients, postoperative residuals impacted survival when exceeding 8 cm3. Other significant predictors of OS were age at diagnosis, IDH-mutant and IDH-wildtype astrocytoma classes, adjuvant radiotherapy, and increasing preoperative volume. CONCLUSIONS The results corroborate the role of EOR in survival and malignant transformation across all molecular subtypes of diffuse LGG. IDH-mutant and IDH-wildtype astrocytomas are affected even by minimal postoperative residuals and patients could potentially benefit from a more aggressive surgical approach.
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Affiliation(s)
- Vasileios K. Kavouridis
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alessandro Boaro
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Dorr
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Elise Y. Cho
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - J. Bryan Iorgulescu
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - David A. Reardon
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Omar Arnaout
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Timothy R. Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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11
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Scherer M, Ahmeti H, Roder C, Gessler F, Jungk C, Pala A, Mayer B, Senft C, Tatagiba M, Synowitz M, Wirtz CR, Unterberg AW, Coburger J. Surgery for Diffuse WHO Grade II Gliomas: Volumetric Analysis of a Multicenter Retrospective Cohort From the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery 2020; 86:E64-E74. [PMID: 31574147 DOI: 10.1093/neuros/nyz397] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In diffuse WHO grade II gliomas (LGG), the extent of resection (EOR) required to achieve significant survival benefits remains elusive. OBJECTIVE To evaluate the association of residual volume (RV) and EOR with progression-free survival (PFS) or overall survival (OS) in LGG in a retrospective, multicenter series by the German study group of intraoperative MRI (GeSGIM). METHODS Consecutive cases were retrospectively assessed from 5 centers. Tumors were volumetrically quantified before and after surgery, and clinical data were analyzed, including IDH mutations and neurologic deficits. Kaplan-Meier estimates, accelerated failure time models (AFT), and multivariate Cox regression models were calculated to identify determinants of survival. RESULTS A total of 140 cases were analyzed. Gross total resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (P = .009). A significant survival disadvantage was evident even for small (>0-5 ml) residuals and increased for moderate (>5-20 ml) and large remnants (>20 ml) P = .001). Accordingly, PFS increased continuously for 20% incremental steps of EOR (P < .001). AFT models supported the notion of a continuous association of RV and EOR with PFS. Multivariate Cox regression models confirmed RV (P = .01) and EOR (P = .005) as continuous prognosticators of PFS. Univariate analysis showed significant associations of RV and EOR with OS. CONCLUSION Our data support the hypothesis of a continuous relationship of RV and EOR with survival for LGG with superiority seen for GTR. Hence, GTR should be achieved whenever safely feasible, and resections should be maximized whenever tumor has to be left behind to spare function.
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Affiliation(s)
- Moritz Scherer
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Hajrulla Ahmeti
- Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
| | - Constantin Roder
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Florian Gessler
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Christine Jungk
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Christian Senft
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
| | | | | | - Jan Coburger
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
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12
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Reuter G, Lommers E, Balteau E, Simon J, Phillips C, Scholtes F, Martin D, Lombard A, Maquet P. Multiparameter quantitative histological MRI values in high-grade gliomas: a potential biomarker of tumor progression. Neurooncol Pract 2020; 7:646-655. [PMID: 33304600 PMCID: PMC7716186 DOI: 10.1093/nop/npaa047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Conventional MRI poorly distinguishes brain parenchyma microscopically invaded by high-grade gliomas (HGGs) from the normal brain. By contrast, quantitative histological MRI (hMRI) measures brain microstructure in terms of physical MR parameters influenced by histochemical tissue composition. We aimed to determine the relationship between hMRI parameters in the area surrounding the surgical cavity and the presence of HGG recurrence. Methods Patients were scanned after surgery with an hMRI multiparameter protocol that allowed for estimations of longitudinal relaxation rate (R1) = 1/T1, effective transverse relaxation rate (R2)*=1/T2*, magnetization transfer saturation (MTsat), and proton density. The initial perioperative zone (IPZ) was segmented on the postoperative MRI. Once recurrence appeared on conventional MRI, the area of relapsing disease was delineated (extension zone, EZ). Conventional MRI showing recurrence and hMRI were coregistered, allowing for the extraction of parameters R1, R2*, MTsat, and PD in 3 areas: the overlap area between the IPZ and EZ (OZ), the peritumoral brain zone, PBZ (PBZ = IPZ - OZ), and the area of recurrence (RZ = EZ - OZ). Results Thirty-one patients with HGG who underwent gross-total resection were enrolled. MTsat and R1 were the most strongly associated with tumor progression. MTsat was significantly lower in the OZ and RZ, compared to PBZ. R1 was significantly lower in RZ compared to PBZ. PD was significantly higher in OZ compared to PBZ, and R2* was higher in OZ compared to PBZ or RZ. These changes were detected 4 to 120 weeks before recurrence recognition on conventional MRI. Conclusions HGG recurrence was associated with hMRI parameters' variation after initial surgery, weeks to months before overt recurrence.
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Affiliation(s)
- Gilles Reuter
- GIGA Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium.,Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Emilie Lommers
- GIGA Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium.,Department of Neurology, University Hospital of Liège, Liège, Belgium
| | - Evelyne Balteau
- GIGA Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium
| | - Jessica Simon
- Psychology and Neuroscience of Cognition-PsyNCogn, University of Liège, Liège, Belgium
| | - Christophe Phillips
- GIGA Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium.,GIGA In Silico Medicine, University of Liège, Liège, Belgium
| | - Felix Scholtes
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium.,Laboratory of Developmental Neurobiology, GIGA-Neurosciences Research Center, University of Liège, Liège, Belgium.,Department of Neuroanatomy, University of Liège, Liège, Belgium
| | - Didier Martin
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium
| | - Arnaud Lombard
- Department of Neurosurgery, University Hospital of Liège, Liège, Belgium.,Laboratory of Developmental Neurobiology, GIGA-Neurosciences Research Center, University of Liège, Liège, Belgium
| | - Pierre Maquet
- GIGA Cyclotron Research Centre-In Vivo Imaging, University of Liège, Liège, Belgium.,Department of Neurology, University Hospital of Liège, Liège, Belgium
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13
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Pseudo-continuous arterial spin labelling shows high diagnostic performance in the detection of postoperative residual lesion in hyper-vascularised adult brain tumours. Eur Radiol 2020; 30:2809-2820. [PMID: 31965259 DOI: 10.1007/s00330-019-06474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/26/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Our aim was to evaluate the contribution of pseudo-continuous arterial spin labelling (pCASL) in the detection of a postoperative residual lesion in adult brain tumours. METHODS Seventy-five patients were prospectively included. Following the results of preoperative DSC-PWI assessment, intra-axial lesions, including high-grade gliomas (n = 43) and certain metastases (n = 14), were classified as hyper-vascular (HV+ group, n = 57); other lesions, including low-grade gliomas and certain metastases, were classified as non-hyper-vascular (HV- group, n = 18). To confirm the absence/presence of a residual lesion or disease progression, postoperative MRI including pCASL sequence and follow-up-MRI were performed within 72 h and 1-6 months after the resection, respectively. Two raters evaluated the images. Mean and maximal ASL cerebral blood flow (CBF) values were measured in the perioperative region and normalised to the contralateral tissue. The pCASL-CBF maps and post-contrast T1WI were visually assessed for residual lesion. Quantitative data were analysed with unpaired Student t and Mann-Whitney U tests and the visual diagnostic performance with the McNemar test. RESULTS In the HV+ group, the mean normalised CBF was 1.97 ± 0.59 and 0.97 ± 0.29 (p < 0.0001, AUC = 0.964, cut-off = 1.27) for patients with or without residual tumours, respectively. The mean normalised CBF was not discriminative for assessing residual tumours in the HV- group (p = 0.454). Visual CBF evaluation allowed 92.98% patients belonging to the HV+ group to be correctly classified (sensitivity 93.02%, specificity 92.86%, p < 0.001). Visual evaluation was correlated with contrast enhancement evaluation and with the mean normalised CBF values (r = 0.505, p < 0.0001 and 0.838, p < 0.0001, respectively). CONCLUSION Qualitative and quantitative ASL evaluation shows high diagnostic performance in postoperative assessment of hyper-perfused tumours. In this case, postoperative pCASL may be useful, especially if contrast injection cannot be performed or when contrast enhancement is doubtful. KEY POINTS • Evaluation of postoperative residual lesion in the case of brain tumours is an imaging challenge. • This prospective monocentric study showed that increased normalised cerebral blood flow assessed by pseudo-continuous arterial spin labelling (pCASL) correlates well with the presence of a residual tumour in the case of hyper-vascular tumour diagnosed on preoperative MRI. • Qualitative and quantitative pCASL is an informative sequence for hyper-vascular residual tumour, especially if acquired more than 48 h after brain tumour surgery, when contrast enhancement can give ambiguous results due to blood-brain barrier disruption.
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14
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Tang F, Liang S, Zhong T, Huang X, Deng X, Zhang Y, Zhou L. Postoperative glioma segmentation in CT image using deep feature fusion model guided by multi-sequence MRIs. Eur Radiol 2019; 30:823-832. [PMID: 31650265 DOI: 10.1007/s00330-019-06441-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/05/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly selected methods for imaging gliomas. Clinically, radiotherapists always delineate the CT glioma region with reference to multi-modal MR image information. On this basis, we develop a deep feature fusion model (DFFM) guided by multi-sequence MRIs for postoperative glioma segmentation in CT images. METHODS DFFM is a multi-sequence MRI-guided convolutional neural network (CNN) that iteratively learns the deep features from CT images and multi-sequence MR images simultaneously by utilizing a multi-channel CNN architecture, and then combines these two deep features together to produce the segmentation result. The whole network is optimized together via a standard back-propagation. A total of 59 CT and MRI datasets (T1/T2-weighted FLAIR, T1-weighted contrast-enhanced, T2-weighted) of postoperative gliomas as tumor grade II (n = 24), grade III (n = 18), or grade IV (n = 17) were included. Dice coefficient (DSC), precision, and recall were used to measure the overlap between automated segmentation results and manual segmentation. The Wilcoxon signed-rank test was used for statistical analysis. RESULTS DFFM showed a significantly (p < 0.01) higher DSC of 0.836 than U-Net trained by single CT images and U-Net trained by stacking the CT and multi-sequence MR images, which yielded 0.713 DSC and 0.818 DSC, respectively. The precision values showed similar behavior as DSC. Moreover, DSC and precision values have no significant statistical difference (p > 0.01) with difference grades. CONCLUSIONS DFFM enables the accurate automated segmentation of CT postoperative gliomas of profit guided by multi-sequence MR images and may thus improve and facilitate radiotherapy planning. KEY POINTS • A fully automated deep learning method was developed to segment postoperative gliomas on CT images guided by multi-sequence MRIs. • CT and multi-sequence MR image integration allows for improvements in deep learning postoperative glioma segmentation method. • This deep feature fusion model produces reliable segmentation results and could be useful in delineating GTV in postoperative glioma radiotherapy planning.
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Affiliation(s)
- Fan Tang
- School of Biomedical Engineering, Southern Medical University, No. 1838 Guangzhou Northern Avenue, Baiyun District, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, Guangdong, China.,Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Shujun Liang
- School of Biomedical Engineering, Southern Medical University, No. 1838 Guangzhou Northern Avenue, Baiyun District, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Tao Zhong
- School of Biomedical Engineering, Southern Medical University, No. 1838 Guangzhou Northern Avenue, Baiyun District, Guangzhou, 510515, Guangdong, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xia Huang
- School of Biomedical Engineering, Southern Medical University, No. 1838 Guangzhou Northern Avenue, Baiyun District, Guangzhou, 510515, Guangdong, China.,Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Xiaogang Deng
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Yu Zhang
- School of Biomedical Engineering, Southern Medical University, No. 1838 Guangzhou Northern Avenue, Baiyun District, Guangzhou, 510515, Guangdong, China. .,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, No. 1838 Guangzhou Northern Avenue, Baiyun District, Guangzhou, 510515, Guangdong, China.
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15
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Masuda Y, Akutsu H, Ishikawa E, Matsuda M, Masumoto T, Hiyama T, Yamamoto T, Kohzuki H, Takano S, Matsumura A. Evaluation of the extent of resection and detection of ischemic lesions with intraoperative MRI in glioma surgery: is intraoperative MRI superior to early postoperative MRI? J Neurosurg 2019; 131:209-216. [PMID: 30095340 DOI: 10.3171/2018.3.jns172516] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI scans obtained within 48-72 hours (early postoperative MRI [epMRI]), prior to any postoperative reactive changes, are recommended for the accurate assessment of the extent of resection (EOR) after glioma surgery. Diffusion-weighted imaging (DWI) enables ischemic lesions to be detected and distinguished from the residual tumor. Prior studies, however, revealed that postoperative reactive changes were often present, even in epMRI. Although intraoperative MRI (iMRI) is widely used to maximize safe resection during glioma surgery, it is unclear whether iMRI is superior to epMRI when evaluating the EOR, because it theoretically shows fewer postoperative reactive changes. In addition, the ability to detect ischemic lesions using iMRI has not been investigated. METHODS The authors retrospectively analyzed prospectively collected data in 30 patients with glioma (22 and 8 patients with enhancing and nonenhancing lesions, respectively) who underwent tumor resection. These patients had received preoperative MRI within 24 hours prior to surgery, postresection radiological evaluation with iMRI during surgery, and epMRI within 24 hours after surgery, with all neuroimaging performed using identical 1.5T MRI scanners. The authors compared iMRI or epMRI with preoperative MRI, and defined a postoperative reactive change as a new postoperative enhancement or T2 high-intensity area (HIA), if this lesion was outside of the preoperative original tumor location. In addition, postoperative ischemia was evaluated on DWI. The iMRI and epMRI findings were compared in terms of 1) postoperative reactive changes, 2) evaluation of the EOR, and 3) presence of ischemic lesion on DWI. RESULTS In patients with enhancing lesions, a new enhancement was seen in 8 of 22 patients (36.4%) on iMRI and in 12 of 22 patients (54.5%) on epMRI. In patients with nonenhancing lesions, a new T2 HIA was seen in 4 of 8 patients (50.0%) on iMRI and in 7 of 8 patients (87.5%) on epMRI. A discrepancy between the EOR measured on iMRI and epMRI was noted in 5 of the 22 patients (22.7%) with enhancing lesions, and in 3 of the 8 patients (37.5%) with nonenhancing lesions. The occurrence of ischemic lesions on DWI was found in 5 of 30 patients (16.7%) on iMRI, whereas it was found in 16 of 30 patients (53.3%) on epMRI (p = 0.003); ischemic lesions were underestimated on iMRI in 11 patients. CONCLUSIONS Overall, given the lower incidence of postoperative reactive changes on iMRI, it was superior to epMRI in evaluating the EOR in patients with glioma, both with enhancing and nonenhancing lesions. However, because ischemic lesions can be overlooked on iMRI, the authors recommend only the additional DWI scan during the early postoperative period. Clinicians need to be mindful about not overestimating the presence of residual tumor on epMRI due to the high incidence of postoperative reactive changes.
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Affiliation(s)
| | | | | | | | - Tomohiko Masumoto
- 2Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki; and
| | - Takashi Hiyama
- 2Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki; and
| | - Tetsuya Yamamoto
- Departments of1Neurosurgery and
- 3Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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16
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Scherer M, Jungk C, Götz M, Kickingereder P, Reuss D, Bendszus M, Maier-Hein K, Unterberg A. Early postoperative delineation of residual tumor after low-grade glioma resection by probabilistic quantification of diffusion-weighted imaging. J Neurosurg 2019; 130:2016-2024. [PMID: 30052158 DOI: 10.3171/2018.2.jns172951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In WHO grade II low-grade gliomas (LGGs), early postoperative MRI (epMRI) may overestimate residual tumor on FLAIR sequences. Consequently, MRI at 3-6 months follow-up (fuMRI) is used for delineation of residual tumor. This study sought to evaluate if integration of apparent diffusion coefficient (ADC) maps permits an accurate estimation of residual tumor early on epMRI. METHODS From a consecutive cohort, 43 cases with an initial surgery for an LGG, and complete epMRI (< 72 hours after resection) and fuMRI including ADC maps, were retrospectively identified. Residual FLAIR hyperintense tumor was manually segmented on epMRI and corresponding ADC maps were coregistered. Using an expectation maximization algorithm, residual tumor segments were probabilistically clustered into areas of residual tumor, ischemia, or normal white matter (NWM) by fitting a mixture model of superimposed Gaussian curves to the ADC histogram. Tumor volumes from epMRI, clustering, and fuMRI were statistically compared and agreement analysis was performed. RESULTS Mean FLAIR hyperintensity suggesting residual tumor was significantly larger on epMRI compared to fuMRI (19.4 ± 16.5 ml vs 8.4 ± 10.2 ml, p < 0.0001). Probabilistic clustering of corresponding ADC histograms on epMRI identified subsegments that were interpreted as mean residual tumor (7.6 ± 10.2 ml), ischemia (8.1 ± 5.9 ml), and NWM (3.7 ± 4.9 ml). Therefore, mean tumor quantification error between epMRI and fuMRI was significantly reduced (11.0 ± 10.6 ml vs -0.8 ± 3.7 ml, p < 0.0001). Mean clustered tumor volumes on epMRI were no longer significantly different from the fuMRI reference (7.6 ± 10.2 ml vs 8.4 ± 10.2 ml, p = 0.16). Correlation (Pearson r = 0.96, p < 0.0001), concordance correlation coefficient (0.89, 95% confidence interval 0.83), and Bland-Altman analysis suggested strong agreement between both measures after clustering. CONCLUSIONS Probabilistic segmentation of ADC maps facilitates accurate assessment of residual tumor within 72 hours after LGG resection. Multiparametric image analysis detected FLAIR signal alterations attributable to surgical trauma, which led to overestimation of residual LGG on epMRI compared to fuMRI. The prognostic value and clinical impact of this method has to be evaluated in larger case series in the future.
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Affiliation(s)
| | | | - Michael Götz
- 2Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - David Reuss
- 4Neuropathology, Heidelberg University Hospital; and
| | | | - Klaus Maier-Hein
- 2Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
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17
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Eijgelaar RS, Bruynzeel AME, Lagerwaard FJ, Müller DMJ, Teunissen FR, Barkhof F, van Herk M, De Witt Hamer PC, Witte MG. Earliest radiological progression in glioblastoma by multidisciplinary consensus review. J Neurooncol 2018; 139:591-598. [PMID: 29777418 PMCID: PMC6132963 DOI: 10.1007/s11060-018-2896-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/02/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Detection of glioblastoma progression is important for clinical decision-making on cessation or initiation of therapy, for enrollment in clinical trials, and for response measurement in time and location. The RANO-criteria are considered standard for the timing of progression. To evaluate local treatment, we aim to find the most accurate progression location. We determined the differences in progression free survival (PFS) and in tumor volumes at progression (Vprog) by three definitions of progression. METHODS In a consecutive cohort of 73 patients with newly-diagnosed glioblastoma between 1/1/2012 and 31/12/2013, progression was established according to three definitions. We determined (1) earliest radiological progression (ERP) by retrospective multidisciplinary consensus review using all available imaging and follow-up, (2) clinical practice progression (CPP) from multidisciplinary tumor board conclusions, and (3) progression by the RANO-criteria. RESULTS ERP was established in 63 (86%), CPP in 64 (88%), RANO progression in 42 (58%). Of the 63 patients who had died, 37 (59%) did with prior RANO-progression, compared to 57 (90%) for both ERP and CPP. The median overall survival was 15.3 months. The median PFS was 8.8 months for ERP, 9.5 months for CPP, and 11.8 months for RANO. The PFS by ERP was shorter than CPP (HR 0.57, 95% CI 0.38-0.84, p = 0.004) and RANO-progression (HR 0.29, 95% CI 0.19-0.43, p < 0.001). The Vprog were significantly smaller for ERP (median 8.8 mL), than for CPP (17 mL) and RANO (22 mL). CONCLUSION PFS and Vprog vary considerably between progression definitions. Earliest radiological progression by retrospective consensus review should be considered to accurately localize progression and to address confounding of lead time bias in clinical trial enrollment.
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Affiliation(s)
- Roelant S Eijgelaar
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank J Lagerwaard
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Domenique M J Müller
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Freek R Teunissen
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Institutes of Neurology & Healthcare Engineering, University College London, London, UK
| | - Marcel van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine & Health, University of Manchester and Christie NHS Trust, Manchester, UK
| | - Philip C De Witt Hamer
- Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Marnix G Witte
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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18
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Freyschlag CF, Krieg SM, Kerschbaumer J, Pinggera D, Forster MT, Cordier D, Rossi M, Miceli G, Roux A, Reyes A, Sarubbo S, Smits A, Sierpowska J, Robe PA, Rutten GJ, Santarius T, Matys T, Zanello M, Almairac F, Mondot L, Jakola AS, Zetterling M, Rofes A, von Campe G, Guillevin R, Bagatto D, Lubrano V, Rapp M, Goodden J, De Witt Hamer PC, Pallud J, Bello L, Thomé C, Duffau H, Mandonnet E. Imaging practice in low-grade gliomas among European specialized centers and proposal for a minimum core of imaging. J Neurooncol 2018; 139:699-711. [PMID: 29992433 PMCID: PMC6132968 DOI: 10.1007/s11060-018-2916-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Imaging studies in diffuse low-grade gliomas (DLGG) vary across centers. In order to establish a minimal core of imaging necessary for further investigations and clinical trials in the field of DLGG, we aimed to establish the status quo within specialized European centers. METHODS An online survey composed of 46 items was sent out to members of the European Low-Grade Glioma Network, the European Association of Neurosurgical Societies, the German Society of Neurosurgery and the Austrian Society of Neurosurgery. RESULTS A total of 128 fully completed surveys were received and analyzed. Most centers (n = 96, 75%) were academic and half of the centers (n = 64, 50%) adhered to a dedicated treatment program for DLGG. There were national differences regarding the sequences enclosed in MRI imaging and use of PET, however most included T1 (without and with contrast, 100%), T2 (100%) and TIRM or FLAIR (20, 98%). DWI is performed by 80% of centers and 61% of centers regularly performed PWI. CONCLUSION A minimal core of imaging composed of T1 (w/wo contrast), T2, TIRM/FLAIR, PWI and DWI could be identified. All morphologic images should be obtained in a slice thickness of ≤ 3 mm. No common standard could be obtained regarding advanced MRI protocols and PET. IMPORTANCE OF THE STUDY We believe that our study makes a significant contribution to the literature because we were able to determine similarities in numerous aspects of LGG imaging. Using the proposed "minimal core of imaging" in clinical routine will facilitate future cooperative studies.
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Affiliation(s)
- Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Dominik Cordier
- Department of Neurosurgery, Universitätsspital Basel, Basel, Switzerland
| | - Marco Rossi
- Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Andrés Reyes
- European Master's in Clinical Linguistics (EMCL), University of Groningen, Groningen, The Netherlands
- EMCL University of Potsdam, Potsdam, Germany
- Neuroscience Institute, and Laboratory of Experimental Psychology, Faculty of Psychology, El Bosque University, Bogotá, Colombia
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, APSS, Trento, Italy
| | - Anja Smits
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Joanna Sierpowska
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
- Department of Cognition, Development and Education Psychology, Barcelona, Spain
| | - Pierre A Robe
- Department of Neurology and Neurosurgery, Rudolf Magnus Brain Institute, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Fabien Almairac
- Neurosurgery Department, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - Lydiane Mondot
- Radiology Department, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria Zetterling
- Department of Neurosurgery, Institution of Neuroscience, Uppsala University Hospital, Uppsala, Sweden
| | - Adrià Rofes
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Department of Cognitive Science, Johns Hopkins University, Baltimore, USA
| | - Gord von Campe
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Remy Guillevin
- DACTIM, UMR CNRS 7348, Université de Poitiers et CHU de Poitiers, Poitiers, France
| | - Daniele Bagatto
- Neuroradiology Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Vincent Lubrano
- Department of Neurosurgery, CHU Toulouse, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - John Goodden
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, West Yorkshire, UK
| | | | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France
- Institute of Neuroscience of Montpellier, INSERM U1051, University of Montpellier, Montpellier, France
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France
- University Paris 7, Paris, France
- IMNC, UMR 8165, Orsay, France
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Moiyadi AV, Shetty P, John R. Non-enhancing gliomas: does intraoperative ultrasonography improve resections? Ultrasonography 2018; 38:156-165. [PMID: 30343559 PMCID: PMC6443592 DOI: 10.14366/usg.18032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/29/2018] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Non-enhancing diffuse gliomas are a challenging surgical proposition. Delineation of tumour extent on preoperative imaging and intraoperative visualization are often difficult. METHODS We retrospectively analyzed all cases of non-enhancing gliomas that were operated on using navigated 3-dimensional ultrasonography (US). Tumour delineation (good, moderate, or poor) on preoperative magnetic resonance imaging (MRI) and intraoperative US was compared. Post-resection US findings with respect to residual tumour status were compared to the postoperative imaging findings. The extent of resection was calculated and recorded. RESULTS There were 55 gliomas (43 high-grade, 12 low-grade). Forty were close to eloquent areas. The pre-resection concordance of MRI with US was 56%, with US defining more tumours as well-delineated (n=26) than MRI (n=13). US was used for resection control in 50 cases. Gross tumour resection was achieved in 24 cases (51%). US correctly predicted the residual tumour status in 78% of cases. The use of US led to radical resections even in some tumours preoperatively deemed to be unresectable. However, eloquent location was the only independent predictor of the extent of resection. CONCLUSION Intraoperative US is a useful tool for guiding resection of non-enhancing gliomas. It may be better than MRI for delineating these tumours, and may thereby facilitate improved resection of these otherwise poorly delineated tumours. However, functional boundaries remain the main limiting factor for achieving complete resection of non-enhancing gliomas.
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Affiliation(s)
- Aliasgar V Moiyadi
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Prakash Shetty
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Robin John
- Division of Neurosurgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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Cordero E, Latka I, Matthäus C, Schie I, Popp J. In-vivo Raman spectroscopy: from basics to applications. JOURNAL OF BIOMEDICAL OPTICS 2018; 23:1-23. [PMID: 29956506 DOI: 10.1117/1.jbo.23.7.071210] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/23/2018] [Indexed: 05/20/2023]
Abstract
For more than two decades, Raman spectroscopy has found widespread use in biological and medical applications. The instrumentation and the statistical evaluation procedures have matured, enabling the lengthy transition from ex-vivo demonstration to in-vivo examinations. This transition goes hand-in-hand with many technological developments and tightly bound requirements for a successful implementation in a clinical environment, which are often difficult to assess for novice scientists in the field. This review outlines the required instrumentation and instrumentation parameters, designs, and developments of fiber optic probes for the in-vivo applications in a clinical setting. It aims at providing an overview of contemporary technology and clinical trials and attempts to identify future developments necessary to bring the emerging technology to the clinical end users. A comprehensive overview of in-vivo applications of fiber optic Raman probes to characterize different tissue and disease types is also given.
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Affiliation(s)
- Eliana Cordero
- Leibniz-Institut für Photonische Technologien e.V., Germany
| | - Ines Latka
- Leibniz-Institut für Photonische Technologien e.V., Germany
| | - Christian Matthäus
- Leibniz-Institut für Photonische Technologien e.V., Germany
- Institut für Physikalische Chemie, Friedrich-Schiller-Univ. Jena, Germany
- Abbe Ctr. of Photonics, Germany
| | - Iwan Schie
- Leibniz-Institut für Photonische Technologien e.V., Germany
| | - Jürgen Popp
- Leibniz-Institut für Photonische Technologien e.V., Germany
- Institute für Physikalische Chemie, Friedrich-Schiller-Univ. Jena, Germany
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21
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Fujii Y, Muragaki Y, Maruyama T, Nitta M, Saito T, Ikuta S, Iseki H, Hongo K, Kawamata T. Threshold of the extent of resection for WHO Grade III gliomas: retrospective volumetric analysis of 122 cases using intraoperative MRI. J Neurosurg 2017; 129:1-9. [PMID: 28885120 DOI: 10.3171/2017.3.jns162383] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%-100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 ( IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.
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Affiliation(s)
- Yu Fujii
- 1Department of Neurosurgery and.,3Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yoshihiro Muragaki
- 1Department of Neurosurgery and.,2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Takashi Maruyama
- 1Department of Neurosurgery and.,2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Masayuki Nitta
- 1Department of Neurosurgery and.,2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | | | - Soko Ikuta
- 2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Hiroshi Iseki
- 2Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Graduate School of Medicine, Tokyo Women's Medical University, Tokyo; and
| | - Kazuhiro Hongo
- 3Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan
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Bette S, Huber T, Gempt J, Boeckh-Behrens T, Wiestler B, Kehl V, Ringel F, Meyer B, Zimmer C, Kirschke JS. Local Fractional Anisotropy Is Reduced in Areas with Tumor Recurrence in Glioblastoma. Radiology 2017; 283:499-507. [DOI: 10.1148/radiol.2016152832] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Stefanie Bette
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Thomas Huber
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Jens Gempt
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Tobias Boeckh-Behrens
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Benedikt Wiestler
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Victoria Kehl
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Florian Ringel
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Bernhard Meyer
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Claus Zimmer
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
| | - Jan S. Kirschke
- From the Departments of Neuroradiology (S.B., T.H., T.B.B., B.W., C.Z., J.S.K.), Neurosurgery (J.G., F.R., B.M.), and Statistics and Epidemiology (V.K.), Klinikum Rechts der Isar, Technische Universität München, Ismaningerstr 22, 81675 Munich, Germany
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Prognostic value of the extent of resection in supratentorial WHO grade II astrocytomas stratified for IDH1 mutation status: a single-center volumetric analysis. J Neurooncol 2016; 129:319-28. [PMID: 27344556 PMCID: PMC4992014 DOI: 10.1007/s11060-016-2177-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 06/04/2016] [Indexed: 01/16/2023]
Abstract
Current evidence supports a maximized extent of resection (EOR) in low-grade gliomas (LGG), regardless of different histological subtypes and molecular markers. We therefore evaluated the prognostic impact of extensive, mainly intraoperative (i)MRI-guided surgery in low-grade astrocytomas stratified for IDH1 mutation status. Retrospective assessment of 46 consecutive cases of newly diagnosed supratentorial WHO grade II astrocytomas treated during the last decade was performed. IDH1 mutation status was obtained for all patients. Volumetric analysis of tumor volumes was performed pre-, intra-, early postoperatively and at first follow-up. Survival analysis was conducted with uni-and multivariate regression models implementing clinical parameters and continuous volumetric variables. Median EOR was 90.4 % (range 17.5–100 %) and was increased to 94.9 % (range 34.8–100 %) in iMRI-guided resections (n = 33). A greater EOR was prognostic for increased progression-free survival (HR 0.23, p = 0.031) and time to re-intervention (TTR) (HR 0.23, p = 0.03). In IDH1 mutant patients, smaller residual tumor volumes were associated with increased TTR (HR 1.01, p = 0.03). IDH1 mutation (38/46 cases) was an independent positive prognosticator for overall survival (OS) in multivariate analysis (HR 0.09, p = 0.002), while extensive surgery had limited impact upon OS. In a subgroup of patients with ≥40 % EOR (n = 39), however, initial and residual tumor volumes were prognostic for OS (HR 1.03, p = 0.005 and HR 1.08, p = 0.007, respectively), persistent to adjustment for IDH1. No association between EOR and neurologic morbidity was found. In this analysis of low-grade astrocytomas stratified for IDH1, extensive tumor resections were prognostic for progression and TTR and, in patients with ≥40 % EOR, for OS.
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Pala A, Brand C, Kapapa T, Hlavac M, König R, Schmitz B, Wirtz CR, Coburger J. The Value of Intraoperative and Early Postoperative Magnetic Resonance Imaging in Low-Grade Glioma Surgery: A Retrospective Study. World Neurosurg 2016; 93:191-7. [PMID: 27288582 DOI: 10.1016/j.wneu.2016.04.120] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The presence of residual tumor is crucial in decision-making for low-grade gliomas (LGGs), because patients older than 40 years of age with residual tumor are considered for adjuvant treatment. There are hints that early postoperative fluid-attenuated inversion recovery (FLAIR) and T2 (within 48 hours) may overestimate residual tumor volume in LGG. Intraoperative magnetic resonance imaging (MRI) without subsequent resection or ultra-early postoperative MRI may assess the amount of residual tumor more adequately. To evaluate the utility of postoperative imaging in LGG, we volumetrically analyzed intraoperative, early, and late (3-4 months after surgery) postoperative MRIs of LGGs. PATIENTS AND METHODS A total of 33 patients with LGG were assessed retrospectively. Residual tumor was defined as signal-enhanced tissue in T2 and FLAIR. Volumetric assessment was performed with intraoperative, early, and late postoperative T2/FLAIR via Brainlab-iPlan 3.0. Wilcoxon and χ(2) tests were used for statistical analysis. RESULTS A significant difference of FLAIR/T2 abnormalities was found in intraoperative and early postoperative MRIs (FLAIR mean volume = 5.433 cm(3), T2 mean volume = 3.374 cm(3) vs. FLAIR mean volume = 14.090 cm(3), P = 0.002, T2 mean volume = 7.597 cm(3), P = 0.006). There was no significant difference between intraoperative and late postoperative FLAIR/T2 abnormalities (late postoperative FLAIR/T2 mean volume = 5.560 cm(3) and 2.370 cm(3), P = 0.520, P = 0.398), whereas a significant difference was detected between early and late postoperative images (FLAIR, P < 0.0001; T2, P < 0.00001). CONCLUSION Intraoperative MRI without further resection or ultra-early postoperative MRI seems to reflect the actual volume of residual tumor in LGG more precisely compared with early postoperative MRI and therefore seems to be more useful regarding decisions for adjuvant therapy.
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Affiliation(s)
- Andrej Pala
- Department of Neurosurgery, University of Ulm, Ulm, Germany.
| | | | - Thomas Kapapa
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | - Michal Hlavac
- Department of Neurosurgery, University of Ulm, Ulm, Germany
| | - Ralph König
- Department of Neurosurgery, University of Ulm, Ulm, Germany
| | - Bernd Schmitz
- Department of Neuroradiology, University of Ulm, Ulm, Germany
| | | | - Jan Coburger
- Department of Neurosurgery, University of Ulm, Ulm, Germany
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Awake Craniotomy: First-Year Experiences and Patient Perception. World Neurosurg 2016; 90:588-596.e2. [DOI: 10.1016/j.wneu.2016.02.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 12/22/2022]
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Bette S, Kaesmacher J, Huber T, Delbridge C, Ringel F, Boeckh-Behrens T, Meyer B, Zimmer C, Kirschke JS, Gempt J. Value of Early Postoperative FLAIR Volume Dynamic in Glioma with No or Minimal Enhancement. World Neurosurg 2016; 91:548-559.e1. [PMID: 27004759 DOI: 10.1016/j.wneu.2016.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The evaluation of postoperative magnetic resonance imaging (MRI) in glioma with no or minimal enhancement is controversial because the evaluation of residual tumor volume can be biased. The purpose of this study was to clarify the value of early postoperative and 3-month MRI regarding its validity in predicting recurrent disease. METHODS For this retrospective, single-center study, overall fluid attenuated inversion recovery (FLAIR) volumes (early postoperative [<48 hours] and 3-month MRI including FLAIR and T1-weighted sequences with and without contrast agent) of 99 patients were assessed using manual segmentation. FLAIR volume dynamic over the first 3 months after surgery and its effect on disease recurrence were evaluated while considering histopathologic features. RESULTS Overall FLAIR-hyperintense volume significantly decreased between early postoperative and 3-month follow-up MRIs (P < 0.001). Early FLAIR volume increase had a high positive predictive value for overall disease recurrence after resection (85.71% [95%-CI: 62.64-96.24]). Early FLAIR volume dynamic (P < 0.001), isocitrate dehydrogenase 1/2 status (P = 0.002), and preoperative Karnofsky Performance Status (P = 0.012) were observed as independent factors for progression-free survival in multivariate analysis. CONCLUSION Early postoperative FLAIR volume assessment in gliomas with no or minimal enhancement is susceptible to a systematic overestimation of residual tumors. Nevertheless, early FLAIR volume dynamic is an independent factor for tumor recurrence that should be evaluated in order timely adapt surveillance and therapy regimens accordingly.
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Affiliation(s)
- Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Huber
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claire Delbridge
- Department of Neuropathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Gempt
- Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Patterns and Time Dependence of Unspecific Enhancement in Postoperative Magnetic Resonance Imaging After Glioblastoma Resection. World Neurosurg 2016; 90:440-447. [PMID: 27001238 DOI: 10.1016/j.wneu.2016.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postoperative magnetic resonance imaging (MRI) is recommended soon after glioma surgery to avoid reactive nonneoplastic contrast enhancement indistinguishable from tumor. The purpose of this study was to analyze these patterns of postoperative contrast enhancement at 3 T to define the optimal time frame for postoperative MRI. METHODS MRI for 206 glioblastoma surgeries in 173 patients who underwent pre- and postoperative and at least 1 follow-up 3T MRI for each surgery were analyzed retrospectively. Postoperative MRI was assessed in consensus by 2 neuroradiologists, blinded to the time after surgery. Postoperative contrast enhancement marginal to the resection cavity was analyzed and classified as vascular, linear, or nodular. The cause of the contrast enhancement (ie, reactive vs. tumor) was assessed by comparing pre-, postoperative, and follow-up MRI. RESULTS Within 45 hours after surgery, reactive enhancement appeared in 17.9% of cases. After 45 hours, the fraction of reactive changes increased to 34.1%. Linear enhancement was more often reactive (66.1%, 39/59 cases), whereas nodular enhancement was mainly residual tumor (93.2%, 68/73 cases). Specificity of nodular enhancement was high for tumor recurrence/tumor progression (91.5%). CONCLUSIONS To avoid an increasing number of MRIs with reactive contrast enhancement, postoperative MRI at 3 T should be performed within 45 hours after surgery. However, reactive contrast enhancement can occur at all time points. In these cases, the pattern of the contrast enhancement may help to differentiate its cause.
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Kalsi P, Mukerji N. Specialists and survival times. J Neurosurg 2016; 124:887-8. [PMID: 26722861 DOI: 10.3171/2015.6.jns151083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pratipal Kalsi
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Nitin Mukerji
- James Cook University Hospital, Middlesbrough, United Kingdom
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Castellano A, Donativi M, Rudà R, De Nunzio G, Riva M, Iadanza A, Bertero L, Rucco M, Bello L, Soffietti R, Falini A. Evaluation of low-grade glioma structural changes after chemotherapy using DTI-based histogram analysis and functional diffusion maps. Eur Radiol 2015; 26:1263-73. [PMID: 26318368 DOI: 10.1007/s00330-015-3934-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To explore the role of diffusion tensor imaging (DTI)-based histogram analysis and functional diffusion maps (fDMs) in evaluating structural changes of low-grade gliomas (LGGs) receiving temozolomide (TMZ) chemotherapy. METHODS Twenty-one LGG patients underwent 3T-MR examinations before and after three and six cycles of dose-dense TMZ, including 3D-fluid-attenuated inversion recovery (FLAIR) sequences and DTI (b = 1000 s/mm(2), 32 directions). Mean diffusivity (MD), fractional anisotropy (FA), and tensor-decomposition DTI maps (p and q) were obtained. Histogram and fDM analyses were performed on co-registered baseline and post-chemotherapy maps. DTI changes were compared with modifications of tumour area and volume [according to Response Assessment in Neuro-Oncology (RANO) criteria], and seizure response. RESULTS After three cycles of TMZ, 20/21 patients were stable according to RANO criteria, but DTI changes were observed in all patients (Wilcoxon test, P ≤ 0.03). After six cycles, DTI changes were more pronounced (P ≤ 0.005). Seventy-five percent of patients had early seizure response with significant improvement of DTI values, maintaining stability on FLAIR. Early changes of the 25th percentiles of p and MD predicted final volume change (R(2) = 0.614 and 0.561, P < 0.0005, respectively). TMZ-related changes were located mainly at tumour borders on p and MD fDMs. CONCLUSIONS DTI-based histogram and fDM analyses are useful techniques to evaluate the early effects of TMZ chemotherapy in LGG patients. KEY POINTS • DTI helps to assess the efficacy of chemotherapy in low-grade gliomas. • Histogram analysis of DTI metrics quantifies structural changes in tumour tissue. • Functional diffusion maps (fDMs) spatially localize the changes of DTI metrics. • Changes in DTI histograms and fDMs precede changes in conventional MRI. • Early changes in DTI histograms and fDMs correlate with seizure response.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milano, Italy
| | - Marina Donativi
- Department of Mathematics and Physics "Ennio De Giorgi" and A.D.A.M. (Advanced Data Analysis in Medicine), University of Salento, Lecce, Italy
| | - Roberta Rudà
- Department of Neuro-oncology, University of Torino, Turin, Italy
| | - Giorgio De Nunzio
- Department of Mathematics and Physics "Ennio De Giorgi" and A.D.A.M. (Advanced Data Analysis in Medicine), University of Salento, Lecce, Italy
- INFN (National Institute of Nuclear Physics), Lecce, Italy
| | - Marco Riva
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, and Humanitas Research Hospital, Rozzano, MI, Italy
| | - Antonella Iadanza
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milano, Italy
| | - Luca Bertero
- Department of Neuro-oncology, University of Torino, Turin, Italy
| | - Matteo Rucco
- School of Science and Technology, Computer Science Division, University of Camerino, Camerino, MC, Italy
| | - Lorenzo Bello
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, and Humanitas Research Hospital, Rozzano, MI, Italy
| | | | - Andrea Falini
- Neuroradiology Unit and CERMAC, San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milano, Italy.
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Mandonnet E, De Witt Hamer P, Poisson I, Whittle I, Bernat AL, Bresson D, Madadaki C, Bouazza S, Ursu R, Carpentier AF, George B, Froelich S. Initial experience using awake surgery for glioma: oncological, functional, and employment outcomes in a consecutive series of 25 cases. Neurosurgery 2015; 76:382-9; discussion 389. [PMID: 25621981 DOI: 10.1227/neu.0000000000000644] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Awake glioma surgery aims to maximize resection to optimize prognosis while minimizing the risk of postoperative deficits. OBJECTIVE To evaluate oncological, functional, and employment outcomes in the first cohort of patients having this type of surgery at our institution and to determine the effects of any learning curve. METHODS All cases of awake adult (>18 years of age) glioma surgery were recorded between the introduction of this technique in 2011 until the end of 2013. Extent of tumor resection was quantified on magnetic resonance imaging and compared with the objective prediction from a resection probability map. Cognitive status was assessed preoperatively and at 3 months postoperatively. Patients were questioned about their job and capability of working before and after surgery. RESULTS Twenty-five patients were included in the analysis. No new motor or language deficits were noted at 6 weeks after surgery. Postoperative magnetic resonance imaging showed complete resection in 11 of 13 patients with glioblastoma and >98% resection in the other 2 patients. For patients with World Health Organization grade II glioma, 3 had total, 4 had subtotal, and 3 had partial resections. Comparison between cognitive levels before and after surgery showed no change in 4 patients, improvement in some tests in 2 patients, and deterioration in some tests in 3 patients. Of 20 patients working at the time of diagnosis, 16 returned to work. CONCLUSION These oncological and functional results of awake glioma surgery during the learning curve are comparable to results from established centers. The use and utility of resection probability maps are well demonstrated. The return to work level is high.
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Affiliation(s)
- Emmanuel Mandonnet
- *Department of Neurosurgery, ‖Neurology, and **Department of Anaesthesiology, Lariboisière Hospital, APHP, Paris, France; ‡University Paris 7, Paris, France; §IMNC UMR8165, Orsay, France; ¶Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; #Department of Clinical Neurosciences, University of Edinburgh, Edinburgh, United Kingdom; ‡‡Department of Neuro-oncology, Avicenne Hospital, APHP, Bobigny, France
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Noell S, Feigl GC, Naros G, Barking S, Tatagiba M, Ritz R. Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution. Clin Neurol Neurosurg 2015; 136:41-50. [PMID: 26056811 DOI: 10.1016/j.clineuro.2015.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Tumour resection in the Rolandic region is a challenge. Aim of this study is to review a series of patients malignant glioma surgery in the Rolandic region which was performed by combinations of neuronavigation, sonography, 5-aminolevulinic acid fluorescence guided (5-ALA) surgery and intraoperative electrophysiological monitoring (IOM). METHODS 29 patients suffering malignant gliomas in the motor cortex (17) and sensory cortex (12) were analyzed with respect to functional outcome and grade of resections. RESULTS Improvement of motor function was seen in 41.5% one week after surgery, 41.5% were stable, only 17% deteriorated. After three months patients had an improvement of motor function in 56%, of Karnofsky Score (KPS) 27% and sensory function was improved in 8%. Deterioration of motor function was seen in 16%, in sensory function 4% and in KPS 28% after three months. 25% showed no residual tumour in early post surgical contrast enhanced MRI. 10% had less than 2% residual tumour and 15% had 2-5% residual tumour. CONCLUSIONS Preoperative functional neuroimaging, neuronavigation for planning the surgical approach and resection margins, intraoperative sonography and 5-ALA guided surgery in combination with the application of IOM shows that functional outcome and total to subtotal resection of malignant glioma in the Rolandic region is feasible.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Guenther C Feigl
- Department of Neurosurgery, Bamberg Hospital, Huger Straße 80, 96049 Bamberg, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Susanne Barking
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; Department of Neurosurgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany.
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Chow KE, Tyrrell D, Long SN. EARLY POSTOPERATIVE MAGNETIC RESONANCE IMAGING FINDINGS IN FIVE DOGS WITH CONFIRMED AND SUSPECTED BRAIN TUMORS. Vet Radiol Ultrasound 2015; 56:531-9. [PMID: 26372362 DOI: 10.1111/vru.12248] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 01/25/2015] [Indexed: 11/29/2022] Open
Abstract
Early postoperative neuroimaging has been performed in people for over 20 years to detect residual brain tumor tissue and surgical complications. The purpose of this retrospective study was to describe characteristics observed using early postoperative magnetic resonance imaging in a group of dogs undergoing craniotomy for brain tumor removal. Two independent observers came to a consensus opinion for presence/absence of the following MRI characteristics: residual tumor tissue; hemorrhage and ischemic lesions; abnormal enhancement (including the margins of the resection cavity, choroid plexus, meninges) and signal intensity changes on diffusion-weighted imaging. Five dogs were included in the study, having had preoperative and early postoperative MRI acquired within four days after surgery. The most commonly observed characteristics were abnormal meningeal enhancement, linear enhancement at margins of the resection cavity, hemorrhage, and a thin rim of hyperintensity surrounding the resection cavity on diffusion-weighted imaging. Residual tumor tissue was detected in one case of an enhancing tumor and in one case of a tumor containing areas of hemorrhage preoperatively. Residual tumor tissue was suspected but could not be confirmed when tumors were nonenhancing. Findings supported the use of early postoperative MRI as a method for detecting residual brain tumor tissue in dogs.
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Affiliation(s)
- Kathleen Ella Chow
- University of Melbourne Veterinary Hospital, Radiology Department, Melbourne, Victoria, Australia
| | - Dayle Tyrrell
- University of Melbourne Veterinary Hospital, Radiology Department, Melbourne, Victoria, Australia
| | - Sam Nicholas Long
- University of Melbourne Veterinary Hospital, Radiology Department, Melbourne, Victoria, Australia
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Jakola AS, Berntsen EM, Christensen P, Gulati S, Unsgård G, Kvistad KA, Solheim O. Surgically acquired deficits and diffusion weighted MRI changes after glioma resection--a matched case-control study with blinded neuroradiological assessment. PLoS One 2014; 9:e101805. [PMID: 24992634 PMCID: PMC4081783 DOI: 10.1371/journal.pone.0101805] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 06/11/2014] [Indexed: 11/19/2022] Open
Abstract
Background Acquired deficits following glioma resection may not only occur due to accidental resection of normal brain tissue. The possible importance of ischemic injuries in causing neurological deficits after brain tumor surgery is not much studied. We aimed to study the volume and frequency of early postoperative circulatory changes (i.e. infarctions) detected by diffusion weighted resonance imaging (DWI) in patients with surgically acquired neurological deficits compared to controls. Methods We designed a 1∶1 matched case-control study in patients with diffuse gliomas (WHO grade II–IV) operated with 3D ultrasound guided resection. 42 consecutive patients with acquired postoperative dysphasia and/or new motor deficits were compared to 42 matched controls without acquired deficits. Controls were matched with respect to histopathology, preoperative tumor volumes, and eloquence of location. Two independent radiologists blinded for clinical status assessed the postoperative DWI findings. Results Postoperative peri-tumoral infarctions were more often seen in patients with acquired deficits (63% versus 41%, p = 0.046) and volumes of DWI abnormalities were larger in cases than in controls with median 1.08 cm3 (IQR 0–2.39) versus median 0 cm3 (IQR 0–1.67), p = 0.047. Inter-rater agreement was substantial (67/82, κ = 0.64, p<0.001) for diagnosing radiological significant DWI abnormalities. Conclusion Peri-tumoral infarctions were more common and were larger in patients with acquired deficits after glioma surgery compared to glioma patients without deficits when assessed by early postoperative DWI. Infarctions may be a frequent and underestimated cause of acquired deficits after glioma resection. DWI changes may be an attractive endpoint in brain tumor surgery with both good inter-rater reliability among radiologists and clinical relevance.
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Affiliation(s)
- Asgeir S. Jakola
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- MI Lab, Norwegian University of Science and Technology, Trondheim, Norway
- National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway
- * E-mail:
| | - Erik M. Berntsen
- Department of Radiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Christensen
- Department of Radiology, St. Olavs University Hospital, Trondheim, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
| | - Geirmund Unsgård
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell A. Kvistad
- Department of Radiology, St. Olavs University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- MI Lab, Norwegian University of Science and Technology, Trondheim, Norway
- National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway
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Muragaki Y, Chernov M, Yoshimitsu K, Suzuki T, Iseki H, Maruyama T, Tamura M, Ikuta S, Nitta M, Watanabe A, Saito T, Okamoto J, Niki C, Hayashi M, Takakura K. Information-Guided Surgery of Intracranial Gliomas: Overview of an Advanced Intraoperative Technology. JOURNAL OF HEALTHCARE ENGINEERING 2012. [DOI: 10.1260/2040-2295.3.4.551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Skrap M, Mondani M, Tomasino B, Weis L, Budai R, Pauletto G, Eleopra R, Fadiga L, Ius T. Surgery of insular nonenhancing gliomas: volumetric analysis of tumoral resection, clinical outcome, and survival in a consecutive series of 66 cases. Neurosurgery 2012; 70:1081-93; discussion 1093-4. [PMID: 22067417 DOI: 10.1227/neu.0b013e31823f5be5] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures. OBJECTIVE To retrospectively investigate the morbidity profile in insular nonenhancing gliomas, with special emphasis on volumetric analysis of tumoral resection. METHODS From 2000 to 2010, 66 patients underwent surgery. All surgical procedures were conducted under cortical-subcortical stimulation and neurophysiological monitoring. Volumetric scan analysis was applied on T2-weighted magnetic resonance images (MRIs) to establish preoperative and postoperative tumoral volume. RESULTS The median preoperative tumor volume was 108 cm. The median extent of resection was 80%. The median follow-up was 4.3 years. An immediate postoperative worsening was detected in 33.4% of cases; a definitive worsening resulted in 6% of cases. Patients with extent of resection of > 90% had an estimated 5-year overall survival rate of 92%, whereas those with extent of resection between 70% and 90% had a 5-year overall survival rate of 82% (P < .001). The difference between preoperative tumoral volumes on T2-weighted MRI and on postcontrast T1-weighted MRI ([T2 - T1] MRI volume) was computed to evaluate the role of the diffusive tumoral growing pattern on overall survival. Patients with preoperative volumetric difference < 30 cm demonstrated a 5-year overall survival rate of 92%, whereas those with a difference of > 30 cm had a 5-year overall survival rate of 57% (P = .02). CONCLUSION With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up.
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Affiliation(s)
- Miran Skrap
- Department of Neurosurgery, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
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Ghaly RF, Candido KD, Chupatanakul L, Knezevic NN. Magnetic resonance imaging is essential prior to spinal subarachnoid blockade for parturients with a history of brain tumor resection undergoing cesarean section. Surg Neurol Int 2012; 3:75. [PMID: 22937476 PMCID: PMC3424678 DOI: 10.4103/2152-7806.98504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/15/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Primary brain tumors are usually treated by surgical removal with the goal of complete resection within the constraints of preservation of neurological function. However, gross total resection may not mean complete tumor removal, and ongoing compression from a mass effect can lead to serious sequelae. Spinal subarachnoid blockade is contraindicated in patients with brain tumors or space occupying lesions. CASE DESCRIPTION A 32-year-old full term parturient presented to Labor and Delivery for semi-urgent repeat cesarean section. Three months ago, she underwent resection of a benign brain tumor and recovered with no new neurological deficits. The neurosurgeon was consulted by the anesthesia team and stated that the tumor was completely extirpated. Since there was no postoperative magnetic resonance imaging (MRI) and the patient still had some neurological deficits, the anesthesia team decided to proceed with a general anesthetic using a rapid sequence induction and intubation. Mild hyperventilation to maintain an end-tidal CO(2) of 30 mmHg was selected and conservative fluid management was maintained. Postcesarean MRI revealed residual tumor compressing the brain stem and a loculated cyst. If a spinal subarachnoid blockade technique had been selected, the risk of uncal herniation, based on the postoperative MRI findings, may have been realized. CONCLUSIONS The present case demonstrates the necessity of a comprehensive and thorough review prior to selecting the anesthetic approach to mange the patients with a history of brain tumor resection. Postoperative MR imaging should be performed to evaluate the extent of tumor resection and possible existence of residual tumor.
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Affiliation(s)
- Ramsis F Ghaly
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60504, USA
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