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Rykkje AM, Carlsen JF, Larsen VA, Skjøth-Rasmussen J, Christensen IJ, Nielsen MB, Poulsen HS, Urup TH, Hansen AE. Prognostic relevance of radiological findings on early postoperative MRI for 187 consecutive glioblastoma patients receiving standard therapy. Sci Rep 2024; 14:10985. [PMID: 38744979 PMCID: PMC11094076 DOI: 10.1038/s41598-024-61925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
Several prognostic factors are known to influence survival for patients treated with IDH-wildtype glioblastoma, but unknown factors may remain. We aimed to investigate the prognostic implications of early postoperative MRI findings. A total of 187 glioblastoma patients treated with standard therapy were consecutively included. Patients either underwent a biopsy or surgery followed by an early postoperative MRI. Progression-free survival (PFS) and overall survival (OS) were analysed for known prognostic factors and MRI-derived candidate factors: resection status as defined by the response assessment in neuro-oncology (RANO)-working group (no contrast-enhancing residual tumour, non-measurable contrast-enhancing residual tumour, or measurable contrast-enhancing residual tumour) with biopsy as reference, contrast enhancement patterns (no enhancement, thin linear, thick linear, diffuse, nodular), and the presence of distant tumours. In the multivariate analysis, patients with no contrast-enhancing residual tumour or non-measurable contrast-enhancing residual tumour on the early postoperative MRI displayed a significantly improved progression-free survival compared with patients receiving only a biopsy. Only patients with non-measurable contrast-enhancing residual tumour showed improved overall survival in the multivariate analysis. Contrast enhancement patterns were not associated with survival. The presence of distant tumours was significantly associated with both poor progression-free survival and overall survival and should be considered incorporated into prognostic models.
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Affiliation(s)
- Alexander Malcolm Rykkje
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Jonathan Frederik Carlsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
- The DCCC Brain Tumor Center, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Michael Bachmann Nielsen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Skovgaard Poulsen
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- The DCCC Brain Tumor Center, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Haargaard Urup
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- The DCCC Brain Tumor Center, Rigshospitalet, Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Radiology, Rigshospitalet, Copenhagen, Denmark
- The DCCC Brain Tumor Center, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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2
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Müller SJ, Khadhraoui E, Voit D, Riedel CH, Frahm J, Romero JM, Ernst M. Comparison of EPI DWI and STEAM DWI in Early Postoperative MRI Controls After Resection of Tumors of the Central Nervous System. Clin Neuroradiol 2023; 33:677-685. [PMID: 36732415 PMCID: PMC10449950 DOI: 10.1007/s00062-023-01261-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Diffusion-weighted imaging (DWI) is important for differentiating residual tumor and subacute infarctions in early postoperative magnetic resonance imaging (MRI) of central nervous system (CNS) tumors. In cases of pneumocephalus and especially in the presence of intraventricular trapped air, conventional echo-planar imaging (EPI) DWI is distorted by susceptibility artifacts. The performance and robustness of a newly developed DWI sequence using the stimulated echo acquisition mode (STEAM) was evaluated in patients after neurosurgical operations with early postoperative MRI. METHODS We compared EPI and STEAM DWI of 43 patients who received 3‑Tesla MRI within 72 h after a neurosurgical operation between 1 October 2019 and 30 September 2021. We analyzed susceptibility artifacts originating from air and blood and whether these artifacts compromised the detection of ischemic changes after surgery. The DWI sequences were (i) visually rated and (ii) volumetrically analyzed. RESULTS In 28 of 43 patients, we found severe and diagnostically relevant artifacts in EPI DWI, but none in STEAM DWI. In these cases, in which artifacts were caused by intracranial air, they led to a worse detection of ischemic lesions and thus to a possible failed diagnosis or lack of judgment using EPI DWI. Additionally, volumetric analysis demonstrated a 14% smaller infarct volume detected with EPI DWI. No significant differences in visual rating and volumetric analysis were detected among the patients without severe artifacts. CONCLUSION The newly developed version of STEAM DWI with highly undersampled radial encodings is superior to EPI DWI in patients with postoperative pneumocephalus.
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Affiliation(s)
- Sebastian Johannes Müller
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany.
- Department of Neuroradiology, University Medicine Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - Eya Khadhraoui
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
| | - Dirk Voit
- Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
| | | | - Jens Frahm
- Max-Planck-Institute for Multidisciplinary Sciences, Göttingen, Germany
| | - Javier M Romero
- Department of Radiology Division of Neuroradiology, Massachusetts General Hospital Harvard Medical School, Boston, MA, USA
| | - Marielle Ernst
- Department of Neuroradiology, University Medical Center Göttingen, Göttingen, Germany
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3
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Kubelt C, Hellmold D, Peschke E, Hauck M, Will O, Schütt F, Lucius R, Adelung R, Scherließ R, Hövener JB, Jansen O, Synowitz M, Held-Feindt J. Establishment of a Rodent Glioblastoma Partial Resection Model for Chemotherapy by Local Drug Carriers-Sharing Experience. Biomedicines 2023; 11:1518. [PMID: 37371613 DOI: 10.3390/biomedicines11061518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023] Open
Abstract
Local drug delivery systems (LDDS) represent a promising therapy strategy concerning the most common and malignant primary brain tumor glioblastoma (GBM). Nevertheless, to date, only a few systems have been clinically applied, and their success is very limited. Still, numerous new LDDS approaches are currently being developed. Here, (partial resection) GBM animal models play a key role, as such models are needed to evaluate the therapy prior to any human application. However, such models are complex to establish, and only a few reports detail the process. Here, we report our results of establishing a partial resection glioma model in rats suitable for evaluating LDDS. C6-bearing Wistar rats and U87MG-spheroids- and patient-derived glioma stem-like cells-bearing athymic rats underwent tumor resection followed by the implantation of an exemplary LDDS. Inoculation, tumor growth, residual tumor tissue, and GBM recurrence were reliably imaged using high-resolution Magnetic Resonance Imaging. The release from an exemplary LDDS was verified in vitro and in vivo using Fluorescence Molecular Tomography. The presented GBM partial resection model appears to be well suited to determine the efficiency of LDDS. By sharing our expertise, we intend to provide a powerful tool for the future testing of these very promising systems, paving their way into clinical application.
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Affiliation(s)
- Carolin Kubelt
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, 24105 Kiel, Germany
| | - Dana Hellmold
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, 24105 Kiel, Germany
| | - Eva Peschke
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, Kiel University, 24118 Kiel, Germany
| | - Margarethe Hauck
- Functional Nanomaterials, Department of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany
| | - Olga Will
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, Kiel University, 24118 Kiel, Germany
| | - Fabian Schütt
- Functional Nanomaterials, Department of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany
- Priority Research Area Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, 24118 Kiel, Germany
| | - Ralph Lucius
- Institute of Anatomy, Kiel University, 24118 Kiel, Germany
| | - Rainer Adelung
- Functional Nanomaterials, Department of Materials Science, Faculty of Engineering, Kiel University, 24143 Kiel, Germany
- Priority Research Area Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, 24118 Kiel, Germany
| | - Regina Scherließ
- Priority Research Area Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, 24118 Kiel, Germany
- Department of Pharmaceutics and Biopharmaceutics, Kiel University, 24118 Kiel, Germany
| | - Jan-Bernd Hövener
- Section Biomedical Imaging, Molecular Imaging North Competence Center (MOIN CC), Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, Kiel University, 24118 Kiel, Germany
- Priority Research Area Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, 24118 Kiel, Germany
| | - Olav Jansen
- Priority Research Area Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, 24118 Kiel, Germany
- Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, 24105 Kiel, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, 24105 Kiel, Germany
| | - Janka Held-Feindt
- Department of Neurosurgery, University Medical Center Schleswig-Holstein, UKSH Campus Kiel, 24105 Kiel, Germany
- Priority Research Area Kiel Nano, Surface and Interface Sciences (KiNSIS), Kiel University, 24118 Kiel, Germany
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Kim MJ, Park JS, Jeun SS, Ahn S. A clinical evaluation of cystic features in patients with newly diagnosed glioblastoma with IDH-wildtype. Clin Neurol Neurosurg 2023; 228:107708. [PMID: 37043844 DOI: 10.1016/j.clineuro.2023.107708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/17/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND The prognostic significance of the presence of cystic features in patients with newly diagnosed glioblastoma (GB) is highly controversial. The purpose of this study was to determine whether cystic GB patients have a more favorable prognosis compared to non-cystic GB patients. METHODS The records of all GB patients diagnosed between August 2008 and December 2020 at Seoul St. Mary's Hospital were reviewed retrospectively. Out of 254 GB patients, we excluded patients with a confirmed isocitrate dehydrogenase (IDH) mutation or an unknown IDH mutation status. A total of 145 patients met our eligibility criteria. RESULTS Of the 145 patients we analyzed, 16 patients were classified as the cystic group, and 129 patients were classified into the non-cystic group. As there was a significant difference in the extent of resection between the two groups, 32 patients were matched according to propensity score matching. A Kaplan-Meier survival curve of the two groups indicated that the cystic group had better survival than the non-cystic group (28.6 months versus 18.8 months, respectively; p = 0.055). On multivariate analysis, the presence of cystic features (hazard ratio [HR]: 0.40, 95% confidence interval [CI]: 0.17-0.91, p = 0.029) was significantly related with a longer OS. Longer OS was also related with well-known prognostic factors, such as grossly total resection (HR: 0.05, CI: 0.01-0.31, respectively; p = 0.001) and lower European Cooperative Oncology Group (ECOG) score (HR: 3.67, CI: 1.56-9.02, respectively; p = 0.003). CONCLUSION Our results suggest that the presence of cystic features could be an independent prognostic factor suggesting better survival in GB patients. Further larger and prospective studies to validate our findings are needed.
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Affiliation(s)
- Min Joo Kim
- College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Sin-Soo Jeun
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Stephen Ahn
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea.
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Timing of Early Postoperative MRI following Primary Glioblastoma Surgery-A Retrospective Study of Contrast Enhancements in 311 Patients. Diagnostics (Basel) 2023; 13:diagnostics13040795. [PMID: 36832282 PMCID: PMC9955136 DOI: 10.3390/diagnostics13040795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 02/03/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
An early postoperative MRI is recommended following Glioblastoma surgery. This retrospective, observational study aimed to investigate the timing of an early postoperative MRI among 311 patients. The patterns of the contrast enhancement (thin linear, thick linear, nodular, and diffuse) and time from surgery to the early postoperative MRI were recorded. The primary endpoint was the frequencies of the different contrast enhancements within and beyond the 48-h from surgery. The time dependence of the resection status and the clinical parameters were analysed as well. The frequency of the thin linear contrast enhancements significantly increased from 99/183 (50.8%) within 48-h post-surgery to 56/81 (69.1%) beyond 48-h post-surgery. Similarly, MRI scans with no contrast enhancements significantly declined from 41/183 (22.4%) within 48-h post-surgery to 7/81 (8.6%) beyond 48-h post-surgery. No significant differences were found for the other types of contrast enhancements and the results were robust in relation to the choice of categorisation of the postoperative periods. Both the resection status and the clinical parameters were not statistically different in patients with an MRI performed before and after 48 h. The findings suggest that surgically induced contrast enhancements are less frequent when an early postoperative MRI is performed earlier than 48-h, supporting the recommendation of a 48-h window for an early postoperative MRI.
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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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Zanier O, Da Mutten R, Vieli M, Regli L, Serra C, Staartjes VE. DeepEOR: automated perioperative volumetric assessment of variable grade gliomas using deep learning. Acta Neurochir (Wien) 2023; 165:555-566. [PMID: 36529785 PMCID: PMC9922220 DOI: 10.1007/s00701-022-05446-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Volumetric assessments, such as extent of resection (EOR) or residual tumor volume, are essential criterions in glioma resection surgery. Our goal is to develop and validate segmentation machine learning models for pre- and postoperative magnetic resonance imaging scans, allowing us to assess the percentagewise tumor reduction after intracranial surgery for gliomas. METHODS For the development of the preoperative segmentation model (U-Net), MRI scans of 1053 patients from the Multimodal Brain Tumor Segmentation Challenge (BraTS) 2021 as well as from patients who underwent surgery at the University Hospital in Zurich were used. Subsequently, the model was evaluated on a holdout set containing 285 images from the same sources. The postoperative model was developed using 72 scans and validated on 45 scans obtained from the BraTS 2015 and Zurich dataset. Performance is evaluated using Dice Similarity score, Jaccard coefficient and Hausdorff 95%. RESULTS We were able to achieve an overall mean Dice Similarity Score of 0.59 and 0.29 on the pre- and postoperative holdout sets, respectively. Our algorithm managed to determine correct EOR in 44.1%. CONCLUSION Although our models are not suitable for clinical use at this point, the possible applications are vast, going from automated lesion detection to disease progression evaluation. Precise determination of EOR is a challenging task, but we managed to show that deep learning can provide fast and objective estimates.
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Affiliation(s)
- Olivier Zanier
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Raffaele Da Mutten
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Moira Vieli
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Luca Regli
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Carlo Serra
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Victor E. Staartjes
- Machine Intelligence in Clinical Neuroscience (MICN) Laboratory, Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
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van der Boog ATJ, Rados M, Akkermans A, Dankbaar JW, Kizilates U, Snijders TJ, Hendrikse J, Verhoeff JJC, Hoff RG, Robe PA. Occurrence, Risk Factors, and Consequences of Postoperative Ischemia After Glioma Resection: A Retrospective Study. Neurosurgery 2023; 92:125-136. [PMID: 36135366 DOI: 10.1227/neu.0000000000002149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/17/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Postoperative ischemia can lead to neurological deficits and is a known complication of glioma resection. There is inconsistency in documented incidence of ischemia after glioma resection, and the precise cause of ischemia is often unknown. OBJECTIVE To assess the incidence of postoperative ischemia and neurological deficits after glioma resection and to evaluate their association with potential risk factors. METHODS One hundred thirty-nine patients with 144 surgeries between January 2012 and September 2014 for World Health Organization (WHO) 2016 grade II-IV diffuse supratentorial gliomas with postoperative MRI within 72 hours were retrospectively included. Patient, tumor, and perioperative data were extracted from the electronic patient records. Occurrence of postoperative confluent ischemia, defined as new confluent areas of diffusion restriction, and new or worsened neurological deficits were analyzed univariably and multivariably using logistic regression models. RESULTS Postoperative confluent ischemia was found in 64.6% of the cases. Occurrence of confluent ischemia was associated with an insular location ( P = .042) and intraoperative administration of vasopressors ( P = .024) in multivariable analysis. Glioma location in the temporal lobe was related to an absence of confluent ischemia ( P = .01). Any new or worsened neurological deficits occurred in 30.6% and 20.9% at discharge from the hospital and at first follow-up, respectively. Occurrence of ischemia was significantly associated with the presence of novel neurological deficits at discharge ( P = .013) and after 3 months ( P = .024). CONCLUSION Postoperative ischemia and neurological deficit were significantly correlated. Intraoperative administration of vasopressors, insular glioma involvement, and absence of temporal lobe involvement were significantly associated with postoperative ischemia.
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Affiliation(s)
- Arthur T J van der Boog
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matea Rados
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annemarie Akkermans
- Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ufuk Kizilates
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Tom J Snijders
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Reinier G Hoff
- Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pierre A Robe
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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9
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Dumba M, Fry A, Shelton J, Booth TC, Jones B, Shuaib H, Williams M. Imaging in patients with glioblastoma: A national cohort study. Neurooncol Pract 2022; 9:487-495. [PMID: 36381650 PMCID: PMC9665056 DOI: 10.1093/nop/npac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Glioblastoma is the most common malignant brain tumor in adults and has a poor prognosis. This cohort of patients is diverse and imaging is vital to formulate treatment plans. Despite this, there is relatively little data on patterns of use of imaging and imaging workload in routine practice. Methods We examined imaging patterns for all patients aged 15–99 years resident in England who were diagnosed with a glioblastoma between 1st January 2013 and 31st December 2014. Patients without imaging and death-certificate-only registrations were excluded. Results The analytical cohort contained 4,307 patients. There was no significant variation in pre- or postdiagnostic imaging practice by sex or deprivation quintile. Postdiagnostic imaging practice was varied. In the group of patients who were treated most aggressively (surgical debulking and chemoradiation) and were MRI compatible, only 51% had a postoperative MRI within 72 hours of surgery. In patients undergoing surgery who subsequently received radiotherapy, only 61% had a postsurgery and preradiotherapy MRI. Conclusions Prediagnostic imaging practice is uniform. Postdiagnostic imaging practice was variable. With increasing evidence and clearer recommendations regarding debulking surgery and planning radiotherapy imaging, the reason for this is unclear and will form the basis of further work.
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Affiliation(s)
- Maureen Dumba
- Department of Neuroradiology, Imperial College Healthcare NHS Trust , London , UK
| | - Anna Fry
- Cancer Research UK , London , UK
- National Cancer Registration and Analysis Service, Public Health England, London , UK
| | | | - Thomas C Booth
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust , London , UK
- School of Biomedical Engineering & Imaging Sciences, St Thomas’ Hospital , London , UK
| | - Brynmor Jones
- Department of Neuroradiology, Imperial College Healthcare NHS Trust , London , UK
| | - Haris Shuaib
- Department of Medical Physics, Guy’s & St. Thomas’ NHS Foundation Trust , London , UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London , London , UK
| | - Matt Williams
- Department of Radiotherapy, Imperial College Healthcare NHS Trust , London , UK
- Computational Oncology Lab, Institute of Global Health Innovation, Imperial College London , London , UK
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10
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Menke C, Lohmann S, Baehr A, Grauer O, Holling M, Brokinkel B, Schwake M, Stummer W, Schipmann S. Classical and disease-specific quality indicators in glioma surgery—Development of a quality checklist to improve treatment quality in glioma patients. Neurooncol Pract 2021; 9:59-67. [DOI: 10.1093/nop/npab063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
There is a pressing demand for more accurate, disease-specific quality measures in the field of neurosurgery. Aiming at most adequately measuring and reflecting the quality of glioma therapy, we developed a novel quality indicator bundle in form of a checklist for all patients that are treated operatively for glioma.
Methods
On the basis of possible glioma-specific quality indicators retrieved from the literature and quality guidelines, a multidisciplinary team developed a checklist containing 13 patient-need-specific outcome measures. Subsequently, the checklist was prospectively applied to a total of 78 patients compared with a control group consisting of 322 patients. A score was generated based on the maximum of quality measures achieved.
Results
Significant improvements in quality after prospectively introducing the checklist were achieved for supplemental physical and occupational therapy during inpatient stay (89.4% vs 100%, P = .002), consultation of a social worker during inpatient stay (64% vs 92.3%, P < .001), psycho-oncological screening (14.3% vs 70.5%, P < .001), psycho-oncological consultation (31.1% vs 82.1%, P < .001), and consultation of the palliative care team (20% vs 40%, P = .031). Overall, after introduction of the checklist one-third (n = 23) of patients reached best-practice measures in all categories, and over half of the patients (n = 44) achieved above 90% with respect to the outcome measures.
Conclusions
Aiming at ensuring comprehensive, consistent, and timely care of glioma patients, the implementation of the checklist for routine use in glioma surgery represents an efficient, easily reproducible, and powerful tool for significant improvements.
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Affiliation(s)
- Christiane Menke
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Sebastian Lohmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Andrea Baehr
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Markus Holling
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Benjamin Brokinkel
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, Haukeland University Hospital Bergen, Bergen, Norway
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11
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Tatekawa H, Uetani H, Hagiwara A, Bahri S, Raymond C, Lai A, Cloughesy TF, Nghiemphu PL, Liau LM, Pope WB, Salamon N, Ellingson BM. Worse prognosis for IDH wild-type diffuse gliomas with larger residual biological tumor burden. Ann Nucl Med 2021; 35:1022-1029. [PMID: 34121166 DOI: 10.1007/s12149-021-01637-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The association of overall survival (OS) with tumor burden, including contrast enhanced (CE) volume on CE T1-weighted images, fluid-attenuated inversion recovery (FLAIR) hyperintense volume, and 3, 4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (FDOPA) hypermetabolic volume, in isocitrate dehydrogenase (IDH) wild-type gliomas remains unclear. This study aimed to assess the association between biological tumor burden in pre- and post-operative status and OS in IDH wild-type gliomas, and evaluated which volume was the best predictor of OS. METHODS Thirty-four patients with treatment-naïve IDH wild-type gliomas (WHO grade II 6, III 15, IV 13) were retrospectively included. Three pre-operative tumor regions of interest (ROIs) were segmented based on the CE, FLAIR hyperintense, and FDOPA hypermetabolic regions. Resected ROIs were segmented from the post-operative images. Residual CE, FLAIR hyperintense, and FDOPA hypermetabolic ROIs were created by subtracting resected ROIs from pre-operative ROIs. Cox regression analysis was conducted to investigate the association of OS with the volume of each ROI, and Akaike information criterion was used to assess the fitness. RESULTS Residual CE volume had a significant association with OS [hazard ratio (HR) = 1.26, p = 0.039], but this effect disappeared when controlling for tumor grade. Residual FDOPA hypermetabolic volume best fit the regression model and was significantly associated with OS (HR = 1.18, p = 0.008), even when controlling for tumor grade. FLAIR hyperintense volume showed no significant association with OS. CONCLUSION Residual FDOPA hypermetabolic burden predicted OS for IDH wild-type gliomas, regardless of the tumor grade. Furthermore, removing hypermetabolic and CE regions may improve the prognosis.
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Affiliation(s)
- Hiroyuki Tatekawa
- UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, USA
| | - Hiroyuki Uetani
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, USA
| | - Shadfar Bahri
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Linda M Liau
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Whitney B Pope
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Noriko Salamon
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
- Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, USA.
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12
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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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13
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Yuan T, Ji X, Liu Y, Gao G, Ren JL, Huang D, Quan G. New Enhancement beyond Radiation Field Improves Survival Prediction in Patients with Post-Treatment High-Grade Glioma. JOURNAL OF ONCOLOGY 2021; 2021:9437090. [PMID: 34035813 PMCID: PMC8118721 DOI: 10.1155/2021/9437090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/29/2021] [Indexed: 11/17/2022]
Abstract
The imaging signs which can accurately predict survival prognosis after standard treatment of high-grade glioma (HGG) are highly desirable. This study aims to explore the role of new enhancement beyond radiation field (NERF) in the survival prediction in patients with post-treatment HGG. The present study included 142 pathologically confirmed HGG patients who had received standard treatment. NERF, as well as other conventional MR findings and clinical variables, were included in univariate and multivariate analyses for evaluating their impactions on progression-free survival (PFS) and overall survival (OS). Univariate analysis showed that histological grade (p=0.008) and NERF (p=0.001) were the prognostic variables for poor PFS, whereas histological grade (p=0.017), NERF (p=0.001), and new subventricular zone enhancement (nSVZE) (p=0.001) were prognostic variables for poor OS. The multivariate analysis showed that NERF (HR 3.93; 95% CI 1.93-8.01; p=0.001) and nSVZE (HR 3.92; 95% CI 1.95-7.89; p=0.001) were the prognostic variables for poor OS. However, only nSVZE was (HR 3.29; 95% CI 2.04-5.28; p=0.001) the prognostic variable for poor PFS. When combining the NERF with the clinical and other MR variables, the highest AUC (0.924) and specificity (0.899) for predicting poor OS were achieved. The location of new developed enhancements relevant to high dose radiation field appears to be the main determinant of their prognostic value. Our results suggest that the new enhancement beyond radiation field can improve the survival prediction in patients with HGG after standard treatment.
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Affiliation(s)
- Tao Yuan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoli Ji
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yawu Liu
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Guodong Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Deyou Huang
- Department of Radiology, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Guanmin Quan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Precise enhancement quantification in post-operative MRI as an indicator of residual tumor impact is associated with survival in patients with glioblastoma. Sci Rep 2021; 11:695. [PMID: 33436737 PMCID: PMC7804103 DOI: 10.1038/s41598-020-79829-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 12/09/2020] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma is the most common primary brain tumor. Standard therapy consists of maximum safe resection combined with adjuvant radiochemotherapy followed by chemotherapy with temozolomide, however prognosis is extremely poor. Assessment of the residual tumor after surgery and patient stratification into prognostic groups (i.e., by tumor volume) is currently hindered by the subjective evaluation of residual enhancement in medical images (magnetic resonance imaging [MRI]). Furthermore, objective evidence defining the optimal time to acquire the images is lacking. We analyzed 144 patients with glioblastoma, objectively quantified the enhancing residual tumor through computational image analysis and assessed the correlation with survival. Pathological enhancement thickness on post-surgical MRI correlated with survival (hazard ratio: 1.98, p < 0.001). The prognostic value of several imaging and clinical variables was analyzed individually and combined (radiomics AUC 0.71, p = 0.07; combined AUC 0.72, p < 0.001). Residual enhancement thickness and radiomics complemented clinical data for prognosis stratification in patients with glioblastoma. Significant results were only obtained for scans performed between 24 and 72 h after surgery, raising the possibility of confounding non-tumor enhancement in very early post-surgery MRI. Regarding the extent of resection, and in agreement with recent studies, the association between the measured tumor remnant and survival supports maximal safe resection whenever possible.
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15
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Towards Personalized Diagnosis of Glioblastoma in Fluid-Attenuated Inversion Recovery (FLAIR) by Topological Interpretable Machine Learning. MATHEMATICS 2020. [DOI: 10.3390/math8050770] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Glioblastoma multiforme (GBM) is a fast-growing and highly invasive brain tumor, which tends to occur in adults between the ages of 45 and 70 and it accounts for 52 percent of all primary brain tumors. Usually, GBMs are detected by magnetic resonance images (MRI). Among MRI, a fluid-attenuated inversion recovery (FLAIR) sequence produces high quality digital tumor representation. Fast computer-aided detection and segmentation techniques are needed for overcoming subjective medical doctors (MDs) judgment. This study has three main novelties for demonstrating the role of topological features as new set of radiomics features which can be used as pillars of a personalized diagnostic systems of GBM analysis from FLAIR. For the first time topological data analysis is used for analyzing GBM from three complementary perspectives—tumor growth at cell level, temporal evolution of GBM in follow-up period and eventually GBM detection. The second novelty is represented by the definition of a new Shannon-like topological entropy, the so-called Generator Entropy. The third novelty is the combination of topological and textural features for training automatic interpretable machine learning. These novelties are demonstrated by three numerical experiments. Topological Data Analysis of a simplified 2D tumor growth mathematical model had allowed to understand the bio-chemical conditions that facilitate tumor growth—the higher the concentration of chemical nutrients the more virulent the process. Topological data analysis was used for evaluating GBM temporal progression on FLAIR recorded within 90 days following treatment completion and at progression. The experiment had confirmed that persistent entropy is a viable statistics for monitoring GBM evolution during the follow-up period. In the third experiment we developed a novel methodology based on topological and textural features and automatic interpretable machine learning for automatic GBM classification on FLAIR. The algorithm reached a classification accuracy up to 97%.
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16
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Impact of Early Reoperation on the Prognosis of Patients Operated on for Glioblastoma. World Neurosurg 2020; 139:e592-e600. [PMID: 32330620 DOI: 10.1016/j.wneu.2020.04.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prognosis for patients with glioblastoma depends particularly on the degree of tumor resection. Patients with tumor remnants in postsurgical magnetic resonance imaging (<72 hours) may benefit from early reoperation. We present our results concerning the impact on overall survival (OS) and progression-free survival (PFS) of reoperation in patients who have already undergone surgery for glioblastoma. METHODS This study included all patients who had undergone surgery for glioblastoma with control magnetic resonance imaging, who received adjuvant therapy as per the Stupp protocol, with a minimum follow-up of 24 months. We recorded the number of complete resections, partial resections, and early reoperations. We determined the impact on OS and PFS of the early reoperations and the functional status. We considered complete resection when the volume of the residual tumor was 0 cm3. RESULTS A total of 112 patients were diagnosed with glioblastoma between March 2014 and March 2017. The study included 58 patients who fulfilled all the inclusion criteria. Complete resection was achieved in 24 patients (41.4%) and partial resection in 34 (58.6%). Of these 34 patients, 11 (32.35%) underwent early reoperation. The final result was complete resection in 58.62% of the patients. In the patients who underwent reoperation, OS and PFS were 30.3 months and 16.6 months compared with 12.7 months and 6.75 months in those without reoperation (P = 0.013 and P = 0.012). The functional prognosis was similar between the 2 groups. CONCLUSIONS Early reoperation in patients with residual tumor improved OS and PFS without increasing the number of complications compared with the patients who did not undergo reoperation.
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17
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Larsson C, Groote I, Vardal J, Kleppestø M, Odland A, Brandal P, Due-Tønnessen P, Holme SS, Hope TR, Meling TR, Fosse E, Emblem KE, Bjørnerud A. Prediction of survival and progression in glioblastoma patients using temporal perfusion changes during radiochemotherapy. Magn Reson Imaging 2020; 68:106-112. [PMID: 32004711 DOI: 10.1016/j.mri.2020.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to investigate changes in structural magnetic resonance imaging (MRI) according to the RANO criteria and perfusion- and permeability related metrics derived from dynamic contrast-enhanced MRI (DCE) and dynamic susceptibility contrast MRI (DSC) during radiochemotherapy for prediction of progression and survival in glioblastoma. METHODS Twenty-three glioblastoma patients underwent biweekly structural and perfusion MRI before, during, and two weeks after a six weeks course of radiochemotherapy. Temporal trends of tumor volume and the perfusion-derived parameters cerebral blood volume (CBV) and blood flow (CBF) from DSC and DCE, in addition to contrast agent capillary transfer constant (Ktrans) from DCE, were assessed. The patients were separated in two groups by median survival and differences between the two groups explored. Clinical- and MRI metrics were investigated using univariate and multivariate survival analysis and a predictive survival index was generated. RESULTS Median survival was 19.2 months. A significant decrease in contrast-enhancing tumor size and CBV and CBF in both DCE- and DSC-derived parameters was seen during and two weeks past radiochemotherapy (p < 0.05). A 10%/30% increase in Ktrans/CBF two weeks after finishing radiochemotherapy resulted in significant shorter survival (13.9/16.8 vs. 31.5/33.1 months; p < 0.05). Multivariate analysis revealed an index using change in Ktrans and relative CBV from DSC significantly corresponding with survival time in months (r2 = 0.843; p < 0.001). CONCLUSIONS Significant temporal changes are evident during radiochemotherapy in tumor size (after two weeks) and perfusion-weighted MRI-derived parameters (after four weeks) in glioblastoma patients. While DCE-based metrics showed most promise for early survival prediction, a multiparametric combination of both DCE- and DSC-derived metrics gave additional information.
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Affiliation(s)
- Christopher Larsson
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway.
| | - Inge Groote
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jonas Vardal
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Magne Kleppestø
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Audun Odland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Petter Brandal
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Paulina Due-Tønnessen
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Sigrun S Holme
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Tuva R Hope
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Torstein R Meling
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Erik Fosse
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Kyrre E Emblem
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Atle Bjørnerud
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
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18
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Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic review and meta-analysis. Neurosurg Rev 2019; 43:1221-1233. [PMID: 31410683 DOI: 10.1007/s10143-019-01160-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Intraoperative ultrasonography (iUS) is considered an accurate, safe, and cost-effective tool to estimate the extent of resection of both high-grade (HGG) and low-grade (DLGG) diffuse gliomas (DGs). However, it is currently missing an evidence-based assessment of iUS diagnostic accuracy in DGs surgery. The objective of review is to perform a systematic review and meta-analysis of the diagnostic performance of iUS in detecting tumor residue after DGs resection. A comprehensive literature search for studies published through October 2018 was performed according to PRISMA-DTA and STARD 2015 guidelines, using the following algorithm: ("ultrasound" OR "ultrasonography" OR "ultra-so*" OR "echo*" OR "eco*") AND ("brain" OR "nervous") AND ("tumor" OR "tumour" OR "lesion" OR "mass" OR "glio*" OR "GBM") AND ("surgery" OR "surgical" OR "microsurg*" OR "neurosurg*"). Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) of iUS in DGs were calculated. A subgroup analysis for HGGs and DLGGs was also conducted. Thirteen studies were included in the systematic review (665 DGs). Ten articles (409 DGs) were selected for the meta-analysis with the following results: sensitivity 72.2%, specificity 93.5%, LR- 0.29, LR+ 3, and DOR 9.67. Heterogeneity among studies was non-significant. Subgroup analysis demonstrates a better diagnostic performance of iUS for DLGGs compared with HGGs. iUS is an effective technique in assessing DGs resection. No significant differences are seen regarding iUS modality and transducer characteristics. Its diagnostic performance is higher in DLGGs than HGGs and could be worsened by previous treatments, surgical artifacts, and small tumor residue volumes.
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Rebrikova VA, Sergeev NI, Padalko VV, Kotlyarov PM, Solodkiy VA. [The use of MR perfusion in assessing the efficacy of treatment for malignant brain tumors]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2019; 83:113-120. [PMID: 31577277 DOI: 10.17116/neiro201983041113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This literature review analyzes the capabilities of magnetic resonance imaging (MRI)-based cerebral perfusion for differentiation between post-radiation changes (e.g., radionecrosis) and continued growth. The technique is compared with other highly informative radiodiagnostic techniques used in neuroradiology. The use of MR perfusion is important in a comprehensive examination protocol. Trends in the technique development are analyzed.
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Affiliation(s)
- V A Rebrikova
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - N I Sergeev
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - V V Padalko
- Sechenov First Moscow Medical University, Moscow, Russia
| | - P M Kotlyarov
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
| | - V A Solodkiy
- Russian Scientific Center of Roentgenology and Radiology, Moscow, Russia
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20
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Prediction value of unmeasurable MR enhancement at early stage after gross-total resection on the survival state of patients with high-grade glioma. J Neurooncol 2018; 140:359-366. [PMID: 30182160 DOI: 10.1007/s11060-018-2961-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023]
Abstract
PROPOSE To explore the value of unmeasurable enhancement pattern of residual cavity in predicting survival at early stage after gross-total resection in high-grade glioma (HGG) patients. METHODS This retrospective study enrolled consecutive 51 HGG patients with unmeasurable enhancement who underwent gross-total resection followed by concurrent chemoradiotherapy and adjuvant chemotherapy. We evaluated the enhancement patterns of residual cavity on contrast-T1WI made within 1 month after tumor resection (20 ± 3 days). The survival state of different enhancement was compared. RESULTS Thin-linear, thick-linear and nodular enhancement were observed in 22 patients (43%), 10 patients (20%), and 19 patients (37%), respectively. The progression-free survival of patients with thin-linear (487, 151-887 days) was longer than those patients with thick-linear (277, 133-573 days), and nodular enhancement (210, 120-765 days) (P = 0.002). The overall survival of patients with thin-linear (774, 457-1343 days) was longer than those with thick-linear (462, 320-678 days), and nodular enhancement (326, 234-1393 days) (P = 0.002). There was no significant difference of orthogonal value between thick-linear and nodular enhancement (0.854), neither between grade III and IV with same enhancement patterns (P = 0.540, P = 0.720). CONCLUSIONS The unmeasurable enhancement patterns in HGG patients within 1 month after gross-total resection, which might be better than the grade of tumor, holds a potential marker in survival state.
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21
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Jordan JT, Sanders AE, Armstrong T, Asher T, Bennett A, Dunbar E, Mohile N, Nghiemphu PL, Smith TR, Ney DE. Quality improvement in neurology: Neuro-oncology quality measurement set. Neurology 2018; 90:652-658. [PMID: 29500290 PMCID: PMC10681057 DOI: 10.1212/wnl.0000000000005251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/04/2017] [Indexed: 12/18/2022] Open
Affiliation(s)
- Justin T Jordan
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Amy E Sanders
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Terri Armstrong
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Tony Asher
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Amy Bennett
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Erin Dunbar
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Nimish Mohile
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - P Leia Nghiemphu
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Timothy R Smith
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
| | - Douglas E Ney
- From the Pappas Center for Neuro-Oncology (J.T.J.), Massachusetts General Hospital, Boston; Department of Neurology (A.E.S.), SUNY Upstate Medical University, Syracuse, NY; Neuro-Oncology Branch, Center for Clinical Research (T. Armstrong), National Cancer Institute, National Institutes of Health, Bethesda, MD; Department of Neurological Surgery (T. Asher), Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC; American Academy of Neurology (A.B.), Minneapolis, MN; Department of Neuro-Oncology (E.D.), Piedmont Brain Tumor Center, Atlanta, GA; Department of Neurology (N.M.), University of Rochester, NY; Department of Neurology (P.L.N.), UCLA, Los Angeles, CA; Cushing Neurosurgical Outcomes Center (T.R.S.), Brigham & Women's Hospital, Harvard Medical School, Boston, MA; and Departments of Neurology and Neurosurgery (D.E.N.), University of Colorado School of Medicine, Aurora
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22
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Jordan JT, Sanders AE, Armstrong T, Asher T, Bennett A, Dunbar E, Mohile N, Nghiemphu PL, Smith TR, Ney DE. Quality improvement in neurology: Neuro-Oncology Quality Measurement Set. Neuro Oncol 2018; 20:531-537. [PMID: 29509930 PMCID: PMC5909638 DOI: 10.1093/neuonc/nox245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Justin T Jordan
- Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA
| | - Amy E Sanders
- Department of Neurology, SUNY Upstate Medical University, Syracuse, NY
| | - Terri Armstrong
- Neuro-Oncology Branch, Center for Clinical Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Tony Asher
- Department of Neurological Surgery, Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC
| | - Amy Bennett
- American Academy of Neurology, Minneapolis, MN
| | - Erin Dunbar
- Department of Neuro-Oncology, Piedmont Brain Tumor Center, Atlanta, GA
| | - Nimish Mohile
- Department of Neurology, University of Rochester, Rochester, NY
| | | | - Timothy R Smith
- Cushing Neurosurgical Outcomes Center, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA
| | - Douglas E Ney
- Departments of Neurology and Neurosurgery, University of Colorado School of Medicine, Aurora, CO
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23
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Ellingson BM, Wen PY, Cloughesy TF. Evidence and context of use for contrast enhancement as a surrogate of disease burden and treatment response in malignant glioma. Neuro Oncol 2018; 20:457-471. [PMID: 29040703 PMCID: PMC5909663 DOI: 10.1093/neuonc/nox193] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The use of contrast enhancement within the brain on CT or MRI has been the gold standard for diagnosis and therapeutic response assessment in malignant gliomas for decades. The use of contrast enhancing tumor size, however, remains controversial as a tool for accurately diagnosing and assessing treatment efficacy in malignant gliomas, particularly in the current, quickly evolving therapeutic landscape. The current article consolidates overwhelming evidence from hundreds of studies in the field of neuro-oncology, providing the necessary evidence base and specific contexts of use for consideration of contrast enhancing tumor size as an appropriate surrogate biomarker for disease burden and as a tool for measuring treatment response in malignant glioma, including glioblastoma.
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Affiliation(s)
- Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- UCLA Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- UCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- UCLA Brain Research Institute, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- Department of Physics in Medicine and Biology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science at UCLA, University of California Los Angeles, Los Angeles, California
| | - Patrick Y Wen
- Department of Neurooncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
- Department of Neurology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California
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24
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Quan GM, Zheng YL, Yuan T, Lei JM. Increasing FLAIR signal intensity in the postoperative cavity predicts progression in gross-total resected high-grade gliomas. J Neurooncol 2018; 137:631-638. [DOI: 10.1007/s11060-018-2758-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/03/2018] [Indexed: 01/01/2023]
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25
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Perfusion of surgical cavity wall enhancement in early post-treatment MR imaging may stratify the time-to-progression in glioblastoma. PLoS One 2017; 12:e0181933. [PMID: 28732091 PMCID: PMC5521835 DOI: 10.1371/journal.pone.0181933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine if perfusion in surgical cavity wall enhancement (SCWE) obtained in early post-treatment MR imaging can stratify time-to-progression (TTP) in glioblastoma. MATERIALS AND METHODS This study enrolled 60 glioblastoma patients with more than 5-mm-thick SCWEs as detected on contrast-enhanced MR imaging after concurrent chemoradiation therapy. Two independent readers categorized the shape and perfusion state of SCWEs as nodular or non-nodular and as having positive or negative perfusion compared with the contralateral grey matter on arterial spin labeling (ASL). The perfusion fraction on ASL within the contrast-enhancing lesion was calculated. The independent predictability of TTP was analyzed using the Kaplan-Meier method and Cox proportional hazards modelling. RESULTS The perfusion fraction was higher in the non-progression group, significantly for reader 2 (P = 0.03) and borderline significantly for reader 1 (P = 0.08). A positive perfusion state and (P = 0.02) a higher perfusion fraction of the SCWE were found to become an independent predictor of longer TTP (P = 0.001 for reader 1 and P < 0.001 for reader 2). The contrast enhancement pattern did not become a TTP predictor. CONCLUSION Assessment of perfusion in early post-treatment MR imaging can stratify TTP in patients with glioblastoma for adjuvant temozolomide therapy. Positive perfusion in SCWEs can become a predictor of a longer TTP.
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26
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Majós C, Cos M, Castañer S, Pons A, Gil M, Fernández-Coello A, Macià M, Bruna J, Aguilera C. Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma. AJNR Am J Neuroradiol 2016; 37:2224-2230. [PMID: 27609621 DOI: 10.3174/ajnr.a4917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Current protocols in patients with glioblastoma include performing an MR examination shortly after surgery and then 2-6 weeks after ending concomitant chemoradiotherapy. The assessment of this first postradiotherapy examination is challenging because the pseudoprogression phenomenon may appear. The aim of this study was to explore if performing an MR examination shortly before radiation therapy (preradiotherapy MR imaging) could improve the radiologic assessment of patients with glioblastoma. MATERIALS AND METHODS A preradiotherapy MR imaging examination was prospectively performed before the start of radiation therapy in 28 consecutive patients with glioblastoma who had undergone surgical resection. Tumor response to chemoradiotherapy was assessed twice: with the early postoperative MR examination as baseline and with the preradiotherapy MR imaging examination as baseline. In addition, tumor growth in the preradiotherapy MR imaging examination was evaluated, and its correlation with patient survival was assessed with Kaplan-Meier analysis and Cox regression. RESULTS Tumor progression after radiation therapy was found in 16 patients, corresponding to pseudoprogression in 7 of them (44%). Four assessments of pseudoprogression switched to partial response or stable disease when preradiotherapy MR imaging was the baseline examination, and the ratio of pseudoprogression was reduced to 25% (3 of 12). Significant differences in survival were found when patients were stratified according to the pattern of tumor growth on preradiotherapy MR imaging (median overall survival "no-growth," 837 days; "focal-growth," 582 days; "global-growth," 344 days; P = .001). CONCLUSIONS Performing a preradiotherapy MR imaging examination may improve the clinical management of patients with glioblastoma by reducing the ratio of pseudoprogression assessments and providing prognostic information.
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Affiliation(s)
- C Majós
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
- Centro de Investigación Red en Bioingeniería, Biomateriales y Nanomedicina (C.M., C.A.), Cerdanyola del Vallès, Spain
| | - M Cos
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
| | - S Castañer
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
| | - A Pons
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
| | - M Gil
- Medical Oncology, Institut Català d'Oncologia L'Hospitalet (M.G.)
| | | | - M Macià
- Radiotherapy Oncology, Institut Català d'Oncologia L'Hospitalet (M.M.)
| | - J Bruna
- Neurology (J.B.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Institut d'Investigació Biomèdica de Bellvitge, IDIBELL (J.B.), L'Hospitalet de Llobregat, Spain
| | - C Aguilera
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
- Centro de Investigación Red en Bioingeniería, Biomateriales y Nanomedicina (C.M., C.A.), Cerdanyola del Vallès, Spain
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27
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Kim BR, Choi SH, Yun TJ, Lee ST, Park CK, Kim TM, Kim JH, Park SW, Sohn CH, Park SH, Kim IH. MR Imaging Analysis of Non-Measurable Enhancing Lesions Newly Appearing after Concomitant Chemoradiotherapy in Glioblastoma Patients for Prognosis Prediction. PLoS One 2016; 11:e0166096. [PMID: 27835666 PMCID: PMC5105956 DOI: 10.1371/journal.pone.0166096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/21/2016] [Indexed: 11/19/2022] Open
Abstract
Purpose To analyze the enhancement patterns and apparent diffusion coefficient (ADC) values of non-measurable surgical cavity wall enhancement pattern, newly appearing after completion of standard concurrent chemoradiotherapy (CCRT) with temozolomide in glioblastoma patients for the prognosis prediction. Materials and Methods From January 2010 to April 2014, among 190 patients with histopathologically confirmed glioblastoma, a total of 33 patients with non-measurable wall enhancement on post-CCRT MR imaging were enrolled and divided into two subgroups: non-progression (n = 18) and progression groups (n = 15). We analyzed the wall enhancement patterns, which were categorized into three patterns: thin, thick and nodular enhancement. ADC values were measured in the enhancing portions of the walls. The progression-free survival (PFS) related to the wall enhancement was analyzed by Kaplan-Meier analysis, and survival curves were compared using the log-rank test. Results Statistically significant differences in the surgical cavity wall enhancement patterns was shown between the progression and non-progression groups (P = 0.0032). Thin wall enhancement was more frequently observed in the non-progression group, and thick or nodular wall enhancement were observed in the progression group (P = 0.0016). There was no statistically significant difference in the mean ADC values between the progression and non-progression groups. The mean PFS was longer in patients with thin wall enhancement than in those with nodular or thick wall enhancement (35.5 months vs. 15.8 months, P = 0.008). Conclusion Pattern analysis of non-measurable surgical cavity wall enhancement on post-CCRT MR imaging might be useful tool for predicting prognosis of GBM patient before clear progression of non-measurable disease.
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Affiliation(s)
- Bo Ram Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Tae Jin Yun
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sun-Won Park
- Department of Radiology, Boramae Medical Center, Seoul, Republic of Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Republic of Korea
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28
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Jeong D, Malalis C, Arrington JA, Field AS, Choi JW, Kocak M. Mean apparent diffusion coefficient values in defining radiotherapy planning target volumes in glioblastoma. Quant Imaging Med Surg 2016; 5:835-45. [PMID: 26807366 DOI: 10.3978/j.issn.2223-4292.2015.12.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND To evaluate mean apparent diffusion coefficient (ADC) values on pre-radiotherapy magnetic resonance (MR) at sites that gave rise to glioblastoma (GBM) recurrence compared to similar surrounding background tissue that did not progress to tumor. METHODS Twenty out of 110 consecutive patients with pathology proven GBM treated at our institution from 1/1/2009 to 5/31/2012 had definitive recurrence 6 months following radiotherapy. In this single-center retrospective cohort study, pre- and post-radiotherapy MR brain exams were evaluated. Sites of tumor recurrence on post-therapy exams were co-localized to pre-therapy exams and the background tissue type which gave rise to tumor was noted (i.e., T2 hyperintensity, normal appearing white or gray matter). Similar surrounding background tissue not progressing to tumor was also selected. Two radiologists compared mean ADC values on pre-radiotherapy MR for sites which gave rise to future tumor recurrence and sites of similar background tissue. RESULTS Pre-radiotherapy mean ADC values were significantly lower in regions of future tumor recurrence than in regions of surrounding background tissue not progressing to tumor (P=0.003). There were no significant quantitative differences on T1-weighted pre contrast (P=0.50) or T2-weighted (P=0.10) sequences between sites. There was strong interobserver agreement with an intraclass correlation of 0.867 for ADC values at sites of future tumor recurrence and background tissue. CONCLUSIONS Mean ADC values may help predict sites of future gross tumor recurrence in GBM, which could be helpful in radiation therapy planning.
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Affiliation(s)
- Daniel Jeong
- 1 Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ; 2 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA ; 3 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Christian Malalis
- 1 Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ; 2 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA ; 3 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - John A Arrington
- 1 Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ; 2 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA ; 3 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Aaron S Field
- 1 Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ; 2 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA ; 3 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jung W Choi
- 1 Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ; 2 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA ; 3 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Mehmet Kocak
- 1 Department of Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA ; 2 Department of Diagnostic Radiology, Rush University Medical Center, Chicago, IL, USA ; 3 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
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