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Sadique MS, Farzana W, Temtam A, Lappinen E, Vossough A, Iftekharuddin KM. Brain Tumor Recurrence vs. Radiation Necrosis Classification and Patient Survivability Prediction. IEEE J Biomed Health Inform 2024; 28:5685-5695. [PMID: 38875078 PMCID: PMC11492206 DOI: 10.1109/jbhi.2024.3406256] [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: 06/16/2024]
Abstract
GB (Glioblastoma WHO Grade 4) is the most aggressive type of brain tumor in adults that has a short survival rate even after aggressive treatment with surgery and radiation therapy. The changes in magnetic resonance imaging (MRI) for patients with GB after radiotherapy are indicative of either radiation-induced necrosis (RN) or recurrent brain tumor (rBT). Screening for rBT and RN at an early stage is crucial for facilitating faster treatment and better outcomes for the patients. Differentiating rBT from RN is challenging as both may present with similar radiological and clinical characteristics on MRI. Moreover, learning-based rBT versus RN classification using MRI may suffer from class imbalance due to a lack of patient data. While synthetic data generation using generative models has shown promise to address class imbalances, the underlying data representation may be different in synthetic or augmented data. This study proposes computational modeling with statistically rigorous repeated random sub-sampling to balance the subset sample size for rBT and RN classification. The proposed pipeline includes multiresolution radiomic feature (MRF) extraction followed by feature selection with statistical significance testing (p<0.05). The five-fold cross validation results show the proposed model with MRF features classifies rBT from RN with an area under the curve (AUC) of 0.892±0.055. Moreover, considering the dependence between survival time and censoring time (where patients are not followed up until death), the feasibility of using MRF radiomic features as a non-invasive biomarker to identify patients who are at higher risk of recurrence or radiation necrosis is demonstrated. The cross-validated results show that the MRF model provides the best overall survival prediction with an AUC of 0.77±0.032. Comparison with state-of-the-art methods suggest the proposed method is effective in RN versus rBT classification and patient survivability prediction.
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Khadhraoui E, Schmidt L, Klebingat S, Schwab R, Hernández-Durán S, Gihr G, Paukisch H, Stein KP, Behme D, Müller SJ. Comparison of a new MR rapid wash-out map with MR perfusion in brain tumors. BMC Cancer 2024; 24:1139. [PMID: 39267002 PMCID: PMC11395865 DOI: 10.1186/s12885-024-12909-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 09/06/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND MR perfusion is a standard marker to distinguish progression and therapy-associated changes after surgery and radiochemotherapy for glioblastoma. TRAMs (Treatment Response Assessment Maps) were introduced, which are intended to facilitate the differentiation of vital tumor cells and radiation necrosis by means of late (20-90 min) contrast clearance and enhancement. The differences of MR perfusion and late-enhancement are not fully understood yet. METHODS We have implemented and established a fully automated creation of rapid wash-out (15-20 min interval) maps in our clinic. We included patients with glioblastoma, CNS lymphoma or brain metastases who underwent our MR protocol with MR perfusion and rapid wash-out between 01/01/2024 and 30/06/2024. Since both wash-out and hyperperfusion are intended to depict the active tumor area, this study involves a quantitative and qualitative comparison of both methods. For this purpose, we volumetrically measured rCBV (relative cerebral blood volume) maps and rapid wash-out maps separately (two raters). Additionally, we rated the agreement between both maps on a Likert scale (0-10). RESULTS Thirty-two patients were included in the study: 15 with glioblastoma, 7 with CNS lymphomas and 10 with brain metastasis. We calculated 36 rapid wash-out maps (9 initial diagnosis, 27 follow-up). Visual agreement of MR perfusion with rapid wash-out by rating were found in 44 ± 40% for initial diagnosis, and 75 ± 31% for follow-up. We found a strong correlation (Pearson coefficient 0.92, p < 0.001) between the measured volumes of MR perfusion and rapid wash-out. The measured volumes of MR perfusion and rapid wash-out did not differ significantly. Small lesions were often not detected by MR perfusion. Nevertheless, the measured volumes showed no significant differences in this small cohort. CONCLUSIONS Rapid wash-out calculation is a simple tool that provides new information and, when used in conjunction with MR perfusion, may increase diagnostic accuracy. The method shows promising results, particularly in the evaluation of small lesions.
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Affiliation(s)
- Eya Khadhraoui
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Leon Schmidt
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Stefan Klebingat
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Roland Schwab
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Silvia Hernández-Durán
- Department of Neurological Surgery, Göttingen University Hospital, Robert-Koch-Str. 40, D-37075, Göttingen, Germany
| | - Georg Gihr
- Clinic for Neuroradiology, Katharinen-Hospital Stuttgart, Kriegsbergstr. 60, D-70174, Stuttgart, Germany
| | - Harald Paukisch
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Daniel Behme
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
- Stimulate Research Campus Magdeburg, Otto-Hahn-Str. 2, D-39106, Magdeburg, Germany
| | - Sebastian Johannes Müller
- Clinic for Neuroradiology, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany.
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Müller SJ, Khadhraoui E, Ganslandt O, Henkes H, Gihr GA. MRI Treatment Response Assessment Maps (TRAMs) for differentiating recurrent glioblastoma from radiation necrosis. J Neurooncol 2024; 166:513-521. [PMID: 38261142 DOI: 10.1007/s11060-024-04573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND MRI treatment response assessment maps (TRAMs) were introduced to distinguish recurrent malignant glioma from therapy related changes. TRAMs are calculated with two contrast-enhanced T1-weighted sequences and reflect the "late" wash-out (or contrast clearance) and wash-in of gadolinium. Vital tumor cells are assumed to produce a wash-out because of their high turnover rate and the associated hypervascularization, whereas contrast medium slowly accumulates in scar tissue. To examine the real value of this method, we compared TRAMs with the pathology findings obtained after a second biopsy or surgery when recurrence was suspected. METHODS We retrospectively evaluated TRAMs in adult patients with histologically demonstrated glioblastoma, contrast-enhancing tissue and a pre-operative MRI between January 1, 2017, and December 31, 2022. Only patients with a second biopsy or surgery were evaluated. Volumes of the residual tumor, contrast clearance and contrast accumulation before the second surgery were analyzed. RESULTS Among 339 patients with mGBM who underwent MRI, we identified 29 repeated surgeries/biopsies in 27 patients 59 ± 12 (mean ± standard deviation) years of age. Twenty-eight biopsies were from patients with recurrent glioblastoma histology, and only one was from a patient with radiation necrosis. We volumetrically evaluated the 29 pre-surgery TRAMs. In recurrent glioblastoma, the ratio of wash-out volume to tumor volume was 36 ± 17% (range 1-73%), and the ratio of the wash-out volume to the sum of wash-out and wash-in volumes was 48 ± 21% (range 22-92%). For the one biopsy with radiation necrosis, the ratios were 42% and 54%, respectively. CONCLUSIONS Typical recurrent glioblastoma shows a > 20%ratio of the wash-out volume to the sum of wash-out and wash-in volumes. The one biopsy with radiation necrosis indicated that such necrosis can also produce high wash-out in individual cases. Nevertheless, the additional information provided by TRAMs increases the reliability of diagnosis.
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Affiliation(s)
| | - Eya Khadhraoui
- Klinik Für Neuroradiologie, Klinikum-Stuttgart, Kriegsbergstr. 60, 70174, Stuttgart, Germany
| | - Oliver Ganslandt
- Abteilung Für Neurochirurgie, Klinikum-Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Klinik Für Neuroradiologie, Klinikum-Stuttgart, Kriegsbergstr. 60, 70174, Stuttgart, Germany
| | - Georg Alexander Gihr
- Klinik Für Neuroradiologie, Klinikum-Stuttgart, Kriegsbergstr. 60, 70174, Stuttgart, Germany
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Dagher R, Gad M, da Silva de Santana P, Sadeghi MA, Yewedalsew SF, Gujar SK, Yedavalli V, Köhler CA, Khan M, Tavora DGF, Kamson DO, Sair HI, Luna LP. Umbrella review and network meta-analysis of diagnostic imaging test accuracy studies in Differentiating between brain tumor progression versus pseudoprogression and radionecrosis. J Neurooncol 2024; 166:1-15. [PMID: 38212574 DOI: 10.1007/s11060-023-04528-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE In this study we gathered and analyzed the available evidence regarding 17 different imaging modalities and performed network meta-analysis to find the most effective modality for the differentiation between brain tumor recurrence and post-treatment radiation effects. METHODS We conducted a comprehensive systematic search on PubMed and Embase. The quality of eligible studies was assessed using the Assessment of Multiple Systematic Reviews-2 (AMSTAR-2) instrument. For each meta-analysis, we recalculated the effect size, sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio from the individual study data provided in the original meta-analysis using a random-effects model. Imaging technique comparisons were then assessed using NMA. Ranking was assessed using the multidimensional scaling approach and by visually assessing surface under the cumulative ranking curves. RESULTS We identified 32 eligible studies. High confidence in the results was found in only one of them, with a substantial heterogeneity and small study effect in 21% and 9% of included meta-analysis respectively. Comparisons between MRS Cho/NAA, Cho/Cr, DWI, and DSC were most studied. Our analysis showed MRS (Cho/NAA) and 18F-DOPA PET displayed the highest sensitivity and negative likelihood ratios. 18-FET PET was ranked highest among the 17 studied techniques with statistical significance. APT MRI was the only non-nuclear imaging modality to rank higher than DSC, with statistical insignificance, however. CONCLUSION The evidence regarding which imaging modality is best for the differentiation between radiation necrosis and post-treatment radiation effects is still inconclusive. Using NMA, our analysis ranked FET PET to be the best for such a task based on the available evidence. APT MRI showed promising results as a non-nuclear alternative.
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Affiliation(s)
- Richard Dagher
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Mona Gad
- Diagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mohammad Amin Sadeghi
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | | | - Sachin K Gujar
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Vivek Yedavalli
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Cristiano André Köhler
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Majid Khan
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | | | - David Olayinka Kamson
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Haris I Sair
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA
| | - Licia P Luna
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe Street Phipps B100F, Baltimore, MD, 21287, USA.
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Alizadeh M, Broomand Lomer N, Azami M, Khalafi M, Shobeiri P, Arab Bafrani M, Sotoudeh H. Radiomics: The New Promise for Differentiating Progression, Recurrence, Pseudoprogression, and Radionecrosis in Glioma and Glioblastoma Multiforme. Cancers (Basel) 2023; 15:4429. [PMID: 37760399 PMCID: PMC10526457 DOI: 10.3390/cancers15184429] [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: 07/11/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Glioma and glioblastoma multiform (GBM) remain among the most debilitating and life-threatening brain tumors. Despite advances in diagnosing approaches, patient follow-up after treatment (surgery and chemoradiation) is still challenging for differentiation between tumor progression/recurrence, pseudoprogression, and radionecrosis. Radiomics emerges as a promising tool in initial diagnosis, grading, and survival prediction in patients with glioma and can help differentiate these post-treatment scenarios. Preliminary published studies are promising about the role of radiomics in post-treatment glioma/GBM. However, this field faces significant challenges, including a lack of evidence-based solid data, scattering publication, heterogeneity of studies, and small sample sizes. The present review explores radiomics's capabilities in following patients with glioma/GBM status post-treatment and to differentiate tumor progression, recurrence, pseudoprogression, and radionecrosis.
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Affiliation(s)
- Mohammadreza Alizadeh
- Physiology Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran;
| | - Nima Broomand Lomer
- Faculty of Medicine, Guilan University of Medical Sciences, Rasht 41937-13111, Iran;
| | - Mobin Azami
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj 66186-34683, Iran;
| | - Mohammad Khalafi
- Radiology Department, Tabriz University of Medical Sciences, Tabriz 51656-65931, Iran;
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran; (P.S.); (M.A.B.)
| | - Melika Arab Bafrani
- School of Medicine, Tehran University of Medical Sciences, Tehran 14167-53955, Iran; (P.S.); (M.A.B.)
| | - Houman Sotoudeh
- Department of Radiology and Neurology, Heersink School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, AL 35294, USA
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Lee SH, Choi JW, Kong DS, Seol HJ, Nam DH, Lee JI. Effect of Bevacizumab Treatment in Cerebral Radiation Necrosis : Investigation of Response Predictors in a Single-Center Experience. J Korean Neurosurg Soc 2023; 66:562-572. [PMID: 36642947 PMCID: PMC10483166 DOI: 10.3340/jkns.2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Bevacizumab is a feasible option for treating cerebral radiation necrosis (RN). We investigated the clinical outcome of RN after treatment with bevacizumab and factors related to the initial response and the sustained effect. METHODS Clinical data of 45 patients treated for symptomatic RN between September 2019 and February 2021 were retrospectively collected. Bevacizumab (7.5 mg/kg) was administered at 3-week intervals with a maximum four-cycle schedule. Changes in the lesions magnetic resonance image (MRI) scans were examined for the response evaluation. The subgroup analysis was performed based on the initial response and the long-term maintenance of the effect. RESULTS Of the 45 patients, 36 patients (80.0%) showed an initial response, and eight patients (17.8%) showed delayed worsening of the corresponding lesion. The non-responders showed a significantly higher incidence of diffusion restriction on MRI than the responders (100.0% vs. 25.0%, p<0.001). The delayed worsening group showed a significantly higher proportion of glioma pathology than the maintenance group (87.5% vs. 28.6%, p=0.005). Cumulative survival rates with sustained effect were significantly higher in the groups with non-glioma pathology (p=0.019) and the absence of diffusion restriction (p<0.001). Pathology of glioma and diffusion restriction in MRI were the independent risk factors for non-response or delayed worsening after initial response. CONCLUSION The initial response of RN to bevacizumab was favorable, with improvement in four-fifths of the patients. However, a certain proportion of patients showed non-responsiveness or delayed exacerbations. Bevacizumab may be more effective in treating RN in patients with non-glioma pathology and without diffusion restriction in the MRI.
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Affiliation(s)
- Shin Heon Lee
- Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Jun Seol
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lopez-Rueda A, Puig J, Thió-Henestrosa S, Moreno-Negrete JL, Zwanzger C, Pujol T, Aldecoa I, Pineda E, Valduvieco I, González JJ, Oleaga L. Texture Analysis of the Apparent Diffusion Coefficient Focused on Contrast-Enhancing Lesions in Predicting Survival for Bevacizumab-Treated Patients with Recurrent Glioblastoma. Cancers (Basel) 2023; 15:cancers15113026. [PMID: 37296988 DOI: 10.3390/cancers15113026] [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: 01/23/2023] [Revised: 04/19/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Glioblastoma often recurs after treatment. Bevacizumab increases progression-free survival in some patients with recurrent glioblastoma. Identifying pretreatment predictors of survival can help clinical decision making. Magnetic resonance texture analysis (MRTA) quantifies macroscopic tissue heterogeneity indirectly linked to microscopic tissue properties. We investigated the usefulness of MRTA in predicting survival in patients with recurrent glioblastoma treated with bevacizumab. METHODS We evaluated retrospective longitudinal data from 33 patients (20 men; mean age 56 ± 13 years) who received bevacizumab on the first recurrence of glioblastoma. Volumes of contrast-enhancing lesions segmented on postcontrast T1-weighted sequences were co-registered on apparent diffusion coefficient maps to extract 107 radiomic features. To assess the performance of textural parameters in predicting progression-free survival and overall survival, we used receiver operating characteristic curves, univariate and multivariate regression analysis, and Kaplan-Meier plots. RESULTS Longer progression-free survival (>6 months) and overall survival (>1 year) were associated with lower values of major axis length (MAL), a lower maximum 2D diameter row (m2Ddr), and higher skewness values. Longer progression-free survival was also associated with higher kurtosis, and longer overall survival with higher elongation values. The model combining MAL, m2Ddr, and skewness best predicted progression-free survival at 6 months (AUC 0.886, 100% sensitivity, 77.8% specificity, 50% PPV, 100% NPV), and the model combining m2Ddr, elongation, and skewness best predicted overall survival (AUC 0.895, 83.3% sensitivity, 85.2% specificity, 55.6% PPV, 95.8% NPV). CONCLUSIONS Our preliminary analyses suggest that in patients with recurrent glioblastoma pretreatment, MRTA helps to predict survival after bevacizumab treatment.
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Affiliation(s)
- Antonio Lopez-Rueda
- Department of Radiology (CDI), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Josep Puig
- Department of Radiology (IDI) and IDIBGI Hospital Universitari de Girona Doctor Josep Trueta, 17190 Girona, Spain
| | - Santiago Thió-Henestrosa
- Department of Computer Science Applied Mathmatics and Statistics, University of Girona, 17003 Girona, Spain
| | | | | | - Teresa Pujol
- Department of Radiology (CDI), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Iban Aldecoa
- Department of Anatomical Pathology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Estela Pineda
- Translational Genomics and Targeted Therapeutics in Solid Tumors Group, Medical Oncology Department, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain
| | - Izaskun Valduvieco
- Radiotherapy Oncology Service, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - José Juan González
- Department of Neurosurgery, Laboratory of Experimental Oncological Neurosurgery, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Laura Oleaga
- Department of Radiology (CDI), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
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Vaios EJ, Winter SF, Shih HA, Dietrich J, Peters KB, Floyd SR, Kirkpatrick JP, Reitman ZJ. Novel Mechanisms and Future Opportunities for the Management of Radiation Necrosis in Patients Treated for Brain Metastases in the Era of Immunotherapy. Cancers (Basel) 2023; 15:2432. [PMID: 37173897 PMCID: PMC10177360 DOI: 10.3390/cancers15092432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
Radiation necrosis, also known as treatment-induced necrosis, has emerged as an important adverse effect following stereotactic radiotherapy (SRS) for brain metastases. The improved survival of patients with brain metastases and increased use of combined systemic therapy and SRS have contributed to a growing incidence of necrosis. The cyclic GMP-AMP (cGAMP) synthase (cGAS) and stimulator of interferon genes (STING) pathway (cGAS-STING) represents a key biological mechanism linking radiation-induced DNA damage to pro-inflammatory effects and innate immunity. By recognizing cytosolic double-stranded DNA, cGAS induces a signaling cascade that results in the upregulation of type 1 interferons and dendritic cell activation. This pathway could play a key role in the pathogenesis of necrosis and provides attractive targets for therapeutic development. Immunotherapy and other novel systemic agents may potentiate activation of cGAS-STING signaling following radiotherapy and increase necrosis risk. Advancements in dosimetric strategies, novel imaging modalities, artificial intelligence, and circulating biomarkers could improve the management of necrosis. This review provides new insights into the pathophysiology of necrosis and synthesizes our current understanding regarding the diagnosis, risk factors, and management options of necrosis while highlighting novel avenues for discovery.
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Affiliation(s)
- Eugene J. Vaios
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - Sebastian F. Winter
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Helen A. Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Katherine B. Peters
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Scott R. Floyd
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - John P. Kirkpatrick
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Zachary J. Reitman
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27710, USA
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
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Huang J, Fu X, Xue Q, Ma P, Yin Y, Jiang M, Lu Y, Ying Q, Jiang J, He H, Wu D. Peptide ARHGEF9 Inhibits Glioma Progression via PI3K/AKT/mTOR Pathway. DISEASE MARKERS 2023; 2023:7146589. [PMID: 36852158 PMCID: PMC9966571 DOI: 10.1155/2023/7146589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/03/2022] [Accepted: 01/18/2023] [Indexed: 02/20/2023]
Abstract
Background The most prevalent malignant tumor in a human brain nervous system is called glioma. Peptide is a compound formed by the peptide bond of α-amino acids, and the development of polypeptide drugs has been widely used in many fields. We plan to investigate the underlying peptides with clinical value in glioma. Method Based on public databases, we targeted the common genes between glioma differentially expressed genes (DEGs) and peptide genes related to glioma prognosis. Then, these common genes were analyzed by LASSO-Cox analysis, prognostic risk model, and nomogram to identify key prognostic peptide genes and the target gene in this study. Next, the mechanism of target gene in glioma was explored by bioinformatics analysis and functional experiments. Results We obtained a total of 26 overlapping genes for the following study. After that, 6 independent prognostic factors (REPIN1, PSD3, RDX, CDK4, FANCI, and ARHGEF9) were obtained and applied to construct the prognostic nomogram, and ARHGEF9 was the target gene in the study. Next, peptide ARHGEF9 was found to inhibit glioma cell development. Through Spearman's correlation analysis, ARHGEF9 had a close relation with PI3K/AKT/mTOR pathway. In functional experiments, peptide ARHGEF9 could suppress the protein expressions of p-PIK3K, p-AKT and p-mTOR, while IGF-1 could reverse this effect. Conclusion This study identifies 6 new prognostic biomarkers for glioma patients. Among them, peptide ARHGEF9 gene is an inhibitory gene functioning by targeting PI3K/AKT/mTOR pathway.
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Affiliation(s)
- Jie Huang
- Department of Neurosurgery, Third Affiliated Hospital, Navy Medical University, Shanghai, China 200432
| | - Xiaoling Fu
- Department of Medical Psychology, The Fourth Medical Center of PLA General Hospital, 51 Fu Cheng Road, Beijing, China 100048
| | - Qiang Xue
- Department of Neurosurgery, Third Affiliated Hospital, Navy Medical University, Shanghai, China 200432
| | - Peng Ma
- Department of Neurosurgery, Third Affiliated Hospital, Navy Medical University, Shanghai, China 200432
| | - Yating Yin
- Department of Neurosurgery, Third Affiliated Hospital, Navy Medical University, Shanghai, China 200432
| | - Minjie Jiang
- Department of Neurosurgery, Yixing People's Hospital, Yixing, Jiangsu Province, China 214200
| | - Yunpeng Lu
- Department of Neurosurgery, Yixing People's Hospital, Yixing, Jiangsu Province, China 214200
| | - Qi Ying
- Department of Neurosurgery, Third Affiliated Hospital, Navy Medical University, Shanghai, China 200432
| | - Jun Jiang
- Endoscopy Center, Minhang Hospital, Fudan University, Shanghai, China
| | - Hua He
- Department of Neurosurgery, Third Affiliated Hospital, Navy Medical University, Shanghai, China 200432
| | - Da Wu
- Department of Neurosurgery, Yixing People's Hospital, Yixing, Jiangsu Province, China 214200
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Eichkorn T, Lischalk JW, Hörner-Rieber J, Deng M, Meixner E, Krämer A, Hoegen P, Sandrini E, Regnery S, Held T, Harrabi S, Jungk C, Herfarth K, Debus J, König L. Analysis of safety and efficacy of proton radiotherapy for IDH-mutated glioma WHO grade 2 and 3. J Neurooncol 2023; 162:489-501. [PMID: 36598613 DOI: 10.1007/s11060-022-04217-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/14/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Proton beam radiotherapy (PRT) has been demonstrated to improve neurocognitive sequelae particularly. Nevertheless, following PRT, increased rates of radiation-induced contrast enhancements (RICE) are feared. How safe and effective is PRT for IDH-mutated glioma WHO grade 2 and 3? METHODS We analyzed 194 patients diagnosed with IDH-mutated WHO grade 2 (n = 128) and WHO grade 3 (n = 66) glioma who were treated with PRT from 2010 to 2020. Serial clinical and imaging follow-up was performed for a median of 5.1 years. RESULTS For WHO grade 2, 61% were astrocytoma and 39% oligodendroglioma while for WHO grade 3, 55% were astrocytoma and 45% oligodendroglioma. Median dose for IDH-mutated glioma was 54 Gy(RBE) [range 50.4-60 Gy(RBE)] for WHO grade 2 and 60 Gy(RBE) [range 54-60 Gy(RBE)] for WHO grade 3. Five year overall survival was 85% in patients with WHO grade 2 and 67% in patients with WHO grade 3 tumors. Overall RICE risk was 25%, being higher in patients with WHO grade 2 (29%) versus in patients with WHO grade 3 (17%, p = 0.13). RICE risk increased independent of tumor characteristics with older age (p = 0.017). Overall RICE was symptomatic in 31% of patients with corresponding CTCAE grades as follows: 80% grade 1, 7% grade 2, 13% grade 3, and 0% grade 3 + . Overall need for RICE-directed therapy was 35%. CONCLUSION These data demonstrate the effectiveness of PRT for IDH-mutated glioma WHO grade 2 and 3. The RICE risk differs with WHO grading and is higher in older patients with IDH-mutated Glioma WHO grade 2 and 3.
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Affiliation(s)
- Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
- National Center for Tumor Diseases (NCT), Heidelberg, Germany.
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jonathan W Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York, University Langone Health at Long Island, New York, NY, USA
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, Heidelberg, Germany
| | - Maximilian Deng
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna Krämer
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Elisabetta Sandrini
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
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11
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Posttherapy technetium-99m pentavalent dimercaptosuccinic acid brain single-photon emission computed tomography/computed tomography: diagnostic and prognostic values in patients with glioma. Nucl Med Commun 2022; 43:1195-1203. [DOI: 10.1097/mnm.0000000000001623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Bhandari A, Marwah R, Smith J, Nguyen D, Bhatti A, Lim CP, Lasocki A. Machine learning imaging applications in the differentiation of true tumour progression from
treatment‐related
effects in brain tumours: A systematic review and
meta‐analysis. J Med Imaging Radiat Oncol 2022; 66:781-797. [PMID: 35599360 PMCID: PMC9545346 DOI: 10.1111/1754-9485.13436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 05/04/2022] [Indexed: 12/21/2022]
Abstract
Introduction Chemotherapy and radiotherapy can produce treatment‐related effects, which may mimic tumour progression. Advances in Artificial Intelligence (AI) offer the potential to provide a more consistent approach of diagnosis with improved accuracy. The aim of this study was to determine the efficacy of machine learning models to differentiate treatment‐related effects (TRE), consisting of pseudoprogression (PsP) and radiation necrosis (RN), and true tumour progression (TTP). Methods The systematic review was conducted in accordance with PRISMA‐DTA guidelines. Searches were performed on PubMed, Scopus, Embase, Medline (Ovid) and ProQuest databases. Quality was assessed according to the PROBAST and CLAIM criteria. There were 25 original full‐text journal articles eligible for inclusion. Results For gliomas: PsP versus TTP (16 studies, highest AUC = 0.98), RN versus TTP (4 studies, highest AUC = 0.9988) and TRE versus TTP (3 studies, highest AUC = 0.94). For metastasis: RN vs. TTP (2 studies, highest AUC = 0.81). A meta‐analysis was performed on 9 studies in the gliomas PsP versus TTP group using STATA. The meta‐analysis reported a high sensitivity of 95.2% (95%CI: 86.6–98.4%) and specificity of 82.4% (95%CI: 67.0–91.6%). Conclusion TRE can be distinguished from TTP with good performance using machine learning‐based imaging models. There remain issues with the quality of articles and the integration of models into clinical practice. Future studies should focus on the external validation of models and utilize standardized criteria such as CLAIM to allow for consistency in reporting.
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Affiliation(s)
- Abhishta Bhandari
- Townsville University Hospital Townsville Queensland Australia
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Ravi Marwah
- Townsville University Hospital Townsville Queensland Australia
| | - Justin Smith
- Townsville University Hospital Townsville Queensland Australia
- College of Medicine and Dentistry James Cook University Townsville Queensland Australia
| | - Duy Nguyen
- Institute for Intelligent Systems Research and Innovation Deakin University Melbourne Victoria Australia
| | - Asim Bhatti
- Department of Cancer Imaging Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Chee Peng Lim
- Institute for Intelligent Systems Research and Innovation Deakin University Melbourne Victoria Australia
| | - Arian Lasocki
- Department of Cancer Imaging Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Victoria Australia
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13
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Brachytherapy for central nervous system tumors. J Neurooncol 2022; 158:393-403. [PMID: 35546384 DOI: 10.1007/s11060-022-04026-3] [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: 03/14/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
Radiation is a mainstay of treatment for central nervous system (CNS) tumors. Brachytherapy involves the placement of a localized/interstitial radiation source into a tumor or resection bed and has distinct advantages that can make it an attractive form of radiation when used in the appropriate setting. However, the data supporting use of brachytherapy is clouded by variability in radiation sources, techniques, delivered doses, and trial designs. The goal of this manuscript is to identify consistent themes, review the highest-level evidence and potential indications for brachytherapy in CNS tumors, as well as highlight avenues for future work. Improved understanding of the underlying biology, indications, complications, and evolving industry-academic collaborations, place brachytherapy on the brink of a resurgence.
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14
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Radiation-induced contrast enhancement following proton radiotherapy for low-grade glioma depends on tumor characteristics and is rarer in children than adults. Radiother Oncol 2022; 172:54-64. [PMID: 35568281 DOI: 10.1016/j.radonc.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/21/2022] [Accepted: 05/05/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Proton beam radiotherapy (PRT) is used in the treatment of low-grade glioma (LGG) to mitigate long-term sequelae. Following PRT, increased rates of radiation-induced contrast enhancements (RICE) are suspected but poorly understood. MATERIALS AND METHODS We analyzed consecutive 227 patients (42 children and 185 adults) treated with PRT (54Gy RBE) for LGG from 2010 to 2020 and followed with serial clinical exams and magnetic resonance imaging for in median 5.6 years. RESULTS Tumors were graded WHO 1 in a minority (n = 22, 12%) of adults, but a majority of children (n = 29, 69%). In contrast, tumors were graded WHO 2 in the majority (n = 160, 87%) of adults and a minority of children (n = 10, 24%). Five-year overall survival following PRT was 81% in adults and 91% in children. The risk of RICE was 5-fold more frequent in adults (25%) versus children (5%) (p = 0.0043). In children and adults, RICE were symptomatic in 50% and 55% (n=1 and 26) of cases with CTCAE grade 0 in 47% (n=23), grade 1 in 25% (n=12), 0% grade 2 (n=0) and 29% grade 3 (n=14), respectively. In adults, RICE risk was associated to WHO grading (8% in WHO grade 1 vs. 24% in WHO grade 2, p = 0.026), independent of age (p=0.44) and irradiation dose (p=0.005), but not independent of IDH mutational status. CONCLUSIONS These data demonstrate effectiveness of PRT for LGG in both children and adults. The RICE risk is lower in children which are a main target group for PRT and differs with WHO grading.
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15
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Vellayappan BA, McGranahan T, Graber J, Taylor L, Venur V, Ellenbogen R, Sloan AE, Redmond KJ, Foote M, Chao ST, Suh JH, Chang EL, Sahgal A, Lo SS. Radiation Necrosis from Stereotactic Radiosurgery-How Do We Mitigate? Curr Treat Options Oncol 2021; 22:57. [PMID: 34097171 DOI: 10.1007/s11864-021-00854-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Intracranial stereotactic radiosurgery (SRS) is an effective and convenient treatment for many brain conditions. Data regarding safety come mostly from retrospective single institutional studies and a small number of prospective studies. Variations in target delineation, treatment delivery, imaging follow-up protocols and dose prescription limit the interpretation of this data. There has been much clinical focus on radiation necrosis (RN) in particular, as it is being increasingly recognized on follow-up imaging. Symptomatic RN may be treated with medical therapy (such as corticosteroids and bevacizumab) with surgical resection being reserved for refractory patients. Nevertheless, RN remains a challenging condition to manage, and therefore upfront patient selection for SRS remains critical to provide complication-free control. Mitigation strategies need to be considered in situations where the baseline risk of RN is expected to be high-such as large target volume or re-irradiation. These may involve reduction in the prescribed dose or hypofractionated stereotactic radiation therapy (HSRT). Recently published guidelines and international meta-analysis report the benefit of HSRT in larger lesions, without compromising control rates. However, careful attention to planning parameters and SRS techniques still need to be adhered, even with HSRT. In cases where the risk is deemed to be high despite mitigation, a combination approach of surgery with or without post-operative radiation should be considered.
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Affiliation(s)
- Balamurugan A Vellayappan
- Department of Radiation oncology, National University Cancer Institute, 1E Kent Ridge Road, Level 7 Tower block, Singapore, 119228, Singapore.
| | - Tresa McGranahan
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Jerome Graber
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Lynne Taylor
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Vyshak Venur
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Richard Ellenbogen
- Department of Neurology, Alvord Brain Tumor Center, University of Washington, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Andrew E Sloan
- Department of Neurological Surgery, Seidman Cancer Center and University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, MD, USA
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Samuel T Chao
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - John H Suh
- Department of Radiation Oncology, Rose Ella Burkhardt Brain Tumor and Neuro-oncology Center, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
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16
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Gao F, Zhao W, Li M, Ren X, Jiang H, Cui Y, Lin S. Role of circulating tumor cell detection in differentiating tumor recurrence from treatment necrosis of brain gliomas. Biosci Trends 2021; 15:107-117. [PMID: 33952802 DOI: 10.5582/bst.2021.01017] [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: 11/05/2022]
Abstract
Differentiating treatment necrosis from tumor recurrence poses a diagnostic conundrum for many clinicians in neuro-oncology. To investigate the potential role of circulating tumor cells (CTCs) detection in differentiating tumor recurrence and treatment necrosis in brain gliomas, we retrospectively analyzed the data of 22 consecutive patients with tumor totally removed and new enhancing mass lesion(s) showed on MRI after initial radiotherapy. The 22 patients were finally classified into tumor recurrence group (n = 10) and treatment necrosis group (n = 12), according to evidence from the clinical course (n = 11) and histological confirmation (n = 11). All 22 patients received CTCs detection, and DSC-MRP and 11C-MET-PET were performed on 20 patients (90.9%) and 17patients (77.3%) respectively. The data of the diagnosis efficacy to differentiate the two lesions by CTC detection, MPR and PET were analyzed by ROC analysis. The mean CTCs counts were significantly higher in the tumor recurrence group (6.10 ± 3.28) compared to the treatment necrosis group (1.08 ± 2.54, p < 0.001). The ROC curve showed that an optimized cell count threshold of 2 had 100% sensitivity and 91.2% specificity with AUC = 0.933 to declare tumor recurrence. The diagnostic efficacy of CTC detection was superior to rCBV of DSC-MRP and rSUVmax in MET-PET. Furthermore, we observed that CTCs detection could have a potential role in predicting tumor recurrence in one patient. Our research results preliminarily showed the potential value of CTC detection in differentiating treatment necrosis from tumor recurrence in brain gliomas, and is worthy of further confirmation with large samples involved.
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Affiliation(s)
- Faliang Gao
- Department of Neurosurgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wenyan Zhao
- General Practice Department, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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17
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L'Hotta AJ, Thomas KM, Milgrom SA, Hemenway MS, Levy JMM. Medical and rehabilitation interventions in pediatric central nervous system radiation necrosis: A case report. Pediatr Blood Cancer 2021; 68:e28705. [PMID: 32985070 DOI: 10.1002/pbc.28705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/12/2022]
Abstract
Radiation necrosis is a potentially debilitating side effect of therapy necessary to treat pediatric central nervous system tumors. Clinical signs of cerebral radiation necrosis (CRN) are similar to symptoms of disease progression and require close monitoring. The case of an infant diagnosed with a malignant rhabdoid tumor is presented to describe the medical and rehabilitation interventions implemented to address CRN. Rehabilitation providers should routinely be consulted in children with CRN as they fill a critical role in treatment, neurological symptom monitoring, and intervention planning to address family-centered functional goals.
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Affiliation(s)
- Allison J L'Hotta
- Department of Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri
| | | | - Sarah A Milgrom
- Department Radiation Oncology, University of Colorado Anschutz, Aurora, Colorado
| | - Molly S Hemenway
- Department of Pediatrics, University of Colorado Anschutz, Aurora, Colorado.,The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado
| | - Jean M Mulcahy Levy
- Department of Pediatrics, University of Colorado Anschutz, Aurora, Colorado.,The Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, Colorado
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18
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Tsakiris C, Siempis T, Alexiou GA, Zikou A, Sioka C, Voulgaris S, Argyropoulou MI. Differentiation Between True Tumor Progression of Glioblastoma and Pseudoprogression Using Diffusion-Weighted Imaging and Perfusion-Weighted Imaging: Systematic Review and Meta-analysis. World Neurosurg 2020; 144:e100-e109. [DOI: 10.1016/j.wneu.2020.07.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/28/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023]
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19
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Peker S, Samanci Y, Aygun MS, Yavuz F, Erden ME, Nokay AE, Atasoy Aİ, Bolukbasi Y. The Use of Treatment Response Assessment Maps in Discriminating Between Radiation Effect and Persistent Tumoral Lesion in Metastatic Brain Tumors Treated with Gamma Knife Radiosurgery. World Neurosurg 2020; 146:e1134-e1146. [PMID: 33253956 DOI: 10.1016/j.wneu.2020.11.114] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Traditional imaging modalities are not useful in the follow-up of irradiated metastatic brain tumors, because radiation can change imaging characteristics. We aimed to assess the ability of treatment response assessment maps (TRAMs) calculated from delayed-contrast magnetic resonance imaging (MRI) in differentiation between radiation effect and persistent tumoral tissue. METHODS TRAMs were calculated by subtracting three-dimensional T1 MRIs acquired 5 minutes after contrast injection from the images acquired 60-105 minutes later. Red areas were regarded as radiation effect and blue areas as persistent tumoral lesion. Thirty-seven patients with 130 metastatic brain tumors who were treated with Gamma Knife radiosurgery and who underwent TRAMs perfusion-weighted MRI were enrolled in this retrospective study. RESULTS The median age was 58 years and the most common primary diagnosis was lung cancer (n = 21). The median follow-up period of patients was 12 months. The overall local control rate was 100% at 1 year and 98.9% at 2 years. The median progression-free survival was 12 months. The mean overall survival was 27.3 months. The radiologic and clinical follow-up showed a clinicoradiologic diagnosis of a persistent tumoral lesion in 3 tumors (2.3%) and radiation effect in 127 tumors (97.7%). There was a fair agreement between clinicoradiologic diagnosis and TRAMs analysis (κ = 0.380). The sensitivity and positive predictive value of TRAMs in diagnosing radiation effect were 96.06% and 99.2%, respectively. TRAMs showed comparable results to perfusion-weighted MRI, with a diagnostic odds ratio of 27.4 versus 20.7, respectively. CONCLUSIONS The presented results show the ability of TRAMs in differentiating radiation effect and persistent tumoral lesions.
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Affiliation(s)
- Selcuk Peker
- Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey.
| | - Yavuz Samanci
- Department of Neurosurgery, Koç University Hospital, Istanbul, Turkey
| | - Murat Serhat Aygun
- Department of Radiology, School of Medicine, Koç University, Istanbul, Turkey
| | - Furkan Yavuz
- School of Medicine, Koç University, Istanbul, Turkey
| | | | | | - Ali İhsan Atasoy
- Department of Radiation Oncology, Koç University Hospital, Istanbul, Turkey
| | - Yasemin Bolukbasi
- Department of Radiation Oncology, School of Medicine, Koç University, Istanbul, Turkey
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20
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Hou X, Chen J, Zhang Q, Fan Y, Xiang C, Zhou G, Cao F, Yao S. Interaction network of immune-associated genes affecting the prognosis of patients with glioblastoma. Exp Ther Med 2020; 21:61. [PMID: 33365061 PMCID: PMC7716634 DOI: 10.3892/etm.2020.9493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/06/2020] [Indexed: 12/18/2022] Open
Abstract
Glioblastoma multiforme (GBM) is a common malignant tumor type of the nervous system. The purpose of the present study was to establish a regulatory network of immune-associated genes affecting the prognosis of patients with GBM. The GSE4290, GSE50161 and GSE2223 datasets from the Gene Expression Omnibus database were screened to identify common differentially expressed genes (co-DEGs). A functional enrichment analysis indicated that the co-DEGs were mainly enriched in cell communication, regulation of enzyme activity, immune response, nervous system, cytokine signaling in immune system and the AKT signaling pathway. The co-DEGs accumulated in immune response were then further investigated. For this, the intersection of those co-DEGs and currently known immune-regulatory genes was obtained and a differential expression analysis of these overlapping immune-associated genes was performed. A risk model was established using immune-regulatory genes that affect the prognosis of patients with GBM. The risk score was significantly associated with the prognosis of patients with GBM and had a significant independent predictive value. The risk model had high accuracy in predicting the prognosis of patients with GBM [area under the receiver operating characteristic curve (AUC)=0.764], which was higher than that of a previously reported model of prognosis-associated biomarkers (AUC=0.667). Furthermore, an interaction network was constructed by using immune-regulatory genes and transcription factors affecting the prognosis of patients with GBM and the University of California Santa Cruz database was used to perform a preliminary analysis of the transcription factors and immune genes of interest. The interaction network of immune-regulatory genes constructed in the present study enhances the current understanding of mechanisms associated with poor prognosis of patients with GBM. The risk score model established in the present study may be used to evaluate the prognosis of patients with GBM.
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Affiliation(s)
- Xiaohong Hou
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Jialin Chen
- Department of Neonatology, The First People's Hospital of Zunyi Affiliated to Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Qiang Zhang
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Yinchun Fan
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Chengming Xiang
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Guiyin Zhou
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Fang Cao
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
| | - Shengtao Yao
- Department of Cerebrovascular Disease, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou 563000, P.R. China
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21
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Gao Y, Xiao X, Han B, Li G, Ning X, Wang D, Cai W, Kikinis R, Berkovsky S, Di Ieva A, Zhang L, Ji N, Liu S. Deep Learning Methodology for Differentiating Glioma Recurrence From Radiation Necrosis Using Multimodal Magnetic Resonance Imaging: Algorithm Development and Validation. JMIR Med Inform 2020; 8:e19805. [PMID: 33200991 PMCID: PMC7708085 DOI: 10.2196/19805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/31/2020] [Accepted: 09/27/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The radiological differential diagnosis between tumor recurrence and radiation-induced necrosis (ie, pseudoprogression) is of paramount importance in the management of glioma patients. OBJECTIVE This research aims to develop a deep learning methodology for automated differentiation of tumor recurrence from radiation necrosis based on routine magnetic resonance imaging (MRI) scans. METHODS In this retrospective study, 146 patients who underwent radiation therapy after glioma resection and presented with suspected recurrent lesions at the follow-up MRI examination were selected for analysis. Routine MRI scans were acquired from each patient, including T1, T2, and gadolinium-contrast-enhanced T1 sequences. Of those cases, 96 (65.8%) were confirmed as glioma recurrence on postsurgical pathological examination, while 50 (34.2%) were diagnosed as necrosis. A light-weighted deep neural network (DNN) (ie, efficient radionecrosis neural network [ERN-Net]) was proposed to learn radiological features of gliomas and necrosis from MRI scans. Sensitivity, specificity, accuracy, and area under the curve (AUC) were used to evaluate performance of the model in both image-wise and subject-wise classifications. Preoperative diagnostic performance of the model was also compared to that of the state-of-the-art DNN models and five experienced neurosurgeons. RESULTS DNN models based on multimodal MRI outperformed single-modal models. ERN-Net achieved the highest AUC in both image-wise (0.915) and subject-wise (0.958) classification tasks. The evaluated DNN models achieved an average sensitivity of 0.947 (SD 0.033), specificity of 0.817 (SD 0.075), and accuracy of 0.903 (SD 0.026), which were significantly better than the tested neurosurgeons (P=.02 in sensitivity and P<.001 in specificity and accuracy). CONCLUSIONS Deep learning offers a useful computational tool for the differential diagnosis between recurrent gliomas and necrosis. The proposed ERN-Net model, a simple and effective DNN model, achieved excellent performance on routine MRI scans and showed a high clinical applicability.
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Affiliation(s)
- Yang Gao
- Beijing Academy of Quantum Information Sciences, Beijing, China
| | - Xiong Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Bangcheng Han
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Guilin Li
- Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xiaolin Ning
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Defeng Wang
- School of Instrumentation and Optoelectronic Engineering, Beihang University, Beijing, China
| | - Weidong Cai
- School of Computer Science, The University of Sydney, Sydney, Australia
| | - Ron Kikinis
- Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Department of Computer Science, University of Bremen, Bremen, Germany
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
| | - Shlomo Berkovsky
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Antonio Di Ieva
- Computational NeuroSurgery Lab, Department of Clinical Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Nan Ji
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sidong Liu
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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22
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Winter SF, Loebel F, Loeffler J, Batchelor TT, Martinez-Lage M, Vajkoczy P, Dietrich J. Treatment-induced brain tissue necrosis: a clinical challenge in neuro-oncology. Neuro Oncol 2020; 21:1118-1130. [PMID: 30828724 DOI: 10.1093/neuonc/noz048] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/04/2018] [Accepted: 02/25/2019] [Indexed: 12/29/2022] Open
Abstract
Cancer therapy-induced adverse effects on the brain are a major challenge in neuro-oncology. Brain tissue necrosis (treatment necrosis [TN]) as a consequence of brain directed cancer therapy remains an insufficiently characterized condition with diagnostic and therapeutic difficulties and is frequently associated with significant patient morbidity. A better understanding of the underlying mechanisms, improvement of diagnostic tools, development of preventive strategies, and implementation of evidence-based therapeutic practices are pivotal to improve patient management. In this comprehensive review, we address existing challenges associated with current TN-related clinical and research practices and highlight unanswered questions and areas in need of further research with the ultimate goal to improve management of patients affected by this important neuro-oncological condition.
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Affiliation(s)
- Sebastian F Winter
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Franziska Loebel
- Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jay Loeffler
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Martinez-Lage
- C S Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité‒Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jorg Dietrich
- MGH Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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23
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Verhoeven J, Baguet T, Piron S, Pauwelyn G, Bouckaert C, Descamps B, Raedt R, Vanhove C, De Vos F, Goethals I. 2-[ 18F]FELP, a novel LAT1-specific PET tracer, for the discrimination between glioblastoma, radiation necrosis and inflammation. Nucl Med Biol 2019; 82-83:9-16. [PMID: 31841816 DOI: 10.1016/j.nucmedbio.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Considering the need for rapid change of treatment in recurrent glioblastoma (GB), it is of utmost importance to characterize PET radiopharmaceuticals that allow early discrimination of tumor from therapy-related effects. In this study, we examined the value of 2-[18F]FELP as a LAT1 tumor-specific PET tracer in comparison with [18F]FDG and [18F]FET in a combined orthotopic rat radiation necrosis and glioblastoma model. A second experiment compared 2-[18F]FELP to [18F]FDG in a mouse glioblastoma - inflammation model. METHODS Using the small animal radiation research platform (SARRP), radiation necrosis (RN) was induced in the left frontal lobe of the rat brain. When radiation-induced changes were visible on MRI, F98 rat glioblastoma cells were stereotactically inoculated in the contralateral right frontal lobe. When tumor growth was confirmed on MRI, 2-[18F]FELP, [18F]FET and [18F]FDG PET scans were acquired on three consecutive days. In an inflammation experiment, mice were inoculated in the left thigh with U87 human glioblastoma cells. After heterotopic tumor growth was confirmed macroscopically, inflammation was induced by injection of turpentine subcutaneously in the right thigh. Subsequently, 2-[18F]FELP and [18F]FDG scans were acquired on two consecutive days. RESULTS The in vivo PET images demonstrated that 2-[18F]FELP could differentiate glioblastoma and radiation necrosis using SUVmean (p = 0.0016) and LNRmean (p = 0.009), while [18F]FET was only able to differentiate both lesions by means of the SUVmean. (p = 0.047) Delayed [18F]FDGlate PET (4 h postinjection) was also able to distinguish glioblastoma from radiation necrosis, but smaller lesion-to-normal brain ratios were observed (SUVmean: p = 0.009; LNRmean: p = 0.028). In the inflammation study, 2-[18F]FELP showed no significant uptake in the inflammation lesion when compared to the control group (SUVmean: p = 0.149; LNRmean: p = 0.083). In contrast, both conventional and delayed [18F]FDG displayed significant uptake in the turpentine-invoked lesion (SUVmean: p = 0.021; LNRmean: p = 0.021). CONCLUSION This study suggests that the 2-[18F]FELP PET is able to differentiate glioblastoma from radiation necrosis and that the 2-[18F]FELP uptake is less likely to be contaminated by the presence of inflammation than the [18F]FDG signal. ADVANCES IN KNOWLEDGE These results are clinically relevant for the differential diagnosis between tumor and radiation necrosis because radiation necrosis always contains a certain amount of inflammatory cells. Hence, 2-[18F]FELP is preferred to discriminate tumor from radiation necrosis.
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Affiliation(s)
| | - Tristan Baguet
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Sarah Piron
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Glenn Pauwelyn
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Charlotte Bouckaert
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Robrecht Raedt
- Laboratory for Clinical and Experimental Neurophysiology, Neurobiology and Neuropsychology (LCEN3), Ghent University Hospital, Ghent, Belgium
| | - Christian Vanhove
- IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Filip De Vos
- Laboratory for Radiopharmacy, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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24
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Differentiation of Recurrence from Radiation Necrosis in Gliomas Based on the Radiomics of Combinational Features and Multimodality MRI Images. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2019; 2019:2893043. [PMID: 31871484 PMCID: PMC6913337 DOI: 10.1155/2019/2893043] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/16/2019] [Accepted: 10/31/2019] [Indexed: 12/30/2022]
Abstract
Purpose To classify radiation necrosis versus recurrence in glioma patients using a radiomics model based on combinational features and multimodality MRI images. Methods Fifty-one glioma patients who underwent radiation treatments after surgery were enrolled in this study. Sixteen patients revealed radiation necrosis while 35 patients showed tumor recurrence during the follow-up period. After treatment, all patients underwent T1-weighted, T1-weighted postcontrast, T2-weighted, and fluid-attenuated inversion recovery scans. A total of 41,284 handcrafted and 24,576 deep features were extracted for each patient. The 0.623 + bootstrap method and the area under the curve (denoted as 0.632 + bootstrap AUC) metric were used to select the features. The stepwise forward method was applied to construct 10 logistic regression models based on different combinations of image features. Results For handcrafted features on multimodality MRI, model 7 with seven features yielded the highest AUC of 0.9624, sensitivity of 0.8497, and specificity of 0.9083 in the validation set. These values were higher than the accuracy of using handcrafted features on single-modality MRI (paired t-test, p < 0.05, except sensitivity). For combined handcrafted and AlexNet features on multimodality MRI, model 6 with six features achieved the highest AUC of 0.9982, sensitivity of 0.9941, and specificity of 0.9755 in the validation set. These values were higher than the accuracy of using handcrafted features on multimodality MRI (paired t-test, p < 0.05). Conclusions Handcrafted and deep features extracted from multimodality MRI images reflecting the heterogeneity of gliomas can provide useful information for glioma necrosis/recurrence classification.
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25
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Dahl NA, Liu A, Foreman N, Widener M, Fenton L, Macy ME. Bevacizumab in the treatment of radiation injury for children with central nervous system tumors. Childs Nerv Syst 2019; 35:2043-2046. [PMID: 31367784 PMCID: PMC7251774 DOI: 10.1007/s00381-019-04304-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/08/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Radiation-induced injury is a well-described toxicity in children receiving radiation therapy for tumors of the central nervous system. Standard therapy has historically consisted primarily of high-dose corticosteroids, which carry significant side effects. Preclinical models suggest that radiation necrosis may be mediated in part through vascular endothelial growth factor (VEGF) overexpression, providing the rationale for use of VEGF inhibitors in the treatment of CNS radiation necrosis. We present the first prospective experience examining the safety, feasibility, neurologic outcomes, and imaging characteristics of bevacizumab therapy for CNS radiation necrosis in children. METHODS Seven patients between 1 and 25 years of age with neurologic deterioration and MRI findings consistent with radiation injury or necrosis were enrolled on an IRB-approved pilot feasibility study. Patients received bevacizumab at a dose of 10 mg/kg intravenously every 2 weeks for up to 6 total doses. RESULTS Five patients (83%) were able to wean off corticosteroid therapy during the study period and 4 patients (57%) demonstrated improvement in serial neurologic exams. All patients demonstrated a decrease in T1-weighted post-gadolinium enhancement on MRI, while 5 (71%) showed a decrease in FLAIR signal. Four patients developed a progressive disease of their underlying tumor during bevacizumab therapy. CONCLUSIONS Our experience lends support to the safety and feasibility of bevacizumab administration for the treatment of radiation necrosis for appropriately selected patients within the pediatric population.
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Affiliation(s)
- Nathan A. Dahl
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Denver, Colorado,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Denver, Colorado
| | - Nicholas Foreman
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Denver, Colorado,Morgan Adams Foundation Pediatric Brain Tumor Research Program, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Melissa Widener
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Denver, Colorado
| | - Laura Fenton
- Department of Radiology, Children’s Hospital Colorado, Denver, Colorado
| | - Margaret E. Macy
- Center for Cancer and Blood Disorders, Children’s Hospital Colorado, Denver, Colorado
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26
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Khangembam BC, Singhal A, Kumar R, Bal C. Tc-99m Glucoheptonate Single Photon Emission Computed Tomography-Computed Tomography for Detection of Recurrent Glioma: A Prospective Comparison with N-13 Ammonia Positron Emission Tomography-Computed Tomography. Indian J Nucl Med 2019; 34:107-117. [PMID: 31040521 PMCID: PMC6481207 DOI: 10.4103/ijnm.ijnm_164_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose of the Study: To assess the efficacies of Tc-99m glucoheptonate single photon emission computed tomography-computed tomography (Tc-99m GHA SPECT-CT) and N-13 ammonia positron emission tomography-computed tomography (N-13 NH3 PET-CT) in detecting recurrent glioma. Materials and Methods: Fifty-five consecutive, histologically proven, and previously treated glioma patients (age, 38.9 ± 12.2 years; 61.8% males) presenting with clinical suspicion of recurrence were evaluated with Tc-99m GHA SPECT-CT and N-13 NH3 PET-CT. Images were evaluated both qualitatively and semiquantitatively. A combination of clinicoradiological follow-up, repeat imaging, and/or biopsy (when available) was considered as the reference standard. Results: Based on the reference standard, 28/55 (50.9%) patients had recurrence. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy of Tc-99m GHA SPECT-CT, and N-13 NH3 PET-CT were 85.7%, 85.2%, 85.7%, 85.2%, 85.5% and 78.6%, 88.9%, 88.0%, 80.0%, 83.6%, respectively (concordant findings in 46 patients). The performances of the two modalities were equivalent both in overall and subgroup McNemar analyses (P = 0.508, overall; P = 0.687, low grade; P = 1.000, high grade). Conclusion: Tc-99m GHA SPECT-CT is an alternative imaging modality equally efficacious as N-13 NH3 PET-CT in detecting recurrent glioma.
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Affiliation(s)
- Bangkim Chandra Khangembam
- Department of Nuclear Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Singhal
- Department of Nuclear Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.,Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Vanhove C, Goethals I. Magnetic resonance imaging-guided radiation therapy using animal models of glioblastoma. Br J Radiol 2018; 92:20180713. [PMID: 30563357 DOI: 10.1259/bjr.20180713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Glioblastoma is the most aggressive and most common malignant primary brain tumour in adults and has a high mortality and morbidity. Because local tumour control in glioblastoma patients is still elusive in the majority of patients, there is an urgent need for alternative treatment strategies. However, to implement changes to the existing clinical standard of care, research must be conducted to develop alternative treatment strategies. A novel approach in radiotherapy is the introduction of pre-clinical precision image-guided radiation research platforms. The aim of this review is to give a brief overview of the efforts that have been made in the field of radiation research using animal models of glioblastoma. Because MRI has become the reference imaging technique for treatment planning and assessment of therapeutic responses in glioblastoma patients, we will focus in this review on small animal radiotherapy combined with MRI.
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Affiliation(s)
- Christian Vanhove
- 1 Department of Electronics and Information Systems, Institute Biomedical Technology (IBiTech), Ghent University , Ghent , Belgium
| | - Ingeborg Goethals
- 2 Department of Nuclear Medicine, Ghent University Hospital , Ghent , Belgium
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28
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Wen J, Tan AP, Yong HRC, Wong YLJ. Delayed Radiation Necrosis and Evolution of Its Imaging Features Over Time: An Illustrative Case Report. J Oncol Pract 2018; 14:754-756. [PMID: 30537451 DOI: 10.1200/jop.18.00488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jinhang Wen
- National University Health System, Singapore
| | - Ai Peng Tan
- National University Health System, Singapore
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29
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Radiation Necrosis, Pseudoprogression, Pseudoresponse, and Tumor Recurrence: Imaging Challenges for the Evaluation of Treated Gliomas. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:6828396. [PMID: 30627060 PMCID: PMC6305027 DOI: 10.1155/2018/6828396] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/15/2018] [Indexed: 01/16/2023]
Abstract
Glioblastoma (GBM) is the most common primary malignant type of brain neoplasm in adults and carries a dismal prognosis. The current standard of care for GBM is surgical excision followed by radiation therapy (RT) with concurrent and adjuvant temozolomide-based chemotherapy (TMZ) by six additional cycles. In addition, antiangiogenic therapy with an antivascular endothelial growth factor (VEGF) agent has been used for recurrent glioblastoma. Over the last years, new posttreatment entities such as pseudoprogression and pseudoresponse have been recognized, apart from radiation necrosis. This review article focuses on the role of different imaging techniques such as conventional magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), dynamic contrast enhancement (DCE-MRI) and dynamic susceptibility contrast (DSE-MRI) perfusion, magnetic resonance spectroscopy (MRS), and PET/SPECT in differentiation of such treatment-related changes from tumor recurrence.
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30
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Vellayappan B, Tan CL, Yong C, Khor LK, Koh WY, Yeo TT, Detsky J, Lo S, Sahgal A. Diagnosis and Management of Radiation Necrosis in Patients With Brain Metastases. Front Oncol 2018; 8:395. [PMID: 30324090 PMCID: PMC6172328 DOI: 10.3389/fonc.2018.00395] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/31/2018] [Indexed: 12/25/2022] Open
Abstract
The use of radiotherapy, either in the form of stereotactic radiosurgery (SRS) or whole-brain radiotherapy (WBRT), remains the cornerstone for the treatment of brain metastases (BM). As the survival of patients with BM is being prolonged, due to improved systemic therapy (i.e., for better extra-cranial control) and increased use of SRS (i.e., for improved intra-cranial control), patients are clinically manifesting late effects of radiotherapy. One of these late effects is radiation necrosis (RN). Unfortunately, symptomatic RN is notoriously hard to diagnose and manage. The features of RN overlap considerably with tumor recurrence, and misdiagnosing RN as tumor recurrence may lead to deleterious treatment which may cause detrimental effects to the patient. In this review, we will explore the pathophysiology of RN, risk factors for its development, and the strategies to evaluate and manage RN.
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Affiliation(s)
- Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Char Loo Tan
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Clement Yong
- Department of Diagnostic Imaging, National University Hospital, Singapore, Singapore
| | - Lih Kin Khor
- Nuclear Medicine, Advanced Medicine Imaging, Singapore Institute of Advanced Medicine Holdings, Singapore, Singapore
| | - Wee Yao Koh
- Department of Radiation Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
| | - Simon Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, United States
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada
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MicroRNA-338-5p plays a tumor suppressor role in glioma through inhibition of the MAPK-signaling pathway by binding to FOXD1. J Cancer Res Clin Oncol 2018; 144:2351-2366. [DOI: 10.1007/s00432-018-2745-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/04/2018] [Indexed: 12/13/2022]
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32
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Bolcaen J, Descamps B, Acou M, Deblaere K, den Broecke CV, Boterberg T, Vanhove C, Goethals I. In Vivo DCE-MRI for the Discrimination Between Glioblastoma and Radiation Necrosis in Rats. Mol Imaging Biol 2018; 19:857-866. [PMID: 28303489 DOI: 10.1007/s11307-017-1071-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE In this study, the potential of semiquantitative and quantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) was investigated to differentiate glioblastoma (GB) from radiation necrosis (RN) in rats. PROCEDURES F98 GB growth was seen on MRI 8-23 days post-inoculation (n = 15). RN lesions developed 6-8 months post-irradiation (n = 10). DCE-MRI was acquired using a fast low-angle shot (FLASH) sequence. Regions of interest (ROIs) encompassed peripheral contrast enhancement in GB (n = 15) and RN (n = 10) as well as central necrosis within these lesions (GB (n = 4), RN (n = 3)). Dynamic contrast-enhanced time series, obtained from the DCE-MRI data, were fitted to determine four function variables (amplitude A, offset from zero C, wash-in rate k, and wash-out rate D) as well as maximal intensity (ImaxF) and time to peak (TTPF). Secondly, maps of semiquantitative and quantitative parameters (extended Tofts model) were created using Olea Sphere (O). Semiquantitative DCE-MRI parameters included wash-inO, wash-outO, area under the curve (AUCO), maximal intensity (ImaxO), and time to peak (TTPO). Quantitative parameters included the rate constant plasma to extravascular-extracellular space (EES) (K trans), the rate constant EES to plasma (K ep), plasma volume (V p), and EES volume (V e). All (semi)quantitative parameters were compared between GB and RN using the Mann-Whitney U test. ROC analysis was performed. RESULTS Wash-in rate (k) and wash-out rate (D) were significantly higher in GB compared to RN using curve fitting (p = 0.016 and p = 0.014). TTPF and TTPO were significantly lower in GB compared to RN (p = 0.001 and p = 0.005, respectively). The highest sensitivity (87 %) and specificity (80 %) were obtained for TTPF by applying a threshold of 581 s. K trans, K ep, and V e were not significantly different between GB and RN. A trend towards higher V p values was found in GB compared to RN, indicating angiogenesis in GB (p = 0.075). CONCLUSIONS Based on our results, in a rat model of GB and RN, wash-in rate, wash-out rate, and the time to peak extracted from DCE-MRI time series data may be useful to discriminate GB from RN.
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Affiliation(s)
- Julie Bolcaen
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Benedicte Descamps
- iMinds-IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Marjan Acou
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | - Karel Deblaere
- Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium
| | | | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Christian Vanhove
- iMinds-IBiTech-MEDISIP, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
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Garbow JR, Tsien CI, Beeman SC. Preclinical MRI: Studies of the irradiated brain. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 292:73-81. [PMID: 29705034 PMCID: PMC6029718 DOI: 10.1016/j.jmr.2018.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/20/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
Radiation therapy (RT) plays a central role in the treatment of primary brain tumors. However, despite recent advances in RT treatment, local recurrences following therapy remain common. Radiation necrosis (RN) is a severe, late complication of radiation therapy in the brain. RN is a serious clinical problem often associated with devastating neurologic complications. Therapeutic strategies, including neuroprotectants, have been described, but have not been widely translated in routine clinical use. We have developed a mouse model that recapitulates all of the major pathologic features of late-onset RN for the purposes of characterizing the basic pathogenesis of RN, identifying non-invasive (imaging) biomarkers of RN that might allow for the radiologic discernment of tumor and RN, systematic testing of tumor and RN therapeutics, and exploring the complex interplay between RN pathogenesis and tumor recurrence. Herein, we describe the fundamental clinical challenges associated with RN and the progress made towards addressing these challenges by combining our novel mouse model of late-onset RN and magnetic resonance imaging (MRI). MRI techniques discussed include conventional T1- and T2-weighted imaging, diffusion-weighted imaging, magnetization transfer, and measures of tissue oxygenation. Studies of RN mitigation and neuroprotection are described, including the use of anti-VEGF antibodies, and inhibitors of GSK-3β, HIF-1α, and CXCR4. We conclude with some future perspectives on the irradiated brain and the study and treatment of recurrent tumor growing in an irradiated tumor microenvironment.
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Affiliation(s)
- Joel R Garbow
- Department of Radiology, Washington University, Saint Louis, MO, United States; The Alvin J. Siteman Cancer Center, Washington University, Saint Louis, MO, United States.
| | - Christina I Tsien
- Department of Radiation Oncology, Washington University, Saint Louis, MO, United States
| | - Scott C Beeman
- Department of Radiology, Washington University, Saint Louis, MO, United States
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Hojjati M, Badve C, Garg V, Tatsuoka C, Rogers L, Sloan A, Faulhaber P, Ros PR, Wolansky LJ. Role of FDG-PET/MRI, FDG-PET/CT, and Dynamic Susceptibility Contrast Perfusion MRI in Differentiating Radiation Necrosis from Tumor Recurrence in Glioblastomas. J Neuroimaging 2017; 28:118-125. [PMID: 28718993 PMCID: PMC5811794 DOI: 10.1111/jon.12460] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/24/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE To compare the utility of quantitative PET/MRI, dynamic susceptibility contrast (DSC) perfusion MRI (pMRI), and PET/CT in differentiating radiation necrosis (RN) from tumor recurrence (TR) in patients with treated glioblastoma multiforme (GBM). METHODS The study included 24 patients with GBM treated with surgery, radiotherapy, and temozolomide who presented with progression on imaging follow‐up. All patients underwent PET/MRI and pMRI during a single examination. Additionally, 19 of 24 patients underwent PET/CT on the same day. Diagnosis was established by pathology in 17 of 24 and by clinical/radiologic consensus in 7 of 24. For the quantitative PET/MRI and PET/CT analysis, a region of interest (ROI) was drawn around each lesion and within the contralateral white matter. Lesion to contralateral white matter ratios for relative maximum, mean, and median were calculated. For pMRI, lesion ROI was drawn on the cerebral blood volume (CBV) maps and histogram metrics were calculated. Diagnostic performance for each metric was assessed using receiver operating characteristic curve analysis and area under curve (AUC) was calculated. RESULTS In 24 patients, 28 lesions were identified. For PET/MRI, relative mean ≥ 1.31 resulted in AUC of .94 with both sensitivity and negative predictive values (NPVs) of 100%. For pMRI, CBV max ≥3.32 yielded an AUC of .94 with both sensitivity and NPV measuring 100%. The joint model utilizing r‐mean (PET/MRI) and CBV mode (pMRI) resulted in AUC of 1.0. CONCLUSION Our study demonstrates that quantitative PET/MRI parameters in combination with DSC pMRI provide the best diagnostic utility in distinguishing RN from TR in treated GBMs.
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Affiliation(s)
- Mojgan Hojjati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Chaitra Badve
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Vasant Garg
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Curtis Tatsuoka
- Department of Neurology (Epidemiology), Case Western Reserve University, Cleveland, OH
| | - Lisa Rogers
- Department of Neurology, Neuro-oncology Program, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Andrew Sloan
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Peter Faulhaber
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Pablo R Ros
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Leo J Wolansky
- Department of Diagnostic Imaging, University of Connecticut School of Medicine, Farmington, CT
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Jena A, Taneja S, Jha A, Damesha NK, Negi P, Jadhav GK, Verma SM, Sogani SK. Multiparametric Evaluation in Differentiating Glioma Recurrence from Treatment-Induced Necrosis Using Simultaneous 18F-FDG-PET/MRI: A Single-Institution Retrospective Study. AJNR Am J Neuroradiol 2017; 38:899-907. [PMID: 28341716 DOI: 10.3174/ajnr.a5124] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 12/21/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating glioma recurrence from treatment-induced necrosis can be a challenge on conventional imaging. This study aimed to assess the diagnostic performance of each functional MR imaging and PET parameter derived by using simultaneous FDG-PET/MR imaging individually and in combination in the evaluation of suspected glioma recurrence. MATERIALS AND METHODS Thirty-five treated glioma patients with 41 enhancing lesions (World Health Organization grade II = 9, III = 13, IV = 19) on MR imaging after an operation followed by radiation therapy and/or chemotherapy formed part of this study. Using PET/MR imaging, we calculated the normalized mean relative CBV, mean ADC, Cho/Cr, and maximum and mean target-to-background ratios. Statistical analysis was performed to determine the diagnostic performance of each parameter by receiver operating characteristic analysis individually and in combination with multivariate receiver operating characteristic analysis for the detection of glioma recurrence. Histopathology or clinicoradiologic follow-up was considered the criterion standard. RESULTS Of 35 patients, 25 (30 lesions) were classified as having a recurrence and 10 (11 lesions) patients as having treatment-induced necrosis. Parameters like rCBVmean (mean relative CBV), ADCmean, Cho/Cr, and maximum and mean target-to-background ratios were statistically significant in the detection of recurrent lesions with an accuracy of 77.5%, 78.0%, 90.9%, 87.8%, and 87.8%, respectively. On multivariate receiver operating characteristic analysis, the combination of all 3 MR imaging parameters resulted in an area under the curve of 0.913 ± 0.053. Furthermore, an area under the curve of 0.935 ± 0.046 was obtained when MR imaging parameters (ADCmean and Cho/Cr) were combined with the PET parameter (mean target-to-background ratio), demonstrating an increase in diagnostic accuracy. CONCLUSIONS Simultaneous PET/MR imaging with FDG offers correlative and synergistic multiparametric assessment of glioma recurrence with increased accuracy and clinical utility.
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Affiliation(s)
- A Jena
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - S Taneja
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - A Jha
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - N K Damesha
- Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
| | - P Negi
- From the PET SUITE (A. Jena, S.T., A. Jha, P.N.)
| | - G K Jadhav
- Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.)
| | - S M Verma
- Departments of Molecular Imaging and Nuclear Medicine, Radiation Oncology (G.K.J., S.M.V.)
| | - S K Sogani
- Neurosurgery (N.K.D., S.K.S.), Indraprastha Apollo Hospitals, Sarita Vihar, New Delhi, India
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Aydın Ö, Büyükkaya R, Hakyemez B. Contrast medium enhanced susceptibility imaging signal mechanism; should we use contrast medium? Acta Radiol 2017; 58:107-113. [PMID: 26966145 DOI: 10.1177/0284185116637246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/09/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Intracranial lesions exhibit clear contrast enhancement in T1-weighted imaging, but the mechanism whereby contrast-enhanced susceptibility-weighted imaging (CE-SWI) generates signals remains unclear. Contrast enhancement patterns cannot be reliably predicted. PURPOSE To explore the mechanism of CE-SWI contrast enhancement. MATERIAL AND METHODS Fifty-five patients were retrospectively enrolled. All of the imaging employed a clinical 3T magnetic resonance imaging (MRI) system fitted with a 32-channel head coil. Minimum-intensity projection reformatted images were evaluated. Intracranial lesions and brain parenchymal intensities were explored using SWI and CE-SWI. signal intensity rates were calculated by dividing the lesional intensity by the white matter intensity, after which the SWI and CE-SWI signal intensity rate were compared. Two observers independently performed intralesional susceptibility signal analysis. RESULTS After contrast medium administration, malignant and extra-axial tumors exhibited obvious contrast enhancement on CE-SWI (P < 0.001 and P = 0.013, respectively). The signal intensity of white matter was significantly reduced. The signal intensity rates rose significantly in the benign, malignant, and extra-axial groups (P < 0.001). Between-radiologist agreement in terms of intralesional susceptibility signal assessment was strong (kappa = 0.8, P < 0.001). CONCLUSION Contrast media can either reduce or increase SWI signal intensities. The dual contrast feature of CE-SWI can be useful when exploring intracranial disorders.
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Affiliation(s)
- Ömer Aydın
- Department of Radiology, Ali Osman Sönmez Oncology Hospital, Bursa, Turkey
| | | | - Bahattin Hakyemez
- Department of Radiology, Uludağ University School of Medicine, Bursa, Turkey
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Patel PD, Patel NV, Davidson C, Danish SF. The Role of MRgLITT in Overcoming the Challenges in Managing Infield Recurrence After Radiation for Brain Metastasis. Neurosurgery 2016; 79 Suppl 1:S40-S58. [DOI: 10.1227/neu.0000000000001436] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Radiation necrosis and tumor recurrence are common sequelae after radiation therapy for brain metastasis. The differentiation of radiation necrosis and recurrent brain metastases continues to remain a difficult task despite a number of diagnostic methods. Techniques including magnetic resonance imaging, diffusion-weighted imaging, nuclear studies, and the gold standard of biopsy have all been studied for their effectiveness in accurately diagnosing the postradiation condition. Various specific treatment options of the distinct pathologies are available with the general theory that recurrences require more immediate treatment whereas radiation necrosis can be observed until symptomatic before intervention. This further emphasizes the necessity to accurately diagnose the condition to start appropriate and effective treatment. Despite both pathologies being pathophysiologically distinct, controversies exist as to whether there should be a distinction made at all or if the two can be perceived as a single condition if treatment and presentation are similar enough. Furthermore, a single treatment option such as magnetic resonance–guided, laser-induced thermal therapy (MRgLITT) can be used, potentially eliminating the need to differentiate the 2 entities because it successfully treats both conditions while being minimally invasive.
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Affiliation(s)
- Purvee D. Patel
- Section of Neurosurgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Nitesh V. Patel
- Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Christian Davidson
- Section of Neurosurgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
- Department of Pathology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Shabbar F. Danish
- Section of Neurosurgery, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
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Masch WR, Wang PI, Chenevert TL, Junck L, Tsien C, Heth JA, Sundgren PC. Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis. Acad Radiol 2016; 23:569-76. [PMID: 26916251 DOI: 10.1016/j.acra.2015.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/26/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance (MR) perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy. MATERIALS AND METHODS Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on posttreatment surveillance MRI were enrolled. DSC perfusion MRI and DTI were performed. Region of interest cursors were manually drawn in the contrast-enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis. RESULTS Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and eight (33%) lesions were placed into the radiation necrosis group using biopsy results as the gold standard in all but three patients. Mean apparent diffusion coefficient values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast-enhancing lesion were significantly lower, and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group (P < 0.01, P = 0.03, P < 0.01, and P < 0.01, respectively). CONCLUSIONS The combined assessment of DTI and DSC MR perfusion properties of new contrast-enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.
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Pilot Preclinical and Clinical Evaluation of (4S)-4-(3-[18F]Fluoropropyl)-L-Glutamate (18F-FSPG) for PET/CT Imaging of Intracranial Malignancies. PLoS One 2016; 11:e0148628. [PMID: 26890637 PMCID: PMC4758607 DOI: 10.1371/journal.pone.0148628] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 01/19/2016] [Indexed: 01/22/2023] Open
Abstract
Purpose (S)-4-(3-[18F]Fluoropropyl)-L-glutamic acid (18F-FSPG) is a novel radiopharmaceutical for Positron Emission Tomography (PET) imaging. It is a glutamate analogue that can be used to measure xC- transporter activity. This study was performed to assess the feasibility of 18F-FSPG for imaging orthotopic brain tumors in small animals and the translation of this approach in human subjects with intracranial malignancies. Experimental Design For the small animal study, GS9L glioblastoma cells were implanted into brains of Fischer rats and studied with 18F-FSPG, the 18F-labeled glucose derivative 18F-FDG and with the 18F-labeled amino acid derivative 18F-FET. For the human study, five subjects with either primary or metastatic brain cancer were recruited (mean age 50.4 years). After injection of 300 MBq of 18F-FSPG, 3 whole-body PET/Computed Tomography (CT) scans were obtained and safety parameters were measured. The three subjects with brain metastases also had an 18F-FDG PET/CT scan. Quantitative and qualitative comparison of the scans was performed to assess kinetics, biodistribution, and relative efficacy of the tracers. Results In the small animals, the orthotopic brain tumors were visualized well with 18F-FSPG. The high tumor uptake of 18F-FSPG in the GS9L model and the absence of background signal led to good tumor visualization with high contrast (tumor/brain ratio: 32.7). 18F-FDG and 18F-FET showed T/B ratios of 1.7 and 2.8, respectively. In the human pilot study, 18F-FSPG was well tolerated and there was similar distribution in all patients. All malignant lesions were positive with 18F-FSPG except for one low-grade primary brain tumor. In the 18F-FSPG-PET-positive tumors a similar T/B ratio was observed as in the animal model. Conclusions 18F-FSPG is a novel PET radiopharmaceutical that demonstrates good uptake in both small animal and human studies of intracranial malignancies. Future studies on larger numbers of subjects and a wider array of brain tumors are planned. Trial Registration ClinicalTrials.gov NCT01186601
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Zhang L, Pan CC, Li D. The historical change of brainstem glioma diagnosis and treatment: from imaging to molecular pathology and then molecular imaging. Chin Neurosurg J 2015. [DOI: 10.1186/s41016-015-0006-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Current standard of care for treatment of newly diagnosed high grade gliomas is surgery followed by concomitant radiotherapy (RT) and chemotherapy (CT) with temozolomide (TMZ). Recently, bevacizumab, an anti – angiogenic agent has also been approved for treatment of recurrent gliomas. Baseline imaging after excision is optimally obtained in the first 24 hours. When baseline postoperative imaging is delayed beyond 24 hours, subacute hemorrhage, subacute ischemia and inflammation at the resection margins render differentiation from residual tumor challenging. Radiation necrosis is a well recognized entity and is differentiated from recurrence based on morphology on structural imaging, presence of lipid – lactate complexes with lack of choline on spectroscopy and low normalized cerebral blood volume (CBV) ratios at perfusion imaging. Novel chemotherapies have lead to the occurrence of interesting but sometimes confusing post treatment imaging appearances including the phenomena of ‘pseudoprogression’ and ‘pseudoresponse’. Pseudoprogression refers to transient, self resolving focal enhancement mediated by TMZ-induced increased vascular permeability and local inflammatory response. Pathologically, these lesions do not have viable tumor. The lesions stabilize or regress without further treatment and are usually clinically asymptomatic. Pseudoresponse refers to rapid regression of enhancement, perfusion, mass effect and midline shift caused by the anti – angiogenic effect of bevacizumab. It is termed pseudoresponse since biological tumor persists as non-enhancing altered signal. It is important for radiologists to be aware of these entities seen on post treatment imaging of gliomas, as misinterpretation may lead to inappropriate management decisions and prognostication.
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Affiliation(s)
- Darshana Sanghvi
- Department of Radiology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
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Zhang H, Ma L, Wang Q, Zheng X, Wu C, Xu BN. Role of magnetic resonance spectroscopy for the differentiation of recurrent glioma from radiation necrosis: a systematic review and meta-analysis. Eur J Radiol 2015; 83:2181-2189. [PMID: 25452098 DOI: 10.1016/j.ejrad.2014.09.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Differentiating glioma recurrence from radiation necrosis remains a great challenge. We conducted a meta-analysis to evaluate the diagnostic quality of magnetic resonance spectroscopy (MRS) in differentiating glioma recurrence from radiation necrosis. METHODS Studies about evaluation of MRS for the differential diagnosis of glioma recurrence from radiation necrosis were systematically searched in PubMed, Embase and Chinese Biomedical databases up to May 4, 2014. The data were extracted to perform heterogeneity test, threshold effect test and to calculate sensitivity (SEN), specificity (SPE) and areas under summary receiver operating characteristic curve (SROC). RESULTS Eighteen articles comprising a total sample size of 455 patients (447 lesions) with suspected glioma recurrence after radiotherapy, met all inclusion and exclusion criteria, and were included in our meta-analysis. Quantitative synthesis of studies showed that the pooled SEN and SPE for Cho/Cr ratio were 0.83 (95% CI: 0.77, 0.89) and 0.83 (95% CI: 0.74, 0.90). The area under the curve (AUC) under the SROC was 0.9001. The pooled SEN and SPE for Cho/NAA ratio were 0.88 (95% CI: 0.81, 0.93) and 0.86 (95% CI: 0.76, 0.93). The AUC under the SROC was 0.9185. CONCLUSION This meta-analysis shows that MRS alone has moderate diagnostic performance in differentiating glioma recurrence from radiation necrosis using metabolite ratios like Cho/Cr and Cho/NAA ratio. It is strongly recommended that MRS should combine other advanced imaging technologies to improve diagnostic accuracy. This article underlines the importance of implementing multimodal imaging trials and multicentre trials in the future.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China; Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Li Ma
- Department of Anesthesiology, Beijing Military General Hospital, Beijing 100700, China
| | - Qun Wang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Xuan Zheng
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Chen Wu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Bai-Nan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China.
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Characterization of pseudoprogression in patients with glioblastoma: is histology the gold standard? J Neurooncol 2015; 123:141-50. [PMID: 25894594 DOI: 10.1007/s11060-015-1774-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 04/02/2015] [Indexed: 01/29/2023]
Abstract
Pseudoprogression (psPD) refers to an increase in size or appearance of new areas of MRI contrast enhancement soon after completing chemoradiation, timely diagnosis of which has been a challenge. Given that tissue sampling of the MRI changes would be expected to accurately distinguish psPD from true progression when MRI changes are first seen, we examined the utility of surgery in diagnosing psPD and influencing patient outcome. We retrospectively reviewed data from adults with GBM who had MRI changes suggestive of progression within 3 months of chemoRT; of these, 34 underwent surgical resection. Three subsets-tumor, psPD or mixed-were identified based on histology and immunohistochemistry in the surgical group and by imaging characteristics in the nonsurgical group. A cohort of patients with stable disease post-chemoRT served as control. PFS and OS were determined using the Kaplan-Meier method and log rank analysis. Concordance for psPD between radiological interpretation and subsequent histological diagnosis was seen in only 32% of cases (11/34) 95%CI 19-49%. A large proportion of patients had a histologically "mixed" pattern with tumor and treatment effect. No significant differences in PFS or OS were seen among the three subtypes. Surgical sampling and histologic review of MRI changes after chemoRT may not serve as a gold standard to distinguish psPD from true progression in GBM patients. Refinement of the histological criteria, careful intraoperative selection of regions of interest and advanced imaging modalities are needed for early differentiation of PsPD from progression to guide clinical management.
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Zhang H, Ma L, Shu C, Wang YB, Dong LQ. Diagnostic accuracy of diffusion MRI with quantitative ADC measurements in differentiating glioma recurrence from radiation necrosis. J Neurol Sci 2015; 351:65-71. [PMID: 25748965 DOI: 10.1016/j.jns.2015.02.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/03/2015] [Accepted: 02/21/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Differentiating radiation necrosis from glioma recurrence remains a great challenge. Several advanced imaging modalities have been developed to differentiate between these two entities with disparate outcomes. We conducted a meta-analysis to evaluate the diagnostic quality of diffusion MRI in differentiating glioma recurrence from radiation necrosis. METHOD PubMed, Embase and Chinese Biomedical databases were systematically searched to identify published articles about evaluation of diffusion MRI for the differential diagnosis of glioma recurrence from radiation necrosis. Pooled sensitivity (SEN), specificity (SPE), negative likelihood ratio (NLR), positive likelihood ratio (PLR), and diagnostic odds ratio (DOR) were calculated. RESULTS Nine studies involving 284 patients (288 lesions) met all inclusion and exclusion criteria. Quantitative synthesis of studies showed that the pooled weighted values were determined to be SEN: 0.82 (95% CI: 0.75, 0.87); SPE: 0.84 (95% CI: 0.76, 0.91); PLR: 5.10 (95% CI: 3.27, 7.95); NLR: 0.21 (95% CI: 0.15, 0.29); and DOR: 23.90 (95% CI: 12.44, 45.89). CONCLUSIONS This meta-analysis shows that diffusion MRI has moderate diagnostic performance in differentiating glioma recurrence from radiation necrosis using quantitative ADC. It is recommended not to use diffusion MRI alone in differentiating between glioma recurrence and radiation necrosis. Multimodal imaging trials should be implemented in the future.
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Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China
| | - Li Ma
- Department of Anesthesiology, Beijing Military General Hospital, Beijing 100700, China.
| | - Cheng Shu
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China
| | - Yu-Bo Wang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China
| | - Lian-Qiang Dong
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China.
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Performance of SPECT in the differential diagnosis of glioma recurrence from radiation necrosis. J Clin Neurosci 2015; 22:229-37. [DOI: 10.1016/j.jocn.2014.06.102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/31/2014] [Accepted: 06/14/2014] [Indexed: 11/17/2022]
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The Pathophysiology of Cerebral Radiation Necrosis and the Role of Laser Interstitial Thermal Therapy. World Neurosurg 2015; 83:23-6. [DOI: 10.1016/j.wneu.2014.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 03/07/2014] [Indexed: 11/20/2022]
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Abstract
Object:To review our institutional experience with Gamma Knife (GK) stereotactic radiosurgery in treating focally recurrent high grade glial neoplasms of World Health Organization (WHO) grade III or IV.Methods:We conducted a retrospective cohort review of all patients treated with GK for focally recurrent high grade gliomas at our institution between November 2003 and April 2013. Data on age, sex, tumor volume, location and maximal diameter, presenting clinical status, complications and clinical outcome was recorded.Results:A total of 33 patients were identified. Four were lost to follow-up. Average post-GK and overall survival was 20.4 months (range: 3 – 72) and 63.3 months (range: 10 – 214) respectively. For WHO grade IV gliomas, the average post-GK and overall survival was 15.8 months (range: 3 – 77) and 40.1 months (range: 13 – 148) respectively. Similarily, for WHO grade III gliomas, the average post-GK and overall survival was 34.9 months (range: 6 – 72) and 136.4 months (range: 22 – 214) respectively. Twenty-two patients (75.9%) had post-GK edema, with 14 requiring dexamethasone and eight being asymptomatic. Four patients (13.8%) had imaging defined radiation necrosis.Conclusions:Gamma Knife SRS affords an extension of local tumor control, acceptable morbidity, and potentially prolonged survival, for highly selected patients with focally recurrent high grade glial neoplasms.
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Bolcaen J, Descamps B, Deblaere K, Boterberg T, De Vos Pharm F, Kalala JP, Van den Broecke C, Decrock E, Leybaert L, Vanhove C, Goethals I. (18)F-fluoromethylcholine (FCho), (18)F-fluoroethyltyrosine (FET), and (18)F-fluorodeoxyglucose (FDG) for the discrimination between high-grade glioma and radiation necrosis in rats: a PET study. Nucl Med Biol 2014; 42:38-45. [PMID: 25218024 DOI: 10.1016/j.nucmedbio.2014.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/04/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Discrimination between (high-grade) brain tumor recurrence and radiation necrosis (RN) remains a diagnostic challenge because both entities have similar imaging characteristics on conventional magnetic resonance imaging (MRI). Metabolic imaging, such as positron emission tomography (PET) could overcome this diagnostic dilemma. In this study, we investigated the potential of 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG), O-(2-[(18)F]-fluoroethyl)-L-tyrosine ((18)F-FET), and [(18)F]-Fluoromethyl-dimethyl-2-hydroxyethylammonium ((18)F-fluoromethylcholine, (18)F-FCho) PET in discriminating high-grade tumor from RN. METHODS We developed a glioblastoma (GB) rat model by inoculating F98 GB cells into the right frontal region. Induction of RN was achieved by irradiating the right frontal region with 60 Gy using three arcs with a beam aperture of 3×3 mm (n=3). Dynamic PET imaging with (18)F-FDG, (18)F-FET, and (18)F-FCho, as well as (18)F-FDG PET at a delayed time interval (240 min postinjection), was acquired. RESULTS MRI revealed contrast-enhancing tumors at 15 days after inoculation (n=4) and contrast-enhancing RN lesions 5-6 months postirradiation (n=3). On (18)F-FDG PET, the mean lesion-to-normal ratio (LNRmean) was significantly higher in GB than in RN (p=0.034). The difference in the LNRmean between tumors and RN was higher on the late (18)F-FDG PET images than on the PET images reconstructed from the last time frame of the dynamic acquisition (this is at a conventional time interval). LNRs obtained from (18)F-FCho PET were not significantly different between GB and RN (p=1.000). On (18)F-FET PET, the LNRmean was significantly higher in GB compared to RN (p=0.034). CONCLUSIONS Unlike (18)F-FCho, (18)F-FDG and (18)F-FET PET were effective in discriminating GB from RN. Interestingly, in the case of (18)F-FDG, delayed PET seems particularly useful. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Our results suggest that (delayed) (18)F-FDG and (18)F-FET PET can be used to discriminate GB (recurrence) from RN. Confirmation of these results in clinical studies is needed.
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Affiliation(s)
- Julie Bolcaen
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- iMinds Medical IT - MEDISIP - Infinity lab, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Karel Deblaere
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Elke Decrock
- Department of Basic Medical Sciences-Physiology group, Ghent University, Ghent, Belgium
| | - Luc Leybaert
- Department of Basic Medical Sciences-Physiology group, Ghent University, Ghent, Belgium
| | - Christian Vanhove
- iMinds Medical IT - MEDISIP - Infinity lab, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
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Perfusion-metabolism coupling in recurrent gliomas: a prospective validation study with 13N-ammonia and 18F-fluorodeoxyglucose PET/CT. Neuroradiology 2014; 56:893-902. [PMID: 24989883 DOI: 10.1007/s00234-014-1389-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION We assessed the validity of "perfusion-metabolism coupling" hypothesis in recurrent glioma with 13N-ammonia (13N-NH3) PET/CT and 18F-fluorodeoxyglucose (18F-FDG) PET/CT. METHODS Fifty-six consecutive patients (age, 38.8 ± 12.1 years; 62.5% males) with histologically proven and previously treated glioma presenting with clinical suspicion of recurrence were prospectively enrolled and evaluated with 13N-NH3 PET/CT and 18F-FDG PET/CT. PET/CT images were evaluated both qualitatively and semiquantitatively. Tumor to white matter uptake ratio (T/W) and tumor to gray matter uptake ratio (T/G) were calculated and analyzed for both the modalities. A combination of clinico-radiological follow-up, repeated imaging, and biopsy (when available) were considered as the reference standard. RESULTS Based on the reference standard, 27/56 patients had recurrence. 13N-NH3 PET/CT and 18F-FDG PET/CT were concordant in 55/56 patients. Overall sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 13N-NH3PET/CT were 77.8, 86.2, 84.0, 80.7, and 82.1%, respectively, and for 18F-FDG PET/CT were 77.8, 89.7, 87.5, 81.2, and 83.9%, respectively. There was excellent agreement between results of 13N-NH3 PET/CT and 18F-FDG PET/CT (ĸ = 0.964; P < 0.001). The performances of 13N-NH3 PET/CT and 18F-FDG PET/CT were not significantly different between high-grade and low-grade glioma (P = 1.000). A strong positive correlation was noted between the uptake ratios derived on the two modalities (ρ = 0.866, P < 0.001 for T/W; ρ = 0.918, P < 0.001 for T/G). CONCLUSION A combination of 13N-NH3 PET/CT and 18F-FDG PET/CT demonstrates that perfusion and metabolism are coupled in recurrent gliomas. These tracers target two different but interrelated aspects of the same pathologic process and can be used as surrogates for each other.
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Comparison of diffusion tensor, dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain SPECT for the detection of recurrent high-grade glioma. Magn Reson Imaging 2014; 32:854-9. [PMID: 24848292 DOI: 10.1016/j.mri.2014.04.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/05/2014] [Accepted: 04/15/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Treatment induced necrosis is a relatively frequent finding in patients treated for high-grade glioma. Differentiation by imaging modalities between glioma recurrence and treatment induced necrosis is not always straightforward. This is a comparative study of diffusion tensor imaging (DTI), dynamic susceptibility contrast MRI and (99m)Tc-Tetrofosmin brain single-photon emission computed tomography (SPECT) for differentiation of recurrent glioma from treatment induced necrosis. METHODS A prospective study was made of 30 patients treated for high-grade glioma who had suspected recurrent tumor on follow-up MRI. All had been treated by surgical resection of the tumor followed by standard postoperative radiotherapy with chemotherapy. No residual tumor had been found on brain imaging immediately after the initial treatment. All the patients were studied with dynamic susceptibility contrast brain MRI and, within a week, (99m)Tc-Tetrofosmin brain SPECT. RESULTS Both (99m)Tc-Tetrofosmin brain SPECT and dynamic susceptibility contrast MRI could discriminate between tumor recurrence and treatment induced necrosis with 100% sensitivity and 100% specificity. An apparent diffusion coefficient (ADC) ratio cut-off value of 1.27 could differentiate recurrence from treatment induced necrosis with 65% sensitivity and 100% specificity and a fractional anisotropy (FA) ratio cut-off value of 0.47 could differentiate recurrence from treatment induced necrosis with 57% sensitivity and 100% specificity. A significant correlation was demonstrated between (99m)Tc-Tetrofosmin uptake ratio and rCBV (P=0.003). CONCLUSIONS Dynamic susceptibility contrast MRI and brain SPECT with (99m)Tc-Tetrofosmin had the same accuracy and may be used to detect recurrent tumor following treatment for glioma. DTI also showed promise for the detection of recurrent tumor, but was inferior to both dynamic susceptibility contrast MRI and brain SPECT.
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