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Li JL, Xu Y, Xiang YS, Wu P, Shen AJ, Wang PJ, Wang F. The Value of Amide Proton Transfer MRI in the Diagnosis of Malignant and Benign Urinary Bladder Lesions: Comparison With Diffusion-Weighted Imaging. J Magn Reson Imaging 2024; 60:1124-1133. [PMID: 38174777 DOI: 10.1002/jmri.29199] [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: 10/06/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Conventional magnetic resonance imaging (MRI) has certain limitations in distinguishing between malignant and benign urinary bladder (UB) lesions. Amide proton transfer (APT) imaging may provide more diagnostic information than diffusion-weighted imaging (DWI) to distinguish between malignant and benign UB. PURPOSE To investigate the potential of APT imaging in the diagnosis of malignant and benign UB lesions and to compare its diagnostic efficacy with that of conventional DWI. STUDY TYPE Prospective. SUBJECTS Eighty patients with UB lesions. FIELD STRENGTH/SEQUENCE A 3.0 T/turbo spin echo (TSE) T1-weighted and T2-weighted imaging, single-shot echo planar DWI, and three-dimensional TSE APT imaging. ASSESSMENT Patients underwent radical cystectomy or transurethral resection of the bladder lesions within 2 weeks after CT urography and MRI examination. APT signal intensity in UB lesions was quantified by the asymmetric magnetization transfer ratio (MTRasym). MTRasym and apparent diffusion coefficient (ADC) values were measured and compared between malignant and benign UB lesions. STATISTICAL TESTS Kolmogorov-Smirnov test, Student's t test or Mann-Whitney U test, Spearman rank correlation coefficient, area under the receiver operating characteristic (ROC) curve (AUC), Delong test, and intraclass correlation coefficient (ICC). The significance threshold was set at P < 0.05. RESULTS Thirty-two patients had pathologically confirmed benign UB lesions, including 2 bladder leiomyomas, 1 submucosal amyloidosis, 1 inflammatory myofibroblastic tumor, and 28 inflammatory lesions, and 48 patients had pathologically confirmed urothelial carcinoma. Urothelial carcinomas showed significantly higher MTRasym values (1.53% [0.74%] vs. 0.85% [0.23%]) and significantly lower ADC values (1.24 ± 0.34 × 10-3 mm2/s vs. 1.43 ± 0.22 × 10-3 mm2/s) than benign UB lesions. The MTRasym value (AUC = 0.928) was significantly better in differentiating urothelial carcinoma from benign UB lesions than the ADC value (AUC = 0.722). DATA CONCLUSION APT imaging may have value in discriminating malignant from benign UB lesions and has better diagnostic performance than DWI. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jing-Lu Li
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China
| | - Yun Xu
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China
| | - Yong-Sheng Xiang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China
| | - Peng Wu
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Ai-Jun Shen
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China
| | - Pei-Jun Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China
| | - Fang Wang
- Department of Medical Imaging, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Medical Imaging Artificial Intelligence, Tongji University School of Medicine, Shanghai, China
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Zhang C, Chen J, Liu Y, Yang Y, Xu Y, You R, Li Y, Liu L, Yang L, Li H, Wang G, Li W, Li Z. Amide proton transfer-weighted MRI for assessing rectal adenocarcinoma T-staging and perineural invasion: a prospective study. Eur Radiol 2024:10.1007/s00330-024-11000-2. [PMID: 39122854 DOI: 10.1007/s00330-024-11000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 06/19/2024] [Accepted: 07/20/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To investigate the value of the pre-operative amide proton transfer-weighted (APTw) MRI to assess the prognostic factors in rectal adenocarcinoma (RA). METHODS This prospective study ran from January 2022 to September 2023 and consecutively enrolled participants with RA who underwent pre-operative MRI and radical surgery. The APTw signal intensity (SI) values of RA with various tumor (T), node (N) stages, perineural invasion (PNI), and tumor grade were compared by Mann-Whitney U-test or t-test. The receiver operating characteristic curve was used to evaluate the diagnostic performance of the APTw SI values. RESULTS A total of 51 participants were enrolled (mean age, 58 years ± 10 [standard deviation], 26 men). There were 24 in the T1-T2 stage and 9 with positive PNI. The APTw SI max, 99th, and 95th values were significantly higher in T3-T4 stage tumor than in T1-T2; the median (interquartile range) (M (IQR)) was (4.0% (3.6-4.9%) vs 3.4% (2.9- 4.3%), p = 0.017), (3.7% (3.2-4.1%) vs 3.2% (2.8-3.8%), p = 0.013), and (3.3% (2.8-3.8%) vs 2.9% (2.3-3.5%), p = 0.033), respectively. These indicators also differed significantly between the PNI groups, with the M (IQR) (4.5% (3.6-5.7%) vs 3.7% (3.2-4.2%), p = 0.017), (4.1% (3.4-4.8%) vs 3.3% (3.0-3.9%), p = 0.022), and (3.7% (2.7-4.2%) vs 2.9% (2.6-3.5%), p = 0.045), respectively. CONCLUSION Pre-operative APTw MRI has potential value in the assessment of T-staging and PNI determination in RA. CLINICAL RELEVANCE STATEMENT Pre-operative amide proton transfer-weighted MRI provides a quantitative method for noninvasive assessment of T-staging and PNI in RA aiding in precision treatment planning. KEY POINTS The efficacy of APTw MRI in RA needs further investigation. T3-T4 stage and PNI positive APTw signal intensities were higher than T1-T2 and non-PNI, respectively. APTw MRI provides a quantitative method for assessment of T staging and PNI in RA.
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Affiliation(s)
- Caixia Zhang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Jianyou Chen
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yifan Liu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yinrui Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | | | - Ruimin You
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Yanli Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Lizhu Liu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Ling Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Huaxiu Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China
| | - Guanshun Wang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
| | - Wenliang Li
- Department of Colorectal Surgery, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
| | - Zhenhui Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Yunnan Cancer Center, Kunming, China.
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Deng HZ, Zhang HW, Huang B, Deng JH, Luo SP, Li WH, Lei Y, Liu XL, Lin F. Advances in diffuse glioma assessment: preoperative and postoperative applications of chemical exchange saturation transfer. Front Neurosci 2024; 18:1424316. [PMID: 39148521 PMCID: PMC11325484 DOI: 10.3389/fnins.2024.1424316] [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: 04/27/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Chemical Exchange Saturation Transfer (CEST) is a technique that uses specific off-resonance saturation pulses to pre-saturate targeted substances. This process influences the signal intensity of free water, thereby indirectly providing information about the pre-saturated substance. Among the clinical applications of CEST, Amide Proton Transfer (APT) is currently the most well-established. APT can be utilized for the preoperative grading of gliomas. Tumors with higher APTw signals generally indicate a higher likelihood of malignancy. In predicting preoperative molecular typing, APTw values are typically lower in tumors with favorable molecular phenotypes, such as isocitrate dehydrogenase (IDH) mutations, compared to IDH wild-type tumors. For differential diagnosis, the average APTw values of meningiomas are significantly lower than those of high-grade gliomas. Various APTw measurement indices assist in distinguishing central nervous system lesions with similar imaging features, such as progressive multifocal leukoencephalopathy, central nervous system lymphoma, solitary brain metastases, and glioblastoma. Regarding prognosis, APT effectively differentiates between tumor recurrence and treatment effects, and also possesses predictive capabilities for overall survival (OS) and progression-free survival (PFS).
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Affiliation(s)
- Hua-Zhen Deng
- Shantou University Medical College, Shantou City, China
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Biao Huang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Jin-Huan Deng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Si-Ping Luo
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei-Hua Li
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiao-Lei Liu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
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Hu X, Ye K, Bo S, Xiao Z, Ma M, Pan J, Zhong X, Zhang D, Mo X, Yu X, Chen M, Luo L, Shi C. Monitoring imatinib decreasing pericyte coverage and HIF-1α level in a colorectal cancer model by an ultrahigh-field multiparametric MRI approach. J Transl Med 2024; 22:712. [PMID: 39085929 PMCID: PMC11293104 DOI: 10.1186/s12967-024-05497-w] [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: 04/10/2024] [Accepted: 07/10/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Excessive pericyte coverage promotes tumor growth, and a downregulation may solve this dilemma. Due to the double-edged sword role of vascular pericytes in tumor microenvironment (TME), indiscriminately decreasing pericyte coverage by imatinib causes poor treatment outcomes. Here, we optimized the use of imatinib in a colorectal cancer (CRC) model in high pericyte-coverage status, and revealed the value of multiparametric magnetic resonance imaging (mpMRI) at 9.4T in monitoring treatment-related changes in pericyte coverage and the TME. METHODS CRC xenograft models were evaluated by histological vascular characterizations and mpMRI. Mice with the highest pericyte coverage were treated with imatinib or saline; then, vascular characterizations, tumor apoptosis and HIF-1α level were analyzed histologically, and alterations in the expression of Bcl-2/bax pathway were assessed through qPCR. The effects of imatinib were monitored by dynamic contrast-enhanced (DCE)-, diffusion-weighted imaging (DWI)- and amide proton transfer chemical exchange saturation transfer (APT CEST)-MRI at 9.4T. RESULTS The DCE- parameters provided a good histologic match the tumor vascular characterizations. In the high pericyte coverage status, imatinib exhibited significant tumor growth inhibition, necrosis increase and pericyte coverage downregulation, and these changes were accompanied by increased vessel permeability, decreased microvessel density (MVD), increased tumor apoptosis and altered gene expression of apoptosis-related Bcl-2/bax pathway. Strategically, a 4-day imatinib effectively decreased pericyte coverage and HIF-1α level, and continuous treatment led to a less marked decrease in pericyte coverage and re-elevated HIF-1α level. Correlation analysis confirmed the feasibility of using mpMRI parameters to monitor imatinib treatment, with DCE-derived Ve and Ktrans being most correlated with pericyte coverage, Ve with vessel permeability, AUC with microvessel density (MVD), DWI-derived ADC with tumor apoptosis, and APT CEST-derived MTRasym at 1 µT with HIF-1α. CONCLUSIONS These results provided an optimized imatinib regimen to achieve decreasing pericyte coverage and HIF-1α level in the high pericyte-coverage CRC model, and offered an ultrahigh-field multiparametric MRI approach for monitoring pericyte coverage and dynamics response of the TME to treatment.
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Affiliation(s)
- Xinpeng Hu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Kunlin Ye
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Shaowei Bo
- Department of Medical Imaging, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Xingang Middle Road No. 466, Guangzhou, 510317, China
| | - Zeyu Xiao
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
- Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Mengjie Ma
- Department of Radiology, Guangzhou First People's Hospital, Panfu Road No. 1, Guangzhou, 510080, China
| | - Jinghua Pan
- Department of General Surgery, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Xing Zhong
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Dong Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Xukai Mo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Xiaojun Yu
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China
| | - Minfeng Chen
- College of Pharmacy, Jinan University, West Huangpu Avenue No.601, Guangzhou, 510632, China.
| | - Liangping Luo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China.
- Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, West Huangpu Avenue No. 613, Guangzhou, 510630, China.
| | - Changzheng Shi
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, West Huangpu Avenue No. 613, Guangzhou, 510630, China.
- Engineering Research Center of Medical Imaging Artificial Intelligence for Precision Diagnosis and Treatment, West Huangpu Avenue No. 613, Guangzhou, 510630, China.
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Sun PZ. Quasi-steady-state (QUASS) reconstruction enhances T 1 normalization in apparent exchange-dependent relaxation (AREX) analysis: A reevaluation of T 1 correction in quantitative CEST MRI of rodent brain tumor models. Magn Reson Med 2024; 92:236-245. [PMID: 38380727 PMCID: PMC11055669 DOI: 10.1002/mrm.30056] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE The apparent exchange-dependent relaxation (AREX) analysis has been proposed as an effective means to correct T1 contribution in CEST quantification. However, it has been recognized that AREX T1 correction is not straightforward if CEST scans are not performed under the equilibrium condition. Our study aimed to test if quasi-steady-state (QUASS) reconstruction could boost the accuracy of the AREX metric under common non-equilibrium scan conditions. THEORY AND METHODS Numerical simulation and in vivo scans were performed to assess the AREX metric accuracy. The CEST signal was simulated under different relaxation delays, RF saturation amplitudes, and durations. The AREX was evaluated as a function of the bulk water T1 and labile proton concentration using the multiple linear regression model. AREX MRI was also assessed in brain tumor rodent models, with both apparent CEST scans and QUASS reconstruction. RESULTS Simulation showed that the AREX calculation from apparent CEST scans, under non-equilibrium conditions, had significant dependence on labile proton fraction ratio, RF saturation time, and T1. In comparison, QUASS-boosted AREX depended on the labile proton fraction ratio without significant dependence on T1 and RF saturation time. Whereas the apparent (2.7 ± 0.8%) and QUASS MTR asymmetry (2.8 ± 0.8%) contrast between normal and tumor regions of interest (ROIs) were significant, the difference was small. In comparison, AREX contrast between normal and tumor ROIs calculated from the apparent CEST scan and QUASS reconstruction was 3.8 ± 1.1%/s and 4.4 ± 1.2%/s, respectively, statistically different from each other. CONCLUSIONS AREX analysis benefits from the QUASS-reconstructed equilibrium CEST effect for improved T1 correction and quantitative CEST analysis.
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Affiliation(s)
- Phillip Zhe Sun
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Winship Cancer Institute, Emory University, Atlanta, GA
- Primate Imaging Center, Emory National Primate Research Center, Emory University, Atlanta, GA
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Tseng CL, Zeng KL, Mellon EA, Soltys SG, Ruschin M, Lau AZ, Lutsik NS, Chan RW, Detsky J, Stewart J, Maralani PJ, Sahgal A. Evolving concepts in margin strategies and adaptive radiotherapy for glioblastoma: A new future is on the horizon. Neuro Oncol 2024; 26:S3-S16. [PMID: 38437669 PMCID: PMC10911794 DOI: 10.1093/neuonc/noad258] [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] [Indexed: 03/06/2024] Open
Abstract
Chemoradiotherapy is the standard treatment after maximal safe resection for glioblastoma (GBM). Despite advances in molecular profiling, surgical techniques, and neuro-imaging, there have been no major breakthroughs in radiotherapy (RT) volumes in decades. Although the majority of recurrences occur within the original gross tumor volume (GTV), treatment of a clinical target volume (CTV) ranging from 1.5 to 3.0 cm beyond the GTV remains the standard of care. Over the past 15 years, the incorporation of standard and functional MRI sequences into the treatment workflow has become a routine practice with increasing adoption of MR simulators, and new integrated MR-Linac technologies allowing for daily pre-, intra- and post-treatment MR imaging. There is now unprecedented ability to understand the tumor dynamics and biology of GBM during RT, and safe CTV margin reduction is being investigated with the goal of improving the therapeutic ratio. The purpose of this review is to discuss margin strategies and the potential for adaptive RT for GBM, with a focus on the challenges and opportunities associated with both online and offline adaptive workflows. Lastly, opportunities to biologically guide adaptive RT using non-invasive imaging biomarkers and the potential to define appropriate volumes for dose modification will be discussed.
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Affiliation(s)
- Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - K Liang Zeng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Simcoe Muskoka Regional Cancer Program, Royal Victoria Regional Health Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eric A Mellon
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Angus Z Lau
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Natalia S Lutsik
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Rachel W Chan
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Pejman J Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Wu J, Huang Q, Shen Y, Guo P, Zhou J, Jiang S. Radiomic feature reliability of amide proton transfer-weighted MR images acquired with compressed sensing at 3T. INTERNATIONAL JOURNAL OF IMAGING SYSTEMS AND TECHNOLOGY 2024; 34:e23027. [PMID: 39185083 PMCID: PMC11343505 DOI: 10.1002/ima.23027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 01/08/2024] [Indexed: 08/27/2024]
Abstract
Compressed sensing (CS) is a novel technique for MRI acceleration. The purpose of this paper was to assess the effects of CS on the radiomic features extracted from amide proton transfer-weighted (APTw) images. Brain tumor MRI data of 40 scans were studied. Standard images using sensitivity encoding (SENSE) with an acceleration factor (AF) of 2 were used as the gold standard, and APTw images using SENSE with CS (CS-SENSE) with an AF of 4 were assessed. Regions of interest (ROIs), including normal tissue, edema, liquefactive necrosis, and tumor, were manually drawn, and the effects of CS-SENSE on radiomics were assessed for each ROI category. An intraclass correlation coefficient (ICC) was first calculated for each feature extracted from APTw images with SENSE and CS-SENSE for all ROIs. Different filters were applied to the original images, and the effects of these filters on the ICCs were further compared between APTw images with SENSE and CS-SENSE. Feature deviations were also provided for a more comprehensive evaluation of the effects of CS-SENSE on radiomic features. The ROI-based comparison showed that most radiomic features extracted from CS-SENSE-APTw images and SENSE-APTw images had moderate or greater reliabilities (ICC ≥ 0.5) for all four ROIs and all eight image sets with different filters. Tumor showed significantly higher ICCs than normal tissue, edema, and liquefactive necrosis. Compared to the original images, filters (such as Exponential or Square) may improve the reliability of radiomic features extracted from CS-SENSE-APTw and SENSE-APTw images.
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Affiliation(s)
- Jingpu Wu
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Applied Mathematics and Statistics, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Qianqi Huang
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yiqing Shen
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Pengfei Guo
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jinyuan Zhou
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Department of Radiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Wu Y, Wood TC, Derks SHAE, Pruis IJ, van der Voort S, van Zanten SEMV, Smits M, Warnert EAH. Reproducibility of APT-weighted CEST-MRI at 3T in healthy brain and tumor across sessions and scanners. Sci Rep 2023; 13:18115. [PMID: 37872418 PMCID: PMC10593824 DOI: 10.1038/s41598-023-44891-0] [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: 05/17/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Amide proton transfer (APT)-weighted chemical exchange saturation transfer (CEST) imaging is a recent MRI technique making its way into clinical application. In this work, we investigated whether APT-weighted CEST imaging can provide reproducible measurements across scan sessions and scanners. Within-session, between-session and between scanner reproducibility was calculated for 19 healthy volunteers and 7 patients with a brain tumor on two 3T MRI scanners. The APT-weighted CEST effect was evaluated by calculating the Lorentzian Difference (LD), magnetization transfer ratio asymmetry (MTRasym), and relaxation-compensated inverse magnetization transfer ratio (MTRREX) averaged in whole brain white matter (WM), enhancing tumor and necrosis. Within subject coefficient of variation (COV) calculations, Bland-Altman plots and mixed effect modeling were performed to assess the repeatability and reproducibility of averaged values. The group median COVs of LD APT were 0.56% (N = 19), 0.84% (N = 6), 0.80% (N = 9) in WM within-session, between-session and between-scanner respectively. The between-session COV of LD APT in enhancing tumor (N = 6) and necrotic core (N = 3) were 4.57% and 5.67%, respectively. There were no significant differences in within session, between session and between scanner comparisons of the APT effect. The COVs of LD and MTRREX were consistently lower than MTRasym in all experiments, both in healthy tissues and tumor. The repeatability and reproducibility of APT-weighted CEST was clinically acceptable across scan sessions and scanners. Although MTRasym is simple to acquire and compute and sufficient to provide robust measurement, it is beneficial to include LD and MTRREX to obtain higher reproducibility for detecting minor signal difference in different tissue types.
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Affiliation(s)
- Yulun Wu
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sophie H A E Derks
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ilanah J Pruis
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sebastian van der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Sophie E M Veldhuijzen van Zanten
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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9
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Nichelli L, Zaiss M, Casagranda S. APT weighted imaging in diffuse gliomas. BJR Open 2023; 5:20230025. [PMID: 37942492 PMCID: PMC10630980 DOI: 10.1259/bjro.20230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 11/10/2023] Open
Abstract
Amide proton transfer-weighted (APTw) imaging is a non-invasive molecular MRI technique with a wide range of applications in neuroradiology and particularly neuro-oncology imaging. More than 15 years of pre-clinical experiments and clinical studies have demonstrated that APTw metrics are reproducible and reliable, leading to large-scale clinical acceptance. At present, major vendors of MRI scanners provide APTw sequences upon request. However, most neuroradiologists are unfamiliar with this advanced MRI contrast, its related metrics, and its established added value to patient care. In this manuscript, we present the APTw contrast and illustrate its clinical potential for glioma patients, before and after tumor therapy. We also show common artifacts of APTw imaging and discuss potential limitations and future refinements. Our goal is to suggest how this emerging technique can aid in diffuse gliomas work-up.
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Affiliation(s)
- Lucia Nichelli
- Department of Neuroradiology, Sorbonne Université, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Paris, France
| | - Moritz Zaiss
- Department of Neuroradiology, University Clinic Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Stefano Casagranda
- Department of Research & Development Advanced Applications, Olea Medical, La Ciotat, France
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10
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von Knebel Doeberitz N, Kroh F, König L, Boyd PS, Graß S, Bauspieß C, Scherer M, Unterberg A, Bendszus M, Wick W, Bachert P, Debus J, Ladd ME, Schlemmer HP, Goerke S, Korzowski A, Paech D. Post-Surgical Depositions of Blood Products Are No Major Confounder for the Diagnostic and Prognostic Performance of CEST MRI in Patients with Glioma. Biomedicines 2023; 11:2348. [PMID: 37760790 PMCID: PMC10525358 DOI: 10.3390/biomedicines11092348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
Amide proton transfer (APT) and semi-solid magnetization transfer (ssMT) imaging can predict clinical outcomes in patients with glioma. However, the treatment of brain tumors is accompanied by the deposition of blood products within the tumor area in most cases. For this reason, the objective was to assess whether the diagnostic interpretation of the APT and ssMT is affected by methemoglobin (mHb) and hemosiderin (Hs) depositions at the first follow-up MRI 4 to 6 weeks after the completion of radiotherapy. A total of 34 participants underwent APT and ssMT imaging by applying reconstruction methods described by Zhou et al. (APTwasym), Goerke et al. (MTRRexAPT and MTRRexMT) and Mehrabian et al. (MTconst). Contrast-enhancing tumor (CE), whole tumor (WT), mHb and Hs were segmented on contrast-enhanced T1wCE, T2w-FLAIR, T1w and T2*w images. ROC-analysis, Kaplan-Meier analysis and the log rank test were used to test for the association of mean contrast values with therapy response and overall survival (OS) before (WT and CE) and after correcting tumor volumes for mHb and Hs (CEC and WTC). CEC showed higher associations of the MTRRexMT with therapy response (CE: AUC = 0.677, p = 0.081; CEC: AUC = 0.705, p = 0.044) and of the APTwasym with OS (CE: HR = 2.634, p = 0.040; CEC: HR = 2.240, p = 0.095). In contrast, WTC showed a lower association of the APTwasym with survival (WT: HR = 2.304, p = 0.0849; WTC: HR = 2.990, p = 0.020). Overall, a sophisticated correction for blood products did not substantially influence the clinical performance of APT and ssMT imaging in patients with glioma early after radiotherapy.
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Affiliation(s)
| | - Florian Kroh
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philip S. Boyd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Svenja Graß
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Cora Bauspieß
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Neuroradiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Wolfgang Wick
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Neurology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Mark E. Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
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11
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Chen L, Li T, Li Y, Zhang J, Li S, Zhu L, Qin J, Tang L, Zeng Z. Combining amide proton transfer-weighted and arterial spin labeling imaging to differentiate solitary brain metastases from glioblastomas. Magn Reson Imaging 2023; 102:96-102. [PMID: 37172748 DOI: 10.1016/j.mri.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate the clinical utility of amide proton transfer-weighted imaging (APTw) and arterial spin labeling (ASL) in differentiating solitary brain metastases (SBMs) from glioblastomas (GBMs). METHODS Forty-eight patients diagnosed with brain tumors were enrolled. All patients underwent conventional MRI, APTw, and ASL scans on a 3.0 T MRI system. The mean APTw value and mean cerebral blood flow (CBF) value were measured. The differences in various parameters between GBMs and SBMs were assessed using the independent-samples t-test. The quantitative performance of these MRI parameters in distinguishing between GBMs and SBMs was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS GBMs exhibited significantly higher APTw and CBF values in peritumoral regions compared with SBMs (P < 0.05). There was no significant difference between SBMs and GBMs in tumor cores. APTw MRI had a higher diagnostic efficiency in differentiating SBMs from GBMs (area under the curve [AUC]: 0.864; 75.0% sensitivity and 81.8% specificity). Combined use of APTw and CBF value increased the AUC to 0.927. CONCLUSION APTw may be superior to ASL for distinguishing between SBMs and GBMs. Combination of APTw and ASL showed better discrimination and a superior diagnostic performance.
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Affiliation(s)
- Ling Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, Guangxi 530021, China; Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Tao Li
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Yao Li
- Department of Neurosurgery, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Jinhuan Zhang
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Shuanghong Li
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Li Zhu
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Jianli Qin
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Lifang Tang
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Zisan Zeng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, Guangxi 530021, China.
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12
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Knebel Doeberitz NV, Kroh F, Breitling J, König L, Maksimovic S, Graß S, Adeberg S, Scherer M, Unterberg A, Bendszus M, Wick W, Bachert P, Debus J, Ladd ME, Schlemmer HP, Korzowski A, Goerke S, Paech D. CEST Imaging of the APT and ssMT predict the overall survival of patients with glioma at the first follow-up after completion of radiotherapy at 3T. Radiother Oncol 2023; 184:109694. [PMID: 37150450 DOI: 10.1016/j.radonc.2023.109694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Outcome prediction of patients with glioma early after the completion of radiotherapy represents a major clinical challenge. Previously, the prognostic value of chemical exchange saturation transfer (CEST) imaging has been demonstrated in patients with newly diagnosed glioma. The objective of this study was to assess the potential of amide proton transfer (APT)-, relayed nuclear Overhauser effect (rNOE)- and semi-solid magnetization transfer (ssMT)-imaging according to Zhou et al. (APTwasym), Goerke et al. (MTRRexAPT, MTRRexNOE and MTRRexMT) and Mehrabian et al. (PeakAreaAPT, PeakAreaNOE and MTconst) for the prognostication of the overall survival (OS) of patients with glioma at the first follow-up after the completion of radiotherapy. MATERIALS AND METHODS 49 of 72 participants with diffuse glioma, who underwent CEST MRI at 3T between July 2018 and December 2021 4 to 6 weeks after the completion of radiotherapy, were analyzed. Contrast-enhancing tumor (CE) and whole tumor (WT) volumes were segmented on T2w-FLAIR and contrast-enhanced T1w images. Kaplan-Meier analysis and logrank-test were used for statistical analyses. RESULTS APTw imaging demonstrated the strongest association with OS (HR=4.66, p<0.001). The MTconst (HR=2.54, p=0.044) was associated with the OS of participants with residual contrast-enhancing glioma tissue, whilst the MTRRexAPT (HR=2.44, p=0.056) showed a trend in this sub-cohort. The MTRRexNOE, MTRRexMT and PeakAreaNOE were not associated with survival. CONCLUSION Imaging of the APT and ssMT at the first follow-up 4 to 6 weeks after the completion of radiotherapy at 3T were associated with the overall survival of patients with glioma.
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Affiliation(s)
| | - Florian Kroh
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Johannes Breitling
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Srdjan Maksimovic
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Svenja Graß
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
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13
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3D Amide Proton Transfer-Weighted Imaging for Grading Glioma and Correlating IDH Mutation Status: Added Value to 3D Pseudocontinuous Arterial Spin Labelling Perfusion. Mol Imaging Biol 2023; 25:343-352. [PMID: 35962302 DOI: 10.1007/s11307-022-01762-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The goal of this study was to evaluate the diagnostic performance of 3D amide proton transfer-weighted (3D-APTW) imaging and 3D pseudocontinuous arterial spin labelling (3D-pCASL) alone and in combination in grading gliomas (low-grade glioma (LGG) vs. high-grade glioma (HGG)) and correlating isocitrate dehydrogenase (IDH) mutation status. PROCEDURES Preoperatively, 81 patients with pathologically confirmed gliomas underwent 3.0-T magnetic resonance imaging (MRI) examinations. The APTW, relative APTW (rAPTW), cerebral blood flow (CBF), and relative CBF (rCBF) values were calculated to evaluate the solid components of the tumours. The MRI parameters were compared in the classification of gliomas by independent- and paired-samples t tests. A receiver operating characteristic (ROC) curve was constructed, and the area under the ROC curve (AUC) was calculated to assess the diagnostic performance of each parameter and the combination of the rAPTW and rCBF values. RESULTS Patients with HGG showed significantly higher APTW, rAPTW, CBF, and rCBF values than those with LGG (all p < 0.001). In the ROC curve analysis, the AUC of rAPTW was the highest at 0.90. By adding the rAPTW signal to the rCBF values, the diagnostic ability of the combined parameters improved from 0.90 to 0.96. The rAPTW value yielded the highest AUC (0.92) in correlating the IDH mutation status, and the diagnostic ability improved to 0.96 by adding it to the rCBF value. CONCLUSION 3D-APTW imaging combined with 3D-pCASL imaging may be used to aid assessment of grading glioma and IDH mutation status.
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14
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Jackson LR, Masi MR, Selman BM, Sandusky GE, Zarrinmayeh H, Das SK, Maharjan S, Wang N, Zheng QH, Pollok KE, Snyder SE, Sun PZ, Hutchins GD, Butch ER, Veronesi MC. Use of multimodality imaging, histology, and treatment feasibility to characterize a transgenic Rag2-null rat model of glioblastoma. Front Oncol 2022; 12:939260. [PMID: 36483050 PMCID: PMC9722958 DOI: 10.3389/fonc.2022.939260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/20/2022] [Indexed: 11/23/2022] Open
Abstract
Many drugs that show potential in animal models of glioblastoma (GBM) fail to translate to the clinic, contributing to a paucity of new therapeutic options. In addition, animal model development often includes histologic assessment, but multiparametric/multimodality imaging is rarely included despite increasing utilization in patient cancer management. This study developed an intracranial recurrent, drug-resistant, human-derived glioblastoma tumor in Sprague-Dawley Rag2-Rag2 tm1Hera knockout rat and was characterized both histologically and using multiparametric/multimodality neuroimaging. Hybrid 18F-fluoroethyltyrosine positron emission tomography and magnetic resonance imaging, including chemical exchange saturation transfer (18F-FET PET/CEST MRI), was performed for full tumor viability determination and characterization. Histological analysis demonstrated human-like GBM features of the intracranially implanted tumor, with rapid tumor cell proliferation (Ki67 positivity: 30.5 ± 7.8%) and neovascular heterogeneity (von Willebrand factor VIII:1.8 to 5.0% positivity). Early serial MRI followed by simultaneous 18F-FET PET/CEST MRI demonstrated consistent, predictable tumor growth, with exponential tumor growth most evident between days 35 and 49 post-implantation. In a second, larger cohort of rats, 18F-FET PET/CEST MRI was performed in mature tumors (day 49 post-implantation) for biomarker determination, followed by evaluation of single and combination therapy as part of the model development and validation. The mean percentage of the injected dose per mL of 18F-FET PET correlated with the mean %CEST (r = 0.67, P < 0.05), but there was also a qualitative difference in hot spot location within the tumor, indicating complementary information regarding the tumor cell demand for amino acids and tumor intracellular mobile phase protein levels. Finally, the use of this glioblastoma animal model for therapy assessment was validated by its increased overall survival after treatment with combination therapy (temozolomide and idasanutlin) (P < 0.001). Our findings hold promise for a more accurate tumor viability determination and novel therapy assessment in vivo in a recently developed, reproducible, intracranial, PDX GBM.
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Affiliation(s)
- Luke R. Jackson
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Megan R. Masi
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Bryce M. Selman
- Department of Pathology and Laboratory Medicine, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - George E. Sandusky
- Department of Pathology and Laboratory Medicine, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Hamideh Zarrinmayeh
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Sudip K. Das
- Department of Pharmaceutical Sciences, Butler University, Indianapolis, IN, United States
| | - Surendra Maharjan
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Nian Wang
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Qi-Huang Zheng
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Karen E. Pollok
- Department of Pediatrics, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Scott E. Snyder
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Phillip Zhe Sun
- Department of Radiology and Imaging Sciences, Emory School of Medicine, Atlanta, GA, United States
| | - Gary D. Hutchins
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Elizabeth R. Butch
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States
| | - Michael C. Veronesi
- Department of Radiology and Imaging Sciences, Indiana University (IU) School of Medicine, Indianapolis, IN, United States,*Correspondence: Michael C. Veronesi,
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15
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B 0 Correction for 3T Amide Proton Transfer (APT) MRI Using a Simplified Two-Pool Lorentzian Model of Symmetric Water and Asymmetric Solutes. Tomography 2022; 8:1974-1986. [PMID: 36006063 PMCID: PMC9412582 DOI: 10.3390/tomography8040165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/16/2022] Open
Abstract
Amide proton transfer (APT)-weighted MRI is a promising molecular imaging technique that has been employed in clinic for detection and grading of brain tumors. MTRasym, the quantification method of APT, is easily influenced by B0 inhomogeneity and causes artifacts. Current model-free interpolation methods have enabled moderate B0 correction for middle offsets, but have performed poorly at limbic offsets. To address this shortcoming, we proposed a practical B0 correction approach that is suitable under time-limited sparse acquisition scenarios and for B1 ≥ 1 μT under 3T. In this study, this approach employed a simplified Lorentzian model containing only two pools of symmetric water and asymmetric solutes, to describe the Z-spectral shape with wide and ‘invisible’ CEST peaks. The B0 correction was then performed on the basis of the fitted two-pool Lorentzian lines, instead of using conventional model-free interpolation. The approach was firstly evaluated on densely sampled Z-spectra data by using the spline interpolation of all acquired 16 offsets as the gold standard. When only six offsets were available for B0 correction, our method outperformed conventional methods. In particular, the errors at limbic offsets were significantly reduced (n = 8, p < 0.01). Secondly, our method was assessed on the six-offset APT data of nine brain tumor patients. Our MTRasym (3.5 ppm), using the two-pool model, displayed a similar contrast to the vendor-provided B0-orrected MTRasym (3.5 ppm). While the vendor failed in correcting B0 at 4.3 and 2.7 ppm for a large portion of voxels, our method enabled well differentiation of B0 artifacts from tumors. In conclusion, the proposed approach could alleviate analysis errors caused by B0 inhomogeneity, which is useful for facilitating the comprehensive metabolic analysis of brain tumors.
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Yao J, Hagiwara A, Oughourlian TC, Wang C, Raymond C, Pope WB, Salamon N, Lai A, Ji M, Nghiemphu PL, Liau LM, Cloughesy TF, Ellingson BM. Diagnostic and Prognostic Value of pH- and Oxygen-Sensitive Magnetic Resonance Imaging in Glioma: A Retrospective Study. Cancers (Basel) 2022; 14:2520. [PMID: 35626127 PMCID: PMC9139712 DOI: 10.3390/cancers14102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 01/19/2023] Open
Abstract
Characterization of hypoxia and tissue acidosis could advance the understanding of glioma biology and improve patient management. In this study, we evaluated the ability of a pH- and oxygen-sensitive magnetic resonance imaging (MRI) technique to differentiate glioma genotypes, including isocitrate dehydrogenase (IDH) mutation, 1p/19q co-deletion, and epidermal growth factor receptor (EGFR) amplification, and investigated its prognostic value. A total of 159 adult glioma patients were scanned with pH- and oxygen-sensitive MRI at 3T. We quantified the pH-sensitive measure of magnetization transfer ratio asymmetry (MTRasym) and oxygen-sensitive measure of R2’ within the tumor region-of-interest. IDH mutant gliomas showed significantly lower MTRasym × R2’ (p < 0.001), which differentiated IDH mutation status with sensitivity and specificity of 90.0% and 71.9%. Within IDH mutants, 1p/19q codeletion was associated with lower tumor acidity (p < 0.0001, sensitivity 76.9%, specificity 91.3%), while IDH wild-type, EGFR-amplified gliomas were more hypoxic (R2’ p = 0.024, sensitivity 66.7%, specificity 76.9%). Both R2’ and MTRasym × R2’ were significantly associated with patient overall survival (R2’: p = 0.045; MTRasym × R2’: p = 0.002) and progression-free survival (R2’: p = 0.010; MTRasym × R2’: p < 0.0001), independent of patient age, treatment status, and IDH status. The pH- and oxygen-sensitive MRI is a clinically feasible and potentially valuable imaging technique for distinguishing glioma subtypes and providing additional prognostic value to clinical practice.
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Affiliation(s)
- Jingwen Yao
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA 90024, USA; (J.Y.); (A.H.); (T.C.O.); (C.W.); (C.R.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA 90024, USA; (J.Y.); (A.H.); (T.C.O.); (C.W.); (C.R.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
| | - Talia C. Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA 90024, USA; (J.Y.); (A.H.); (T.C.O.); (C.W.); (C.R.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
- Neuroscience Interdepartmental Program, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Chencai Wang
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA 90024, USA; (J.Y.); (A.H.); (T.C.O.); (C.W.); (C.R.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA 90024, USA; (J.Y.); (A.H.); (T.C.O.); (C.W.); (C.R.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
| | - Whitney B. Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
| | - Noriko Salamon
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
| | - Albert Lai
- UCLA Neuro-Oncology Program, University of California, Los Angeles, CA 90024, USA; (A.L.); (M.J.); (P.L.N.); (T.F.C.)
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Matthew Ji
- UCLA Neuro-Oncology Program, University of California, Los Angeles, CA 90024, USA; (A.L.); (M.J.); (P.L.N.); (T.F.C.)
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Phioanh L. Nghiemphu
- UCLA Neuro-Oncology Program, University of California, Los Angeles, CA 90024, USA; (A.L.); (M.J.); (P.L.N.); (T.F.C.)
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Linda M. Liau
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA;
| | - Timothy F. Cloughesy
- UCLA Neuro-Oncology Program, University of California, Los Angeles, CA 90024, USA; (A.L.); (M.J.); (P.L.N.); (T.F.C.)
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA
| | - Benjamin M. Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA 90024, USA; (J.Y.); (A.H.); (T.C.O.); (C.W.); (C.R.)
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA; (W.B.P.); (N.S.)
- UCLA Neuro-Oncology Program, University of California, Los Angeles, CA 90024, USA; (A.L.); (M.J.); (P.L.N.); (T.F.C.)
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17
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Shaffer A, Kwok SS, Naik A, Anderson AT, Lam F, Wszalek T, Arnold PM, Hassaneen W. Ultra-High-Field MRI in the Diagnosis and Management of Gliomas: A Systematic Review. Front Neurol 2022; 13:857825. [PMID: 35449515 PMCID: PMC9016277 DOI: 10.3389/fneur.2022.857825] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/02/2022] [Indexed: 12/03/2022] Open
Abstract
Importance: Gliomas, tumors of the central nervous system, are classically diagnosed through invasive surgical biopsy and subsequent histopathological study. Innovations in ultra-high field (UHF) imaging, namely 7-Tesla magnetic resonance imaging (7T MRI) are advancing preoperative tumor grading, visualization of intratumoral structures, and appreciation of small brain structures and lesions. Objective Summarize current innovative uses of UHF imaging techniques in glioma diagnostics and treatment. Methods A systematic review in accordance with PRISMA guidelines was performed utilizing PubMed. Case reports and series, observational clinical trials, and randomized clinical trials written in English were included. After removing unrelated studies and those with non-human subjects, only those related to 7T MRI were independently reviewed and summarized for data extraction. Some preclinical animal models are briefly described to demonstrate future usages of ultra-high-field imaging. Results We reviewed 46 studies (43 human and 3 animal models) which reported clinical usages of UHF MRI in the diagnosis and management of gliomas. Current literature generally supports greater resolution imaging from 7T compared to 1.5T or 3T MRI, improving visualization of cerebral microbleeds and white and gray matter, and providing more precise localization for radiotherapy targeting. Additionally, studies found that diffusion or susceptibility-weighted imaging techniques applied to 7T MRI, may be used to predict tumor grade, reveal intratumoral structures such as neovasculature and microstructures like axons, and indicate isocitrate dehydrogenase 1 mutation status in preoperative imaging. Similarly, newer imaging techniques such as magnetic resonance spectroscopy and chemical exchange saturation transfer imaging can be performed on 7T MRI to predict tumor grading and treatment efficacy. Geometrical distortion, a known challenge of 7T MRI, was at a tolerable level in all included studies. Conclusion UHF imaging has the potential to preoperatively and non-invasively grade gliomas, provide precise therapy target areas, and visualize lesions not seen on conventional MRI.
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Affiliation(s)
- Annabelle Shaffer
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Susanna S Kwok
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Anant Naik
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Aaron T Anderson
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Carle Illinois Advanced Imaging Center, University of Illinois and Carle Health, Urbana, IL, United States
| | - Fan Lam
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Department of Bioengineering, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Tracey Wszalek
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Carle Illinois Advanced Imaging Center, University of Illinois and Carle Health, Urbana, IL, United States
| | - Paul M Arnold
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Carle Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, United States
| | - Wael Hassaneen
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Champaign, IL, United States.,Carle Department of Neurosurgery, Carle Foundation Hospital, Urbana, IL, United States
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18
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Zhou J, Zaiss M, Knutsson L, Sun PZ, Ahn SS, Aime S, Bachert P, Blakeley JO, Cai K, Chappell MA, Chen M, Gochberg DF, Goerke S, Heo HY, Jiang S, Jin T, Kim SG, Laterra J, Paech D, Pagel MD, Park JE, Reddy R, Sakata A, Sartoretti-Schefer S, Sherry AD, Smith SA, Stanisz GJ, Sundgren PC, Togao O, Vandsburger M, Wen Z, Wu Y, Zhang Y, Zhu W, Zu Z, van Zijl PCM. Review and consensus recommendations on clinical APT-weighted imaging approaches at 3T: Application to brain tumors. Magn Reson Med 2022; 88:546-574. [PMID: 35452155 PMCID: PMC9321891 DOI: 10.1002/mrm.29241] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
Abstract
Amide proton transfer-weighted (APTw) MR imaging shows promise as a biomarker of brain tumor status. Currently used APTw MRI pulse sequences and protocols vary substantially among different institutes, and there are no agreed-on standards in the imaging community. Therefore, the results acquired from different research centers are difficult to compare, which hampers uniform clinical application and interpretation. This paper reviews current clinical APTw imaging approaches and provides a rationale for optimized APTw brain tumor imaging at 3 T, including specific recommendations for pulse sequences, acquisition protocols, and data processing methods. We expect that these consensus recommendations will become the first broadly accepted guidelines for APTw imaging of brain tumors on 3 T MRI systems from different vendors. This will allow more medical centers to use the same or comparable APTw MRI techniques for the detection, characterization, and monitoring of brain tumors, enabling multi-center trials in larger patient cohorts and, ultimately, routine clinical use.
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Affiliation(s)
- Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moritz Zaiss
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Institute of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Linda Knutsson
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Medical Radiation Physics, Lund University, Lund, Sweden.,F.M. Kirby Research Center for Functional Brain Imaging, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| | - Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Silvio Aime
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Peter Bachert
- Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kejia Cai
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael A Chappell
- Mental Health and Clinical Neurosciences and Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daniel F Gochberg
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physics, Vanderbilt University, Nashville, Tennessee, USA
| | - Steffen Goerke
- Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tao Jin
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science and Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - John Laterra
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.,Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Mark D Pagel
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ravinder Reddy
- Center for Advance Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - A Dean Sherry
- Advanced Imaging Research Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Chemistry and Biochemistry, University of Texas at Dallas, Richardson, Texas, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Greg J Stanisz
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Pia C Sundgren
- Department of Diagnostic Radiology/Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Bioimaging Center, Lund University, Lund, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Osamu Togao
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yin Wu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter C M van Zijl
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
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19
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Booth TC, Wiegers EC, Warnert EAH, Schmainda KM, Riemer F, Nechifor RE, Keil VC, Hangel G, Figueiredo P, Álvarez-Torres MDM, Henriksen OM. High-Grade Glioma Treatment Response Monitoring Biomarkers: A Position Statement on the Evidence Supporting the Use of Advanced MRI Techniques in the Clinic, and the Latest Bench-to-Bedside Developments. Part 2: Spectroscopy, Chemical Exchange Saturation, Multiparametric Imaging, and Radiomics. Front Oncol 2022; 11:811425. [PMID: 35340697 PMCID: PMC8948428 DOI: 10.3389/fonc.2021.811425] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/28/2021] [Indexed: 01/16/2023] Open
Abstract
Objective To summarize evidence for use of advanced MRI techniques as monitoring biomarkers in the clinic, and to highlight the latest bench-to-bedside developments. Methods The current evidence regarding the potential for monitoring biomarkers was reviewed and individual modalities of metabolism and/or chemical composition imaging discussed. Perfusion, permeability, and microstructure imaging were similarly analyzed in Part 1 of this two-part review article and are valuable reading as background to this article. We appraise the clinic readiness of all the individual modalities and consider methodologies involving machine learning (radiomics) and the combination of MRI approaches (multiparametric imaging). Results The biochemical composition of high-grade gliomas is markedly different from healthy brain tissue. Magnetic resonance spectroscopy allows the simultaneous acquisition of an array of metabolic alterations, with choline-based ratios appearing to be consistently discriminatory in treatment response assessment, although challenges remain despite this being a mature technique. Promising directions relate to ultra-high field strengths, 2-hydroxyglutarate analysis, and the use of non-proton nuclei. Labile protons on endogenous proteins can be selectively targeted with chemical exchange saturation transfer to give high resolution images. The body of evidence for clinical application of amide proton transfer imaging has been building for a decade, but more evidence is required to confirm chemical exchange saturation transfer use as a monitoring biomarker. Multiparametric methodologies, including the incorporation of nuclear medicine techniques, combine probes measuring different tumor properties. Although potentially synergistic, the limitations of each individual modality also can be compounded, particularly in the absence of standardization. Machine learning requires large datasets with high-quality annotation; there is currently low-level evidence for monitoring biomarker clinical application. Conclusion Advanced MRI techniques show huge promise in treatment response assessment. The clinical readiness analysis highlights that most monitoring biomarkers require standardized international consensus guidelines, with more facilitation regarding technique implementation and reporting in the clinic.
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Affiliation(s)
- Thomas C. Booth
- School of Biomedical Engineering and Imaging Sciences, King’s College London, St. Thomas’ Hospital, London, United Kingdom
- Department of Neuroradiology, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Evita C. Wiegers
- Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Kathleen M. Schmainda
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Frank Riemer
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Ruben E. Nechifor
- Department of Clinical Psychology and Psychotherapy International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Vera C. Keil
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location VUmc, Amsterdam, Netherlands
| | - Gilbert Hangel
- Department of Neurosurgery & High-Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University Vienna, Vienna, Austria
| | - Patrícia Figueiredo
- Department of Bioengineering and Institute for Systems and Robotics - Lisboa, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | | | - Otto M. Henriksen
- Department of Clinical Physiology, Nuclear medicine and PET, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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20
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Liu Z, Zou L, Yang Q, Qian L, Li T, Luo H, Che C, Lei Y, Chen P, Qiu C, Liu X, Wu Y, Luo D. Baseline Amide Proton Transfer Imaging at 3T Fails to Predict Early Response to Induction Chemotherapy in Nasopharyngeal Carcinoma. Front Oncol 2022; 12:822756. [PMID: 35211414 PMCID: PMC8861375 DOI: 10.3389/fonc.2022.822756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Early identification of nasopharyngeal carcinoma (NPC) patients with high risk of failure to induction chemotherapy (IC) would facilitate prompt individualized treatment decisions and thus reduce toxicity and improve overall survival rate. This study aims to investigate the value of amide proton transfer (APT) imaging in predicting short-term response of NPC to IC and its potential correlation with well-established prognosis-related clinical characteristics. Methods and Materials A total of 80 pathologically confirmed NPC patients receiving pre-treatment APT imaging at 3T were retrospectively enrolled. Using asymmetry analysis, APT maps were calculated with mean (APTmean), 90th percentile (APT90) of APT signals in manually segmented NPC measured. APT values were compared among groups with different histopathological subtypes, clinical stages (namely, T, M, N, and overall stages), EBV-related indices (EBV-DNA), or responses to induction chemotherapy, using Mann–Whitney U test or Kruskal–Wallis H test. Results NPC showed significantly higher APTmean than normal nasopharyngeal tissues (1.81 ± 0.62% vs.1.32 ± 0.56%, P <0.001). APT signals showed no significant difference between undifferentiated and differentiated NPC subtypes groups, different EBV-DNA groups, or among T, N, M stages and overall clinical stages of II, III, IVA and IVB (all P >0.05). Similarly, baseline APT-related parameters did not differ significantly among different treatment response groups after IC, no matter if evaluated with RECIST criteria or sum volumetric regression ratio (SVRR) (all P >0.05). Conclusion NPC showed significantly stronger APT effect than normal nasopharyngeal tissue, facilitating NPC lesion detection and early identification. However, stationary baseline APT values exhibited no significant correlation with histologic subtypes, clinical stages and EBV-related indices, and showed limited value to predict short-term treatment response to IC.
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Affiliation(s)
- Zhou Liu
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Liyan Zou
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Qian Yang
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Long Qian
- MR Research, GE Healthcare, Beijing, China
| | - Tianran Li
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Honghong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Canwen Che
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yuanyuan Lei
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Peng Chen
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Chunyan Qiu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xin Liu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yin Wu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Dehong Luo
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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21
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Huang J, Chen Z, Park SW, Lai JHC, Chan KWY. Molecular Imaging of Brain Tumors and Drug Delivery Using CEST MRI: Promises and Challenges. Pharmaceutics 2022; 14:451. [PMID: 35214183 PMCID: PMC8880023 DOI: 10.3390/pharmaceutics14020451] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) detects molecules in their natural forms in a sensitive and non-invasive manner. This makes it a robust approach to assess brain tumors and related molecular alterations using endogenous molecules, such as proteins/peptides, and drugs approved for clinical use. In this review, we will discuss the promises of CEST MRI in the identification of tumors, tumor grading, detecting molecular alterations related to isocitrate dehydrogenase (IDH) and O-6-methylguanine-DNA methyltransferase (MGMT), assessment of treatment effects, and using multiple contrasts of CEST to develop theranostic approaches for cancer treatments. Promising applications include (i) using the CEST contrast of amide protons of proteins/peptides to detect brain tumors, such as glioblastoma multiforme (GBM) and low-grade gliomas; (ii) using multiple CEST contrasts for tumor stratification, and (iii) evaluation of the efficacy of drug delivery without the need of metallic or radioactive labels. These promising applications have raised enthusiasm, however, the use of CEST MRI is not trivial. CEST contrast depends on the pulse sequences, saturation parameters, methods used to analyze the CEST spectrum (i.e., Z-spectrum), and, importantly, how to interpret changes in CEST contrast and related molecular alterations in the brain. Emerging pulse sequence designs and data analysis approaches, including those assisted with deep learning, have enhanced the capability of CEST MRI in detecting molecules in brain tumors. CEST has become a specific marker for tumor grading and has the potential for prognosis and theranostics in brain tumors. With increasing understanding of the technical aspects and associated molecular alterations detected by CEST MRI, this young field is expected to have wide clinical applications in the near future.
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Affiliation(s)
- Jianpan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China; (J.H.); (Z.C.); (S.-W.P.); (J.H.C.L.)
| | - Zilin Chen
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China; (J.H.); (Z.C.); (S.-W.P.); (J.H.C.L.)
| | - Se-Weon Park
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China; (J.H.); (Z.C.); (S.-W.P.); (J.H.C.L.)
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
| | - Joseph H. C. Lai
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China; (J.H.); (Z.C.); (S.-W.P.); (J.H.C.L.)
| | - Kannie W. Y. Chan
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong, China; (J.H.); (Z.C.); (S.-W.P.); (J.H.C.L.)
- Hong Kong Centre for Cerebro-Cardiovascular Health Engineering (COCHE), Hong Kong, China
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Shenzhen Research Institute, City University of Hong Kong, Shenzhen 518057, China
- Tung Biomedical Science Centre, City University of Hong Kong, Hong Kong, China
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22
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Lingl JP, Wunderlich A, Goerke S, Paech D, Ladd ME, Liebig P, Pala A, Kim SY, Braun M, Schmitz BL, Beer M, Rosskopf J. The Value of APTw CEST MRI in Routine Clinical Assessment of Human Brain Tumor Patients at 3T. Diagnostics (Basel) 2022; 12:diagnostics12020490. [PMID: 35204583 PMCID: PMC8871436 DOI: 10.3390/diagnostics12020490] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Background. With fast-growing evidence in literature for clinical applications of chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI), this prospective study aimed at applying amide proton transfer-weighted (APTw) CEST imaging in a clinical setting to assess its diagnostic potential in differentiation of intracranial tumors at 3 tesla (T). Methods. Using the asymmetry magnetization transfer ratio (MTRasym) analysis, CEST signals were quantitatively investigated in the tumor areas and in a similar sized region of the normal-appearing white matter (NAWM) on the contralateral hemisphere of 27 patients with intracranial tumors. Area under curve (AUC) analyses were used and results were compared to perfusion-weighted imaging (PWI). Results. Using APTw CEST, contrast-enhancing tumor areas showed significantly higher APTw CEST metrics than contralateral NAWM (AUC = 0.82; p < 0.01). In subgroup analyses of each tumor entity vs. NAWM, statistically significant effects were yielded for glioblastomas (AUC = 0.96; p < 0.01) and for meningiomas (AUC = 1.0; p < 0.01) but not for lymphomas as well as metastases (p > 0.05). PWI showed results comparable to APTw CEST in glioblastoma (p < 0.01). Conclusions. This prospective study confirmed the high diagnostic potential of APTw CEST imaging in a routine clinical setting to differentiate brain tumors.
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Affiliation(s)
- Julia P. Lingl
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
| | - Arthur Wunderlich
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
| | - Steffen Goerke
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (S.G.); (M.E.L.)
| | - Daniel Paech
- German Cancer Research Center (DKFZ), Division of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
- Department of Neuroradiology, Venusberg-Campus 1, Bonn University, 53127 Bonn, Germany
| | - Mark E. Ladd
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (S.G.); (M.E.L.)
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany
| | - Patrick Liebig
- Siemens Healthcare GmbH, Henkestraße 127, 91052 Erlangen, Germany;
| | - Andrej Pala
- Department of Neurosurgery, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany;
| | - Soung Yung Kim
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
| | - Michael Braun
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
| | - Bernd L. Schmitz
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
| | - Meinrad Beer
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
| | - Johannes Rosskopf
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
- Correspondence:
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23
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Zhou Q, Xue C, Ke X, Zhou J. Treatment Response and Prognosis Evaluation in High-Grade Glioma: An Imaging Review Based on MRI. J Magn Reson Imaging 2022; 56:325-340. [PMID: 35129845 DOI: 10.1002/jmri.28103] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
In recent years, the development of advanced magnetic resonance imaging (MRI) technology and machine learning (ML) have created new tools for evaluating treatment response and prognosis of patients with high-grade gliomas (HGG); however, patient prognosis has not improved significantly. This is mainly due to the heterogeneity between and within HGG tumors, resulting in standard treatment methods not benefitting all patients. Moreover, the survival of patients with HGG is not only related to tumor cells, but also to noncancer cells in the tumor microenvironment (TME). Therefore, during preoperative diagnosis and follow-up treatment of patients with HGG, noninvasive imaging markers are needed to characterize intratumoral heterogeneity, and then to evaluate treatment response and predict prognosis, timeously adjust treatment strategies, and achieve individualized diagnosis and treatment. In this review, we summarize the research progress of conventional MRI, advanced MRI technology, and ML in evaluation of treatment response and prognosis of patients with HGG. We further discuss the significance of the TME in the prognosis of HGG patients, associate imaging features with the TME, indirectly reflecting the heterogeneity within the tumor, and shifting treatment strategies from tumor cells alone to systemic therapy of the TME, which may be a major development direction in the future. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 4.
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Affiliation(s)
- Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Second Clinical School, Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
| | - Caiqiang Xue
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Second Clinical School, Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
| | - Xiaoai Ke
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
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24
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Tang PLY, Méndez Romero A, Jaspers JPM, Warnert EAH. The potential of advanced MR techniques for precision radiotherapy of glioblastoma. MAGMA (NEW YORK, N.Y.) 2022; 35:127-143. [PMID: 35129718 PMCID: PMC8901515 DOI: 10.1007/s10334-021-00997-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
As microscopic tumour infiltration of glioblastomas is not visible on conventional magnetic resonance (MR) imaging, an isotropic expansion of 1-2 cm around the visible tumour is applied to define the clinical target volume for radiotherapy. An opportunity to visualize microscopic infiltration arises with advanced MR imaging. In this review, various advanced MR biomarkers are explored that could improve target volume delineation for radiotherapy of glioblastomas. Various physiological processes in glioblastomas can be visualized with different advanced MR techniques. Combining maps of oxygen metabolism (CMRO2), relative cerebral blood volume (rCBV), vessel size imaging (VSI), and apparent diffusion coefficient (ADC) or amide proton transfer (APT) can provide early information on tumour infiltration and high-risk regions of future recurrence. Oxygen consumption is increased 6 months prior to tumour progression being visible on conventional MR imaging. However, presence of the Warburg effect, marking a switch from an infiltrative to a proliferative phenotype, could result in CMRO2 to appear unaltered in high-risk regions. Including information on biomarkers representing angiogenesis (rCBV and VSI) and hypercellularity (ADC) or protein concentration (APT) can omit misinterpretation due to the Warburg effect. Future research should evaluate these biomarkers in radiotherapy planning to explore the potential of advanced MR techniques to personalize target volume delineation with the aim to improve local tumour control and/or reduce radiation-induced toxicity.
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Affiliation(s)
- Patrick L Y Tang
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| | - Alejandra Méndez Romero
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Jaap P M Jaspers
- Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - Esther A H Warnert
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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25
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Wu Y, Wood TC, Arzanforoosh F, Hernandez-Tamames JA, Barker GJ, Smits M, Warnert EAH. 3D APT and NOE CEST-MRI of healthy volunteers and patients with non-enhancing glioma at 3 T. MAGMA (NEW YORK, N.Y.) 2022; 35:63-73. [PMID: 34994858 PMCID: PMC8901510 DOI: 10.1007/s10334-021-00996-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Clinical application of chemical exchange saturation transfer (CEST) can be performed with investigation of amide proton transfer (APT) and nuclear Overhauser enhancement (NOE) effects. Here, we investigated APT- and NOE-weighted imaging based on advanced CEST metrics to map tumor heterogeneity of non-enhancing glioma at 3 T. MATERIALS AND METHODS APT- and NOE-weighted maps based on Lorentzian difference (LD) and inverse magnetization transfer ratio (MTRREX) were acquired with a 3D snapshot CEST acquisition at 3 T. Saturation power was investigated first by varying B1 (0.5-2 µT) in 5 healthy volunteers then by applying B1 of 0.5 and 1.5 µT in 10 patients with non-enhancing glioma. Tissue contrast (TC) and contrast-to-noise ratios (CNR) were calculated between glioma and normal appearing white matter (NAWM) and grey matter, in APT- and NOE-weighted images. Volume percentages of the tumor showing hypo/hyperintensity (VPhypo/hyper,CEST) in APT/NOE-weighted images were calculated for each patient. RESULTS LD APT resulting from using a B1 of 1.5 µT was found to provide significant positive TCtumor,NAWM and MTRREX NOE (B1 of 1.5 µT) provided significant negative TCtumor,NAWM in tissue differentiation. MTRREX-based NOE imaging under 1.5 µT provided significantly larger VPhypo,CEST than MTRREX APT under 1.5 µT. CONCLUSION This work showed that with a rapid CEST acquisition using a B1 saturation power of 1.5 µT and covering the whole tumor, analysis of both LD APT and MTRREX NOE allows for observing tumor heterogeneity, which will be beneficial in future studies using CEST-MRI to improve imaging diagnostics for non-enhancing glioma.
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Affiliation(s)
- Yulun Wu
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Tobias C Wood
- Centre for Neuroimaging Science, King's College London, London, UK
| | - Fatemeh Arzanforoosh
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Juan A Hernandez-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Gareth J Barker
- Centre for Neuroimaging Science, King's College London, London, UK
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther A H Warnert
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
- Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
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26
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Mancini L, Casagranda S, Gautier G, Peter P, Lopez B, Thorne L, McEvoy A, Miserocchi A, Samandouras G, Kitchen N, Brandner S, De Vita E, Torrealdea F, Rega M, Schmitt B, Liebig P, Sanverdi E, Golay X, Bisdas S. CEST MRI provides amide/amine surrogate biomarkers for treatment-naïve glioma sub-typing. Eur J Nucl Med Mol Imaging 2022; 49:2377-2391. [PMID: 35029738 PMCID: PMC9165287 DOI: 10.1007/s00259-022-05676-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Accurate glioma classification affects patient management and is challenging on non- or low-enhancing gliomas. This study investigated the clinical value of different chemical exchange saturation transfer (CEST) metrics for glioma classification and assessed the diagnostic effect of the presence of abundant fluid in glioma subpopulations. METHODS Forty-five treatment-naïve glioma patients with known isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion status received CEST MRI (B1rms = 2μT, Tsat = 3.5 s) at 3 T. Magnetization transfer ratio asymmetry and CEST metrics (amides: offset range 3-4 ppm, amines: 1.5-2.5 ppm, amide/amine ratio) were calculated with two models: 'asymmetry-based' (AB) and 'fluid-suppressed' (FS). The presence of T2/FLAIR mismatch was noted. RESULTS IDH-wild type had higher amide/amine ratio than IDH-mutant_1p/19qcodel (p < 0.022). Amide/amine ratio and amine levels differentiated IDH-wild type from IDH-mutant (p < 0.0045) and from IDH-mutant_1p/19qret (p < 0.021). IDH-mutant_1p/19qret had higher amides and amines than IDH-mutant_1p/19qcodel (p < 0.035). IDH-mutant_1p/19qret with AB/FS mismatch had higher amines than IDH-mutant_1p/19qret without AB/FS mismatch ( < 0.016). In IDH-mutant_1p/19qret, the presence of AB/FS mismatch was closely related to the presence of T2/FLAIR mismatch (p = 0.014). CONCLUSIONS CEST-derived biomarkers for amides, amines, and their ratio can help with histomolecular staging in gliomas without intense contrast enhancement. T2/FLAIR mismatch is reflected in the presence of AB/FS CEST mismatch. The AB/FS CEST mismatch identifies glioma subgroups that may have prognostic and clinical relevance.
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Affiliation(s)
- Laura Mancini
- Box65, Lysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, 8-11 Queen Square, London, WC1N 3BG, UK.
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK.
| | | | | | | | | | - Lewis Thorne
- Department of Neurosurgery, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrew McEvoy
- Department of Neurosurgery, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Anna Miserocchi
- Department of Neurosurgery, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - George Samandouras
- Department of Neurosurgery, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neil Kitchen
- Department of Neurosurgery, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, UCL Queen Square Institute of Neurology, London, UK
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Enrico De Vita
- Box65, Lysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, 8-11 Queen Square, London, WC1N 3BG, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Francisco Torrealdea
- University College Hospital, University College of London Hospitals NHS Foundation Trust, London, UK
| | - Marilena Rega
- University College Hospital, University College of London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Eser Sanverdi
- Box65, Lysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, 8-11 Queen Square, London, WC1N 3BG, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Xavier Golay
- Box65, Lysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, 8-11 Queen Square, London, WC1N 3BG, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Sotirios Bisdas
- Box65, Lysholm Department of Neuroradiology, The National Hospital for Neurology & Neurosurgery, University College London Hospitals NHS Foundation Trust, 8-11 Queen Square, London, WC1N 3BG, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, UK
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Platt T, Ladd ME, Paech D. 7 Tesla and Beyond: Advanced Methods and Clinical Applications in Magnetic Resonance Imaging. Invest Radiol 2021; 56:705-725. [PMID: 34510098 PMCID: PMC8505159 DOI: 10.1097/rli.0000000000000820] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/07/2021] [Accepted: 08/07/2021] [Indexed: 12/15/2022]
Abstract
ABSTRACT Ultrahigh magnetic fields offer significantly higher signal-to-noise ratio, and several magnetic resonance applications additionally benefit from a higher contrast-to-noise ratio, with static magnetic field strengths of B0 ≥ 7 T currently being referred to as ultrahigh fields (UHFs). The advantages of UHF can be used to resolve structures more precisely or to visualize physiological/pathophysiological effects that would be difficult or even impossible to detect at lower field strengths. However, with these advantages also come challenges, such as inhomogeneities applying standard radiofrequency excitation techniques, higher energy deposition in the human body, and enhanced B0 field inhomogeneities. The advantages but also the challenges of UHF as well as promising advanced methodological developments and clinical applications that particularly benefit from UHF are discussed in this review article.
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Affiliation(s)
- Tanja Platt
- From the Medical Physics in Radiology, German Cancer Research Center (DKFZ)
| | - Mark E. Ladd
- From the Medical Physics in Radiology, German Cancer Research Center (DKFZ)
- Faculty of Physics and Astronomy
- Faculty of Medicine, University of Heidelberg, Heidelberg
- Erwin L. Hahn Institute for MRI, University of Duisburg-Essen, Essen
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg
- Clinic for Neuroradiology, University of Bonn, Bonn, Germany
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28
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Guo P, Wang P, Yasarla R, Zhou J, Patel VM, Jiang S. Anatomic and Molecular MR Image Synthesis Using Confidence Guided CNNs. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2832-2844. [PMID: 33351754 PMCID: PMC8543492 DOI: 10.1109/tmi.2020.3046460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Data-driven automatic approaches have demonstrated their great potential in resolving various clinical diagnostic dilemmas in neuro-oncology, especially with the help of standard anatomic and advanced molecular MR images. However, data quantity and quality remain a key determinant, and a significant limit of the potential applications. In our previous work, we explored the synthesis of anatomic and molecular MR image networks (SAMR) in patients with post-treatment malignant gliomas. In this work, we extend this through a confidence-guided SAMR (CG-SAMR) that synthesizes data from lesion contour information to multi-modal MR images, including T1-weighted ( [Formula: see text]), gadolinium enhanced [Formula: see text] (Gd- [Formula: see text]), T2-weighted ( [Formula: see text]), and fluid-attenuated inversion recovery ( FLAIR ), as well as the molecular amide proton transfer-weighted ( [Formula: see text]) sequence. We introduce a module that guides the synthesis based on a confidence measure of the intermediate results. Furthermore, we extend the proposed architecture to allow training using unpaired data. Extensive experiments on real clinical data demonstrate that the proposed model can perform better than current the state-of-the-art synthesis methods. Our code is available at https://github.com/guopengf/CG-SAMR.
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29
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Abstract
This article reviews recent advances in the use of standard and advanced imaging techniques for diagnosis and treatment of central nervous system (CNS) tumors, including glioma and brain metastasis. Following the recent transition from a histology-based approach in classifying CNS tumors to one that integrates histology with the molecular information of tumor, the approaches for imaging CNS tumors have also been adapted to this new framework. Some challenges related to the diagnosis and treatment of CNS tumors, such as differentiating tumor from treatment-related imaging changes, require further progress to implement advanced imaging for clinical use.
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Affiliation(s)
- Raymond Y Huang
- Department of Neuroradiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Whitney B Pope
- Radiology, Section of Neuroradiology, Brain Tumor Imaging, UCLA Medical Center, Los Angeles, CA, USA; Department of Radiological Sciences, David Geffen School of Medicine, University of California-Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA; Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
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30
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Morrison MA, Lupo JM. 7-T Magnetic Resonance Imaging in the Management of Brain Tumors. Magn Reson Imaging Clin N Am 2021; 29:83-102. [PMID: 33237018 DOI: 10.1016/j.mric.2020.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article provides an overview of the current status of ultrahigh-field 7-T magnetic resonance (MR) imaging in neuro-oncology, specifically for the management of patients with brain tumors. It includes a discussion of areas across the pretherapeutic, peritherapeutic, and posttherapeutic stages of patient care where 7-T MR imaging is currently being exploited and holds promise. This discussion includes existing technical challenges, barriers to clinical integration, as well as our impression of the future role of 7-T MR imaging as a clinical tool in neuro-oncology.
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Affiliation(s)
- Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
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Vachha B, Huang SY. MRI with ultrahigh field strength and high-performance gradients: challenges and opportunities for clinical neuroimaging at 7 T and beyond. Eur Radiol Exp 2021; 5:35. [PMID: 34435246 PMCID: PMC8387544 DOI: 10.1186/s41747-021-00216-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
Research in ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology has provided enormous gains in sensitivity, resolution, and contrast for neuroimaging. This article provides an overview of the technical advantages and challenges of performing clinical neuroimaging studies at ultrahigh magnetic field strength combined with ultrahigh and ultrafast gradient technology. Emerging clinical applications of 7-T MRI and state-of-the-art gradient systems equipped with up to 300 mT/m gradient strength are reviewed, and the impact and benefits of such advances to anatomical, structural and functional MRI are discussed in a variety of neurological conditions. Finally, an outlook and future directions for ultrahigh field MRI combined with ultrahigh and ultrafast gradient technology in neuroimaging are examined.
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Affiliation(s)
- Behroze Vachha
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, 149 13th Street, Room 2301, Charlestown, MA, 02129, USA.
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32
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Capozza M, Anemone A, Dhakan C, Della Peruta M, Bracesco M, Zullino S, Villano D, Terreno E, Longo DL, Aime S. GlucoCEST MRI for the Evaluation Response to Chemotherapeutic and Metabolic Treatments in a Murine Triple-Negative Breast Cancer: A Comparison with[ 18F]F-FDG-PET. Mol Imaging Biol 2021; 24:126-134. [PMID: 34383241 DOI: 10.1007/s11307-021-01637-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/30/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Triple-negative breast cancer (TNBC) patients have usually poor outcome after chemotherapy and early prediction of therapeutic response would be helpful. [18F]F-FDG-PET/CT acquisitions are often carried out to monitor variation in metabolic activity associated with response to the therapy, despite moderate accuracy and radiation exposure limit its application. The glucoCEST technique relies on the use of unlabelled D-glucose to assess glucose uptake with conventional MRI scanners and is currently under active investigations at clinical level. This work aims at validating the potential of MRI-glucoCEST in monitoring the therapeutic responses in a TNBC tumor murine model. PROCEDURES Breast tumor (4T1)-bearing mice were treated with doxorubicin or dichloroacetate for 1 week. PET/CT with [18F]F-FDG and MRI-glucoCEST were performed at baseline and after 3 cycles of treatment. Metabolic changes measured with [18F]F-FDG-PET and glucoCEST were compared and evaluated with changes in tumor volumes. RESULTS Doxorubicin-treated mice showed a significant decrease in tumor growth when compared to the control group. GlucoCEST imaging provided metabolic response after three cycles of treatment. Conversely, no variations were detected in [18F]F-FDG uptake. Dichloroacetate-treated mice did not show any decrease either in tumor volume or in tumor metabolic activity as assessed by both glucoCEST and [18F]F-FDG-PET. CONCLUSIONS Metabolic changes during doxorubicin treatment can be predicted by glucoCEST imaging that appears more sensitive than [18F]F-FDG-PET in reporting on therapeutic response. These findings support the view that glucoCEST may be a sensitive technique for monitoring metabolic response, but future studies are needed to explore the accuracy of this approach in other tumor types and treatments.
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Affiliation(s)
- Martina Capozza
- Center for Preclinical Imaging, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy
| | - Annasofia Anemone
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy
| | - Chetan Dhakan
- Institute of Biostructures and Bioimaging (IBB), National Research Council of Italy (CNR), Via Nizza 52, Turin, 10126, Italy
| | - Melania Della Peruta
- Center for Preclinical Imaging, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy
| | - Martina Bracesco
- Center for Preclinical Imaging, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy
| | - Sara Zullino
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy
| | - Daisy Villano
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy
| | - Enzo Terreno
- Center for Preclinical Imaging, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy.,Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy.,Institute of Biostructures and Bioimaging (IBB), National Research Council of Italy (CNR), Via Nizza 52, Turin, 10126, Italy
| | - Dario Livio Longo
- Institute of Biostructures and Bioimaging (IBB), National Research Council of Italy (CNR), Via Nizza 52, Turin, 10126, Italy
| | - Silvio Aime
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Turin, Via Nizza, 52, Turin, 10126, Italy.,Institute of Biostructures and Bioimaging (IBB), National Research Council of Italy (CNR), Via Nizza 52, Turin, 10126, Italy
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33
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Sun PZ. Quasi-steady-state chemical exchange saturation transfer (QUASS CEST) MRI analysis enables T 1 normalized CEST quantification - Insight into T 1 contribution to CEST measurement. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2021; 329:107022. [PMID: 34144360 PMCID: PMC8316384 DOI: 10.1016/j.jmr.2021.107022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/29/2021] [Accepted: 06/07/2021] [Indexed: 05/26/2023]
Abstract
Chemical exchange saturation transfer (CEST) MRI depends not only on the labile proton concentration and exchange rate but also on relaxation rates, particularly T1 relaxation time. However, T1 normalization has shown to be not straightforward under non-steady-state conditions and in the presence of radiofrequency spillover effect. Our study aimed to test if the combined use of the new quasi-steady-state (QUASS) analysis and inverse CEST calculation facilitates T1 normalization for improved CEST quantification. The CEST signal was simulated with Bloch-McConnell equations, and the apparent CEST, QUASS CEST, and the inverse CEST effects were calculated. T1-normalized CEST effects were tested for their specificity to the underlying CEST system (i.e., labile proton ratio and exchange rate). CEST experiments were performed from a 9-vial phantom of independently varied concentrations of creatine (20, 40, and 60 mM) and manganese chloride (20, 30, and 40 µM) under a range of RF saturation amplitudes (0.5-4 µT) and durations (1-4 s). The simulation showed that while T1 normalization of the apparent CEST effect was subject to noticeable T1 contamination, the T1-normalized inverse QUASS CEST effect had little T1 dependence. The experimental data were analyzed using a multiple linear regression model, showing that T1-normalized inverse QUASS analysis significantly depended on creatine concentration and saturation power (P < 0.05), not on manganese chloride concentration and saturation duration, advantageous over other CEST indices. The QUASS CEST algorithm reconstructs the steady-state CEST effect, enabling T1-normalized inverse CEST effect calculation for improved quantification of the underlying CEST system.
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Affiliation(s)
- Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, GA, United States; Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA, United States.
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Chan RW, Lawrence LSP, Oglesby RT, Chen H, Stewart J, Theriault A, Campbell M, Ruschin M, Myrehaug S, Atenafu EG, Keller B, Chugh B, MacKenzie S, Tseng CL, Detsky J, Maralani PJ, Czarnota GJ, Stanisz GJ, Sahgal A, Lau AZ. Chemical exchange saturation transfer MRI in central nervous system tumours on a 1.5 T MR-Linac. Radiother Oncol 2021; 162:140-149. [PMID: 34280403 DOI: 10.1016/j.radonc.2021.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the implementation and initial results of using Chemical Exchange Saturation Transfer (CEST) for monitoring patients with central nervous system (CNS) tumours treated using a 1.5 tesla MR-guided radiotherapy system. METHODS CNS patients were treated with up to 30 fractions (total dose up to 60 Gy) using a 1.5 T Elekta Unity MR-Linac. CEST scans were obtained in 54 subjects at one or more time points during treatment. CEST metrics, including the amide magnetization transfer ratio (MTRAmide), nuclear Overhauser effect (NOE) MTR (MTRNOE) and asymmetry, were quantified in phantoms and CNS patients. The signal was investigated between tumour and white matter, across time, and across disease categories including high- and low-grade tumours. RESULTS The gross tumour volume (GTV) exhibited lower MTRAmide and MTRNOE and higher asymmetry compared to contralateral normal appearing white matter. Signal changes in the GTV during fractionated radiotherapy were observed. There were differences between high- and low-grade tumours, with higher CEST asymmetry associated with higher grade disease. CONCLUSION CEST MRI using a 1.5 T MR-Linac was demonstrated to be feasible for in vivo imaging of CNS tumours. CEST images showed tumour/white-matter contrast, temporal CEST signal changes, and associations with tumour grade. These results show promise for the eventual goal of using metabolic imaging to inform the design of adaptive radiotherapy protocols.
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Affiliation(s)
- Rachel W Chan
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada.
| | - Liam S P Lawrence
- Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Ryan T Oglesby
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - James Stewart
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Aimee Theriault
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mikki Campbell
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Brian Keller
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Canada
| | - Brige Chugh
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada; Department of Physics, Ryerson University, Toronto, Canada
| | - Scott MacKenzie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Pejman J Maralani
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Greg J Czarnota
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Greg J Stanisz
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada; Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Angus Z Lau
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
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35
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Schüre JR, Pilatus U, Deichmann R, Hattingen E, Shrestha M. A fast and novel method for amide proton transfer-chemical exchange saturation transfer multislice imaging. NMR IN BIOMEDICINE 2021; 34:e4524. [PMID: 33942941 DOI: 10.1002/nbm.4524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 06/12/2023]
Abstract
Amide proton transfer-chemical exchange saturation transfer (APT-CEST) imaging provides important information for the diagnosis and monitoring of tumors. For such analysis, complete coverage of the brain is advantageous, especially when registration is performed with other magnetic resonance (MR) modalities, such as MR spectroscopy (MRS). However, the acquisition of Z-spectra across several slices via multislice imaging may be time-consuming. Therefore, in this paper, we present a new approach for fast multislice imaging, allowing us to acquire 16 slices per frequency offset within 8 s. The proposed fast CEST-EPI sequence employs a presaturation module, which drives the magnetization into the steady-state equilibrium for the first frequency offset. A second module, consisting of a single CEST pulse (for maintaining the steady-state) followed by an EPI acquisition, passes through a loop to acquire multiple slices and adjacent frequency offsets. Thus, the whole Z-spectrum can be recorded much faster than the conventional saturation scheme, which employs a presaturation for each single frequency offset. The validation of the CEST sequence parameters was performed by using the conventional saturation scheme. Subsequently, the proposed and a modified version of the conventional CEST sequence were compared in vitro on a phantom with different T1 times and in vivo on a brain tumor patient. No significant differences between both sequences could be found in vitro. The in vivo data yielded almost identical MTRasym contrasts for the white and gray matter as well as for tumor tissue. Our results show that the proposed fast CEST-EPI sequence allows for rapid data acquisition and provides similar CEST contrasts as the modified conventional scheme while reducing the scanning time by approximately 50%.
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Affiliation(s)
- Jan-Rüdiger Schüre
- Department of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ulrich Pilatus
- Department of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center (BIC), Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Manoj Shrestha
- Brain Imaging Center (BIC), Goethe University Frankfurt, Frankfurt am Main, Germany
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36
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Chen Y, Wang X, Su T, Xu Z, Wang Y, Zhang Z, Xue H, Zhuo Z, Zhu Y, Jin Z, Zhang T. Feasibility evaluation of amide proton transfer-weighted imaging in the parotid glands: a strategy to recognize artifacts and measure APT value. Quant Imaging Med Surg 2021; 11:2279-2291. [PMID: 34079701 DOI: 10.21037/qims-20-675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The feasibility and image quality of three-dimensional (3D) amide proton transfer (APT)-weighted (APTw) in parotid tumor lesions have not been well established in previous studies. This study aimed to evaluate the utility of APT imaging in parotid lesions and glands. Methods Patients with parotid lesions received 3D turbo spin echo (TSE) APTw on a 3.0T scanner. Two radiologists, who were blinded to the clinical data, independently evaluated the APTw image quality using 4-point Likert scales (1= poor, 4= excellent) in terms of integrity and hyperintensity artifacts. An image quality selection protocol was built based on the two scores. Evaluable images (integrity score >1) and trustable images (integrity score >3 and hyperintensity artifacts score >2) were then enrolled for APTw value comparison between parotid lesions and glands. Results Forty consecutive patients were included in this study. Four patients were excluded due to severe motion (n=3) or dental (n=1) artifacts, and 36 patients received the APT sequence. Among these, more parotid tumor lesions (34/36, 94.4%) than normal parotid glands (23/31, 74.2%) revealed excellent integrity scores (score =4) (P=0.034). Most parotid tumor lesions (24/34, 70.6%) and glands (16/28, 57.1%) revealed no or little hyperintensity artifacts for diagnosis (scores 3 and 4). APT values of parotid lesions and glands in the evaluable groups were 2.11%±1.15% and 1.60%±1.56%, respectively, and the difference was not significant (P=0.197). APT values of parotid lesions and glands in the trustable groups were 1.99%±1.18% and 1.03%±1.09%, respectively, and the difference was statistically significant (P=0.018). Conclusions 3D APTw could be used to differentiate parotid tumors and normal parotid glands; however, the technology still needs to be improved to remove artifacts. In our study, most APTw images of tumor lesions in parotid glands had acceptable image quality, and these APTw images are feasible for diagnostic use.
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Affiliation(s)
- Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Tong Su
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhentan Xu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunting Wang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Yuanli Zhu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Tao Zhang
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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37
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Zhang H, Yong X, Ma X, Zhao J, Shen Z, Chen X, Tian F, Chen W, Wu D, Zhang Y. Differentiation of low- and high-grade pediatric gliomas with amide proton transfer imaging: added value beyond quantitative relaxation times. Eur Radiol 2021; 31:9110-9119. [PMID: 34047848 DOI: 10.1007/s00330-021-08039-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate whether amide proton transfer (APT) MRI can be used to characterize gliomas in pediatric patients and whether it provides added value beyond relaxation times. METHODS In this prospective study, APT imaging and relaxation time mapping were performed in 203 pediatric patients suspected of gliomas from February 2018 to December 2019. The region of interest (ROI) in the tumor was automatically generated with artifact detection and ROI-shrinking algorithms. Several APT-related metrics (CESTR, CESTRnr, MTRRex, AREX, and APT#) and quantitative T1 and T2 were compared between low-grade and high-grade gliomas using the student's t-test or Mann-Whitney U-test. The performance of these parameters was assessed using the receiver operating characteristic (ROC) analysis. A stepwise multivariate logistic regression model was used to combine the imaging parameters. RESULTS Forty-eight patients (mean age: 6 ± 4 years; 23 males and 25 females) were included in the final analysis. All the APT-related metrics except APT# had significantly (p < 0.05) higher values in the high-grade group than the low-grade group. Under different ROI-shrinking cutoffs, the quantitative T1 (p = 0.045-0.200) and T2 (p = 0.037-0.171) values of high-grade gliomas were typically lower than those of low-grade ones. The stepwise multivariate logistic regression revealed that CESTRnr and APT# were combined significant predictors of glioma grades (p < 0.05), with an area under the ROC curve (AUC) of 0.86 substantially larger than those of T1 (AUC = 0.69) and T2 (AUC = 0.68). CONCLUSIONS APT imaging can be used to differentiate high-grade and low-grade gliomas in pediatric patients and provide added value beyond quantitative relaxation times. KEY POINTS • Amide proton transfer (APT) MRI showed significantly (p < 0.05) higher values in pediatric patients with high-grade gliomas than those with low-grade ones. • The area under the curve was 0.86 for APT MRI to differentiate low-grade and high-grade gliomas in pediatric patients, which was substantially higher than that for quantitative T1 (0.69) and T2 (0.68). • APT MRI demonstrated added value beyond quantitative T1 and T2 mapping in characterizing pediatric gliomas.
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Affiliation(s)
- Hongxi Zhang
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xingwang Yong
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaohui Ma
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianjiang Zhao
- Kangqiao Street Community Health Service Center, Gongshu District, Hangzhou, Zhejiang, China
| | - Zhipeng Shen
- Department of Neurosurgery, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xinchun Chen
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fengyu Tian
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Dan Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China. .,Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
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38
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Liebert A, Tkotz K, Herrler J, Linz P, Mennecke A, German A, Liebig P, Gumbrecht R, Schmidt M, Doerfler A, Uder M, Zaiss M, Nagel AM. Whole-brain quantitative CEST MRI at 7T using parallel transmission methods and B 1 + correction. Magn Reson Med 2021; 86:346-362. [PMID: 33634505 DOI: 10.1002/mrm.28745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/31/2021] [Accepted: 02/02/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To enable whole-brain quantitative CEST MRI at ultra-high magnetic field strengths (B0 ≥ 7T) within short acquisition times. METHODS Multiple interleaved mode saturation (MIMOSA) was combined with fast online-customized (FOCUS) parallel transmission (pTx) excitation pulses and B 1 + correction to achieve homogenous whole-brain coverage. Examinations of 13 volunteers were performed on a 7T MRI system with 3 different types of pulse sequences: (1) saturation in circular polarized (CP) mode and CP mode readout, (2) MIMOSA and CP readout, and (3) MIMOSA and FOCUS readout. For comparison, the inverse magnetic transfer ratio metric for relayed nuclear Overhauser effect and amide proton transfer were calculated. To investigate the number of required acquisitions for a good B 1 + correction, 4 volunteers were measured with 6 different B1 amplitudes. Finally, time point repeatability was investigated for 6 volunteers. RESULTS MIMOSA FOCUS sequence using B 1 + correction, with both single and multiple points, reduced inhomogeneity of the CEST contrasts around the occipital lobe and cerebellum. Results indicate that the most stable inter-subject coefficient of variation was achieved using the MIMOSA FOCUS sequence. Time point repeatability of MIMOSA FOCUS with single-point B 1 + correction showed a maximum coefficient of variation below 8% for 3 measurements in a single volunteer. CONCLUSION A combination of MIMOSA FOCUS with a single-point B 1 + correction can be used to achieve quantitative CEST measurements at ultra-high magnetic field strengths. Compared to previous B 1 + correction methods, acquisition time can be reduced as additional scans required for B 1 + correction can be omitted.
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Affiliation(s)
- Andrzej Liebert
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Katharina Tkotz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jürgen Herrler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Peter Linz
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Angelika Mennecke
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Alex German
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | | | | | - Manuel Schmidt
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Arnd Doerfler
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Moritz Zaiss
- Department of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,High-Field Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tuebingen, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.,Division of Medical Physics in Radiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany
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von Knebel Doeberitz N, Maksimovic S, Loi L, Paech D. [Chemical exchange saturation transfer (CEST) : Magnetic resonance imaging in diagnostic oncology]. Radiologe 2021; 61:43-51. [PMID: 33337509 DOI: 10.1007/s00117-020-00786-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Contrast generation by chemical exchange saturation transfer (CEST) is a recently emerging magnetic resonance imaging (MRI) research field with high clinical potential. METHODS This review covers the methodological principles and summarizes the clinical experience of CEST imaging studies in diagnostic oncology performed to date. RESULTS AND CONCLUSION CEST enables the detection of lowly concentrated metabolites, such as peptides and glucose, through selective saturation of metabolite-bound protons and subsequent magnetization transfer to free water. This technology yields additional information about metabolic activity and the tissue microenvironment without the need for conventional contrast agents or radioactive tracers. Various studies, mainly conducted in patients with neuro-oncolgic diseases, suggest that this technology may aid to assess tumor malignancy as well as therapeutic response prior to and in the first follow-up after intervention. KEY POINTS CEST-MRI enables the indirect detection of metabolites without radioactive tracers or contrast agents. Clinical experience exists especially in the setting of neuro-oncologic imaging. In oncologic imaging, CEST-MRI may improve assessment of prognosis and therapy response.
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Affiliation(s)
- N von Knebel Doeberitz
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - S Maksimovic
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - L Loi
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - D Paech
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
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40
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Romdhane F, Villano D, Irrera P, Consolino L, Longo DL. Evaluation of a similarity anisotropic diffusion denoising approach for improving in vivo CEST-MRI tumor pH imaging. Magn Reson Med 2021; 85:3479-3496. [PMID: 33496986 DOI: 10.1002/mrm.28676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 12/18/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Chemical exchange saturation transfer MRI provides new approaches for investigating tumor microenvironment, including tumor acidosis that plays a key role in tumor progression and resistance to therapy. Following iopamidol injection, the detection of the contrast agent inside the tumor tissue allows measurements of tumor extracellular pH. However, accurate tumor pH quantifications are hampered by the low contrast efficiency of the CEST technique and by the low SNR of the acquired CEST images, hence in a reduced detectability of the injected agent. This work aims to investigate a novel denoising method for improving both tumor pH quantification and accuracy of CEST-MRI pH imaging. METHODS An hybrid denoising approach was investigated for CEST-MRI pH imaging based on the combination of the nonlocal mean filter and the anisotropic diffusion tensor method. The denoising approach was tested in simulated and in vitro data and compared with previously reported methods for CEST imaging and with established denoising approaches. Finally, it was validated with in vivo data to improve the accuracy of tumor pH maps. RESULTS The proposed method outperforms current denoising methods in CEST contrast quantification and detection of the administered contrast agent at several increasing noise levels with simulated data. In addition, it achieved a better pH quantification in in vitro data and demonstrated a marked improvement in contrast detection and a substantial improvement in tumor pH accuracy in in vivo data. CONCLUSION The proposed approach effectively reduces the noise in CEST images and increases the sensitivity detection in CEST-MRI pH imaging.
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Affiliation(s)
- Feriel Romdhane
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.,National Engineering School of Tunis, University al Manar, Tunis, Tunisia
| | - Daisy Villano
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Pietro Irrera
- University of Campania "Luigi Vanvitelli,", Caserta, Italy.,Institute of Biostructures and Bioimaging (IBB), Italian National Research Council (CNR), Torino, Italy
| | - Lorena Consolino
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Dario Livio Longo
- Institute of Biostructures and Bioimaging (IBB), Italian National Research Council (CNR), Torino, Italy
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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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Durmo F, Rydhög A, Testud F, Lätt J, Schmitt B, Rydelius A, Englund E, Bengzon J, van Zijl P, Knutsson L, Sundgren PC. Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas. PLoS One 2020; 15:e0244003. [PMID: 33373375 PMCID: PMC7771875 DOI: 10.1371/journal.pone.0244003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Radiological assessment of primary brain neoplasms, both high (HGG) and low grade tumors (LGG), based on contrast-enhancement alone can be inaccurate. We evaluated the radiological value of amide proton transfer weighted (APTw) MRI as an imaging complement for pre-surgical radiological diagnosis of brain tumors. METHODS Twenty-six patients were evaluated prospectively; (22 males, 4 females, mean age 55 years, range 26-76 years) underwent MRI at 3T using T1-MPRAGE pre- and post-contrast administration, conventional T2w, FLAIR, and APTw imaging pre-surgically for suspected primary/secondary brain tumor. Assessment of the additional value of APTw imaging compared to conventional MRI for correct pre-surgical brain tumor diagnosis. The initial radiological pre-operative diagnosis was based on the conventional contrast-enhanced MR images. The range, minimum, maximum, and mean APTw signals were evaluated. Conventional normality testing was performed; with boxplots/outliers/skewness/kurtosis and a Shapiro-Wilk's test. Mann-Whitney U for analysis of significance for mean/max/min and range APTw signal. A logistic regression model was constructed for mean, max, range and Receiver Operating Characteristic (ROC) curves calculated for individual and combined APTw signals. RESULTS Conventional radiological diagnosis prior to surgery/biopsy was HGG (8 patients), LGG (12 patients), and metastasis (6 patients). Using the mean and maximum: APTw signal would have changed the pre-operative evaluation the diagnosis in 8 of 22 patients (two LGGs excluded, two METs excluded). Using a cut off value of >2.0% for mean APTw signal integral, 4 of the 12 radiologically suspected LGG would have been diagnosed as high grade glioma, which was confirmed by histopathological diagnosis. APTw mean of >2.0% and max >2.48% outperformed four separate clinical radiological assessments of tumor type, P-values = .004 and = .002, respectively. CONCLUSIONS Using APTw-images as part of the daily clinical pre-operative radiological evaluation may improve diagnostic precision in differentiating LGGs from HGGs, with potential improvement of patient management and treatment.
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Affiliation(s)
- Faris Durmo
- Division of Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anna Rydhög
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | | | - Jimmy Lätt
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | | | - Anna Rydelius
- Division of Neurology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Elisabet Englund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Bengzon
- Division of Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Peter van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - Linda Knutsson
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Pia C. Sundgren
- Division of Radiology, Department of Clinical Sciences, Lund University, Lund, Sweden
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
- LBIC, Lund University Bioimaging Center, Lund University, Lund, Sweden
- * E-mail:
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Kang H, Chen P, Guo H, Zhang L, Tan Y, Xiao H, Yang A, Fang J, Zhang W. Vessel Size Imaging is Associated with IDH Mutation and Patient Survival in Diffuse Lower-Grade Glioma. Cancer Manag Res 2020; 12:9801-9811. [PMID: 33116839 PMCID: PMC7550213 DOI: 10.2147/cmar.s266533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Background Patients with isocitrate dehydrogenase (IDH) mutant gliomas have better survival and appear to be more sensitive to chemotherapy than their IDH wild-type counterparts. We attempted to assess the correlations of vessel size imaging (VSI) values with IDH mutation status and patient survival in diffuse lower-grade glioma (LGG). Methods We enrolled 60 patients with diffuse LGGs, among which 43 had IDH-mutant tumors. All patients underwent VSI examination and VSI values for active tumors were calculated. Receiver operating characteristic (ROC) curves were established to evaluate the detection efficiency. Logistic regression was employed to determine the ability of variables to discriminate IDH mutational status. Kaplan–Meier survival analysis and Cox proportional hazards models were utilized to estimate the correlations of VSI values and other risk factors with patient survival. Results We observed that VSI values were lower in IDH-mutant LGGs than IDH wild-type LGGs. The VSImax and VSImean values had AUC values of 0.7305 and 0.7401, respectively, in distinguishing IDH-mutant LGGs from IDH wild-type LGGs. Logistic regression showed that VSImean values, age and tumor location were associated with IDH-mutant status, and the formula integrating the three factors had an AUC value of 0.7798 when distinguishing IDH-mutant LGGs from IDH wild-type LGGs. Moreover, LGG patients with high VSI values exhibited worse survival rates than those with low VSI values for both progression-free survival (PFS) and overall survival (OS). Multivariate Cox proportional hazards regression analysis suggested that IDH mutation status, VSImean values and multiple lesions or lobes were risk factors for PFS of LGG patients. Conclusion VSI value is associated with IDH genotype and maybe an independent predictor of the survival of patients with LGGs.
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Affiliation(s)
- Houyi Kang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
| | - Peng Chen
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
| | - Hong Guo
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
| | - Letian Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
| | - Yong Tan
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
| | - Hualiang Xiao
- Department of Pathology, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ao Yang
- Department of Traffic Injury Research Office, Daping Hospital, Army Medical Center of PLA, Chongqing, People's Republic of China
| | - Jingqin Fang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
| | - Weiguo Zhang
- Department of Radiology, Daping Hospital, Army Medical University, Chongqing 400042, People's Republic of China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, People's Republic of China
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Kleimaier D, Goerke S, Nies C, Zaiss M, Kunz P, Bachert P, Ladd ME, Gottwald E, Schad LR. The cellular heat shock response monitored by chemical exchange saturation transfer MRI. Sci Rep 2020; 10:11118. [PMID: 32632120 PMCID: PMC7338423 DOI: 10.1038/s41598-020-68022-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/17/2020] [Indexed: 02/01/2023] Open
Abstract
CEST-MRI of the rNOE signal has been demonstrated in vitro to be closely linked to the protein conformational state. As the detectability of denaturation and aggregation processes on a physiologically relevant scale in living organisms has yet to be verified, the aim of this study was to perform heat-shock experiments with living cells to monitor the cellular heat-shock response of the rNOE CEST signal. Cancer cells (HepG2) were dynamically investigated after a mild, non-lethal heat-shock of 42 °C for 20 min using an MR-compatible bioreactor system at 9.4 T. Reliable and fast high-resolution CEST imaging was realized by a relaxation-compensated 2-point contrast metric. After the heat-shock, a substantial decrease of the rNOE CEST signal by 8.0 ± 0.4% followed by a steady signal recovery within a time of 99.1 ± 1.3 min was observed in two independent trials. This continuous signal recovery is in coherence with chaperone-induced refolding of heat-shock induced protein aggregates. We demonstrated that protein denaturation processes influence the CEST-MRI signal on a physiologically relevant scale. Thus, the protein folding state is, along with concentration changes, a relevant physiological parameter for the interpretation of CEST signal changes in diseases that are associated with pathological changes in protein expression, like cancer and neurodegenerative diseases.
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Affiliation(s)
- Dennis Kleimaier
- Computer Assisted Clinical Medicine, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cordula Nies
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Moritz Zaiss
- Neuroradiology, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Patrick Kunz
- Division of Functional Genome Analysis, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany.,Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Eric Gottwald
- Institute of Functional Interfaces, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Lothar R Schad
- Computer Assisted Clinical Medicine, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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45
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Qamar S, King AD, Ai QYH, Mo FKF, Chen W, Poon DMC, Tong M, Ma BB, Yeung DKW, Wang YX, Yuan J. Pre-treatment amide proton transfer imaging predicts treatment outcome in nasopharyngeal carcinoma. Eur Radiol 2020; 30:6339-6347. [DOI: 10.1007/s00330-020-06985-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/25/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
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46
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Loi L, Zimmermann F, Goerke S, Korzowski A, Meissner JE, Deike-Hofmann K, Stieber A, Bachert P, Ladd ME, Schlemmer HP, Bickelhaupt S, Schott S, Paech D. Relaxation-compensated CEST (chemical exchange saturation transfer) imaging in breast cancer diagnostics at 7T. Eur J Radiol 2020; 129:109068. [PMID: 32574936 DOI: 10.1016/j.ejrad.2020.109068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/06/2020] [Accepted: 05/09/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To investigate whether fat-corrected and relaxation-compensated amide proton transfer (APT) and guanidyl CEST-MRI enables the detection of signal intensity differences between breast tumors and normal-appearing fibroglandular tissue in patients with newly-diagnosed breast cancer. METHOD Ten patients with newly-diagnosed breast cancer and seven healthy volunteers were included in this prospective IRB-approved study. CEST-MRI was performed on a 7 T-whole-body scanner followed by a multi-Lorentzian fit analysis. APT and guanidyl CEST signal intensities were quantified in the tumor and in healthy fibroglandular tissue after correction of B0/B1-field inhomogeneities, fat signal contribution, T1- and T2-relaxation; signal intensity differences of APT and guanidyl resonances were compared using Mann-Whitney-U-tests. Pearson correlations between tumor CEST signal intensities and the proliferation index Ki-67 were performed. RESULTS APT CEST signal in tumor tissue (6.70 ± 1.38%Hz) was increased compared to normal-appearing fibroglandular tissue of patients (3.56 ± 0.54%Hz, p = 0.001) and healthy volunteers (3.70 ± 0.68%Hz, p = 0.001). Further, a moderate positive correlation was found between the APT signal and the proliferation index Ki-67 (R2 = 0.367, r = 0.606, p = 0.11). Guanidyl CEST signal was also increased in tumor tissue (5.24 ± 1.85%Hz) compared to patients' (2.42 ± 0.45%Hz, p = 0.006) and volunteers' (2.36 ± 0.54%Hz, p < 0.001) normal-appearing fibroglandular tissue and a positive correlation with the Ki-67 level was observed (R2 = 0.365, r = 0.604, p = 0.11). APT and guanidyl CEST signal in normal-appearing fibroglandular tissue was not different between patients and healthy volunteers (p = 0.88; p = 0.93). CONCLUSION Relaxation-compensated and fat-corrected CEST-MRI allowed a non-invasive differentiation of breast cancer and normal-appearing breast tissue. Thus, this approach represents a contrast agent-free method that may help to increase diagnostic accuracy in MR-mammography.
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Affiliation(s)
- Lisa Loi
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany.
| | - Ferdinand Zimmermann
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany.
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Jan-Eric Meissner
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Katerina Deike-Hofmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Anne Stieber
- Department of Clinical and Interventional Radiology, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany.
| | - Mark Edward Ladd
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany.
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Sebastian Bickelhaupt
- Junior Group Medical Imaging and Radiology - Cancer Prevention, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| | - Sarah Schott
- Department of Gynecology and Obstetrics, University Hospital of Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany.
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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Jia F, Wu B, Yan R, Li L, Wang K, Han D. Prediction Model for Intermediate-Stage Hepatocellular Carcinoma Response to Transarterial Chemoembolization. J Magn Reson Imaging 2020; 52:1657-1667. [PMID: 32424881 DOI: 10.1002/jmri.27189] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The outcome of intermediate-stage hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) is greatly heterogeneous. Current means for predicting HCC response to TACE are lacking. PURPOSE To investigate whether the combination of parameters derived from amide proton transfer (APT) and intravoxel incoherent motion (IVIM) imaging, and morphological characteristics of tumor can establish a better prediction model than the univariant model for HCC response to TACE. STUDY TYPE Prospective. SUBJECTS 56 patients with intermediate-stage HCC (50 males and six females). FIELD STRENGTH/SEQUENCES 3.0T; T2 -weighted-fast spin echo, 3D liver acquisition with volume flex, single-shot fast spin echo-planar imaging (EPI), spin echo-EPI. ASSESSMENT Pretreatment APT signal intensities (SIs), apparent diffusion coefficient (ADC), true molecular diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) for tumor, peritumoral, and normal tissues were measured. Follow-up MRI scanning was performed, and the patients were classified as responders or nonresponders based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. STATISTICAL TESTS The imaging parameters were compared among the three tissues and between the two groups using analysis of variance (ANOVA) or two-sample t-test. The prediction model's variables were derived from univariate and multivariate logistic regression analyses. Receiver operating characteristic (ROC) curve analysis was used to explore the predictive performance. RESULTS Based on the logistic regression analysis results, we established a prediction model that integrated the APT SI and D values in the tumor tissue and the tumor size. ROC analyses revealed that the model was better able to predict tumor response to TACE (area under the ROC curve = 0.851) than the individual parameters on their own. DATA CONCLUSION A prediction model incorporating pretreatment APT SI, D in the tumor tissue and tumor size may be useful for predicting the response of intermediate-stage HCC to TACE. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1 J. MAGN. RESON. IMAGING 2020;52:1657-1667.
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Affiliation(s)
- Fei Jia
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Baolin Wu
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Ruifang Yan
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Lei Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Kaiyu Wang
- MR Research China, GE Healthcare, Beijing, China
| | - Dongming Han
- Department of MR, First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Comparison of the reproducibility of 2D and 3D amide proton transfer weighted imaging in intracranial rat gliomas at 3 T. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42058-020-00028-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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49
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Abstract
Non-invasive magnetic resonance imaging (MRI) techniques are increasingly applied in the clinic with a fast growing body of evidence regarding its value for clinical decision making. In contrast to biochemical or histological markers, the key advantages of imaging biomarkers are the non-invasive nature and the spatial and temporal resolution of these approaches. The following chapter focuses on clinical applications of novel MR biomarkers in humans with a strong focus on oncologic diseases. These include both clinically established biomarkers (part 1-4) and novel MRI techniques that recently demonstrated high potential for clinical utility (part 5-7).
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Affiliation(s)
- Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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50
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Homeobox B8 Targets Sterile Alpha Motif Domain-Containing Protein 9 and Drives Glioma Progression. Neurosci Bull 2019; 36:359-371. [PMID: 31646435 DOI: 10.1007/s12264-019-00436-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/27/2019] [Indexed: 02/07/2023] Open
Abstract
Gliomas are the most commonly occurring tumors of the central nervous system. Glioblastoma multiforme (GBM) is the most malignant and aggressive brain cancer in adults. Further understanding of the mechanisms underlying the aggressive nature of GBM is urgently needed. Here we identified homeobox B8 (HOXB8), a member of the homeobox family, as a crucial contributor to the aggressiveness of GBM. Data mining of publicly accessible RNA sequence datasets and our patient cohorts confirmed a higher expression of HOXB8 in the tumor tissue of GBM patients, and a strong positive correlation between the expression level and pathological grading of tumors and a negative correlation between the expression level and the overall survival rate. We next showed that HOXB8 promotes the proliferation and migration of glioblastoma cells and is crucial for the activation of the PI3K/AKT pathway and expression of epithelial-mesenchymal transition-related genes, possibly through direct binding to the promoter of SAMD9 (Sterile Alpha Motif Domain-Containing Protein 9) and activating its transcription. Collectively, we identified HOXB8 as a critical contributor to the aggressiveness of GBM, which provides insights into a potential therapeutic target for GBM and opens new avenues for improving its treatment outcome.
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