1
|
Chen Q, Worthoff WA, Shah NJ. Accelerated multiple-quantum-filtered sodium magnetic resonance imaging using compressed sensing at 7 T. Magn Reson Imaging 2024; 107:138-148. [PMID: 38171423 DOI: 10.1016/j.mri.2023.12.011] [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: 03/06/2023] [Revised: 07/17/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Multiple-quantum-filtered (MQF) sodium magnetic resonance imaging (MRI), such as enhanced single-quantum and triple-quantum-filtered imaging of 23Na (eSISTINA), enables images to be weighted towards restricted sodium, a promising biomarker in clinical practice, but often suffers from clinically infeasible acquisition times and low image quality. This study aims to mitigate the above limitation by implementing a novel eSISTINA sequence at 7 T with the application of compressed sensing (CS) to accelerate eSISTINA acquisitions without a noticeable loss of information. METHODS A novel eSISTINA sequence with a 3D spiral-based sampling scheme was implemented at 7 T for the application of CS. Fully sampled datasets were obtained from one phantom and ten healthy subjects, and were then retrospectively undersampled by various undersampling factors. CS undersampled reconstructions were compared to fully sampled and undersampled nonuniform fast Fourier transform (NUFFT) reconstructions. Reconstruction performance was evaluated based on structural similarity (SSIM), signal-to-noise ratio (SNR), weightings towards total and compartmental sodium, and in vivo quantitative estimates. RESULTS CS-based phantom and in vivo images have less noise and better structural delineation while maintaining the weightings towards total, non-restricted (predominantly extracellular), and restricted (primarily intracellular) sodium. CS generally outperforms NUFFT with a higher SNR and a better SSIM, except for the SSIM in TQ brain images, which is likely due to substantial noise contamination. CS enables in vivo quantitative estimates with <15% errors at an undersampling factor of up to two. CONCLUSIONS Successful implementation of an eSISTINA sequence with an incoherent sampling scheme at 7 T was demonstrated. CS can accelerate eSISTINA by up to twofold at 7 T with reduced noise levels compared to NUFFT, while maintaining major structural information, reasonable weightings towards total and compartmental sodium, and relatively reliable in vivo quantification. The associated reduction in acquisition time has the potential to facilitate the clinical applicability of MQF sodium MRI.
Collapse
Affiliation(s)
- Qingping Chen
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich GmbH, Jülich, Germany; Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich GmbH, Jülich, Germany.
| | - N Jon Shah
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich GmbH, Jülich, Germany; Institute of Neuroscience and Medicine - 11, Forschungszentrum Jülich GmbH, Jülich, Germany; JARA-BRAIN-Translational Medicine, Aachen, Germany; Department of Neurology, RWTH Aachen University, Aachen, Germany
| |
Collapse
|
2
|
Gast LV, Platt T, Nagel AM, Gerhalter T. Recent technical developments and clinical research applications of sodium ( 23Na) MRI. PROGRESS IN NUCLEAR MAGNETIC RESONANCE SPECTROSCOPY 2023; 138-139:1-51. [PMID: 38065665 DOI: 10.1016/j.pnmrs.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 12/18/2023]
Abstract
Sodium is an essential ion that plays a central role in many physiological processes including the transmembrane electrochemical gradient and the maintenance of the body's homeostasis. Due to the crucial role of sodium in the human body, the sodium nucleus is a promising candidate for non-invasively assessing (patho-)physiological changes. Almost 10 years ago, Madelin et al. provided a comprehensive review of methods and applications of sodium (23Na) MRI (Madelin et al., 2014) [1]. More recent review articles have focused mainly on specific applications of 23Na MRI. For example, several articles covered 23Na MRI applications for diseases such as osteoarthritis (Zbyn et al., 2016, Zaric et al., 2020) [2,3], multiple sclerosis (Petracca et al., 2016, Huhn et al., 2019) [4,5] and brain tumors (Schepkin, 2016) [6], or for imaging certain organs such as the kidneys (Zollner et al., 2016) [7], the brain (Shah et al., 2016, Thulborn et al., 2018) [8,9], and the heart (Bottomley, 2016) [10]. Other articles have reviewed technical developments such as radiofrequency (RF) coils for 23Na MRI (Wiggins et al., 2016, Bangerter et al., 2016) [11,12], pulse sequences (Konstandin et al., 2014) [13], image reconstruction methods (Chen et al., 2021) [14], and interleaved/simultaneous imaging techniques (Lopez Kolkovsky et al., 2022) [15]. In addition, 23Na MRI topics have been covered in review articles with broader topics such as multinuclear MRI or ultra-high-field MRI (Niesporek et al., 2019, Hu et al., 2019, Ladd et al., 2018) [16-18]. During the past decade, various research groups have continued working on technical improvements to sodium MRI and have investigated its potential to serve as a diagnostic and prognostic tool. Clinical research applications of 23Na MRI have covered a broad spectrum of diseases, mainly focusing on the brain, cartilage, and skeletal muscle (see Fig. 1). In this article, we aim to provide a comprehensive summary of methodological and hardware developments, as well as a review of various clinical research applications of sodium (23Na) MRI in the last decade (i.e., published from the beginning of 2013 to the end of 2022).
Collapse
Affiliation(s)
- Lena V Gast
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Tanja Platt
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Teresa Gerhalter
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
| |
Collapse
|
3
|
Langen KJ, Galldiks N, Mauler J, Kocher M, Filß CP, Stoffels G, Régio Brambilla C, Stegmayr C, Willuweit A, Worthoff WA, Shah NJ, Lerche C, Mottaghy FM, Lohmann P. Hybrid PET/MRI in Cerebral Glioma: Current Status and Perspectives. Cancers (Basel) 2023; 15:3577. [PMID: 37509252 PMCID: PMC10377176 DOI: 10.3390/cancers15143577] [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: 05/31/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Advanced MRI methods and PET using radiolabelled amino acids provide valuable information, in addition to conventional MR imaging, for brain tumour diagnostics. These methods are particularly helpful in challenging situations such as the differentiation of malignant processes from benign lesions, the identification of non-enhancing glioma subregions, the differentiation of tumour progression from treatment-related changes, and the early assessment of responses to anticancer therapy. The debate over which of the methods is preferable in which situation is ongoing, and has been addressed in numerous studies. Currently, most radiology and nuclear medicine departments perform these examinations independently of each other, leading to multiple examinations for the patient. The advent of hybrid PET/MRI allowed a convergence of the methods, but to date simultaneous imaging has reached little relevance in clinical neuro-oncology. This is partly due to the limited availability of hybrid PET/MRI scanners, but is also due to the fact that PET is a second-line examination in brain tumours. PET is only required in equivocal situations, and the spatial co-registration of PET examinations of the brain to previous MRI is possible without disadvantage. A key factor for the benefit of PET/MRI in neuro-oncology is a multimodal approach that provides decisive improvements in the diagnostics of brain tumours compared with a single modality. This review focuses on studies investigating the diagnostic value of combined amino acid PET and 'advanced' MRI in patients with cerebral gliomas. Available studies suggest that the combination of amino acid PET and advanced MRI improves grading and the histomolecular characterisation of newly diagnosed tumours. Few data are available concerning the delineation of tumour extent. A clear additive diagnostic value of amino acid PET and advanced MRI can be achieved regarding the differentiation of tumour recurrence from treatment-related changes. Here, the PET-guided evaluation of advanced MR methods seems to be helpful. In summary, there is growing evidence that a multimodal approach can achieve decisive improvements in the diagnostics of cerebral gliomas, for which hybrid PET/MRI offers optimal conditions.
Collapse
Affiliation(s)
- Karl-Josef Langen
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
- Department of Nuclear Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 53127 Bonn, Germany
| | - Norbert Galldiks
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 53127 Bonn, Germany
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
| | - Jörg Mauler
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Martin Kocher
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine, University Hospital Cologne, 50931 Cologne, Germany
| | - Christian Peter Filß
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
- Department of Nuclear Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Gabriele Stoffels
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Cláudia Régio Brambilla
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Carina Stegmayr
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Antje Willuweit
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Wieland Alexander Worthoff
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Nadim Jon Shah
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
- Department of Neurology, RWTH Aachen University Hospital, 52074 Aachen, Germany
| | - Christoph Lerche
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| | - Felix Manuel Mottaghy
- Department of Nuclear Medicine, RWTH Aachen University Hospital, 52074 Aachen, Germany
- Center of Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and Duesseldorf, 53127 Bonn, Germany
- Department of Neurology, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50931 Cologne, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), 6229 HX Maastricht, The Netherlands
| | - Philipp Lohmann
- Institute of Neuroscience and Medicine (INM-3, INM-4, INM-11), Forschungszentrum Juelich, 52425 Juelich, Germany
| |
Collapse
|
4
|
Cho NS, Sanvito F, Thakuria S, Wang C, Hagiwara A, Nagaraj R, Oshima S, Lopez Kolkovsky AL, Lu J, Raymond C, Liau LM, Everson RG, Patel KS, Kim W, Yang I, Bergsneider M, Nghiemphu PL, Lai A, Nathanson DA, Cloughesy TF, Ellingson BM. Multi-nuclear sodium, diffusion, and perfusion MRI in human gliomas. J Neurooncol 2023; 163:417-427. [PMID: 37294422 PMCID: PMC10322966 DOI: 10.1007/s11060-023-04363-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/02/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE There is limited knowledge about the associations between sodium and proton MRI measurements in brain tumors. The purpose of this study was to quantify intra- and intertumoral correlations between sodium, diffusion, and perfusion MRI in human gliomas. METHODS Twenty glioma patients were prospectively studied on a 3T MRI system with multinuclear capabilities. Three mutually exclusive tumor volumes of interest (VOIs) were segmented: contrast-enhancing tumor (CET), T2/FLAIR hyperintense non-enhancing tumor (NET), and necrosis. Median and voxel-wise associations between apparent diffusion coefficient (ADC), normalized relative cerebral blood volume (nrCBV), and normalized sodium measurements were quantified for each VOI. RESULTS Both relative sodium concentration and ADC were significantly higher in areas of necrosis compared to NET (P = 0.003 and P = 0.008, respectively) and CET (P = 0.02 and P = 0.02). Sodium concentration was higher in CET compared to NET (P = 0.04). Sodium and ADC were higher in treated compared to treatment-naïve gliomas within NET (P = 0.006 and P = 0.01, respectively), and ADC was elevated in CET (P = 0.03). Median ADC and sodium concentration were positively correlated across patients in NET (r = 0.77, P < 0.0001) and CET (r = 0.84, P < 0.0001), but not in areas of necrosis (r = 0.45, P = 0.12). Median nrCBV and sodium concentration were negatively correlated across patients in areas of NET (r=-0.63, P = 0.003). Similar associations were observed when examining voxel-wise correlations within VOIs. CONCLUSION Sodium MRI is positively correlated with proton diffusion MRI measurements in gliomas, likely reflecting extracellular water. Unique areas of multinuclear MRI contrast may be useful in future studies to understand the chemistry of the tumor microenvironment.
Collapse
Affiliation(s)
- Nicholas S Cho
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA
- Medical Scientist Training Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Francesco Sanvito
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Shruti Thakuria
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Chencai Wang
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Raksha Nagaraj
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sonoko Oshima
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alfredo L Lopez Kolkovsky
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- NMR Laboratory, Neuromuscular Investigation Center, Institute of Myology, Paris, France
| | - Jianwen Lu
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Richard G Everson
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kunal S Patel
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Won Kim
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Isaac Yang
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Marvin Bergsneider
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - David A Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
- UCLA Brain Tumor Imaging Laboratory (BTIL) Professor of Radiology, Psychiatry, and Neurosurgery Departments of Radiological Sciences, Psychiatry, and Neurosurgery David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.
| |
Collapse
|
5
|
Neumaier F, Zlatopolskiy BD, Neumaier B. Mutated Isocitrate Dehydrogenase (mIDH) as Target for PET Imaging in Gliomas. Molecules 2023; 28:molecules28072890. [PMID: 37049661 PMCID: PMC10096429 DOI: 10.3390/molecules28072890] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/21/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Gliomas are the most common primary brain tumors in adults. A diffuse infiltrative growth pattern and high resistance to therapy make them largely incurable, but there are significant differences in the prognosis of patients with different subtypes of glioma. Mutations in isocitrate dehydrogenase (IDH) have been recognized as an important biomarker for glioma classification and a potential therapeutic target. However, current clinical methods for detecting mutated IDH (mIDH) require invasive tissue sampling and cannot be used for follow-up examinations or longitudinal studies. PET imaging could be a promising approach for non-invasive assessment of the IDH status in gliomas, owing to the availability of various mIDH-selective inhibitors as potential leads for the development of PET tracers. In the present review, we summarize the rationale for the development of mIDH-selective PET probes, describe their potential applications beyond the assessment of the IDH status and highlight potential challenges that may complicate tracer development. In addition, we compile the major chemical classes of mIDH-selective inhibitors that have been described to date and briefly consider possible strategies for radiolabeling of the most promising candidates. Where available, we also summarize previous studies with radiolabeled analogs of mIDH inhibitors and assess their suitability for PET imaging in gliomas.
Collapse
Affiliation(s)
- Felix Neumaier
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Str., 52428 Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Boris D Zlatopolskiy
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Str., 52428 Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernd Neumaier
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine, Nuclear Chemistry (INM-5), Wilhelm-Johnen-Str., 52428 Jülich, Germany
- Institute of Radiochemistry and Experimental Molecular Imaging, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| |
Collapse
|
6
|
Two Decades of Brain Tumour Imaging with O-(2-[18F]fluoroethyl)-L-tyrosine PET: The Forschungszentrum Jülich Experience. Cancers (Basel) 2022; 14:cancers14143336. [PMID: 35884396 PMCID: PMC9319157 DOI: 10.3390/cancers14143336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/28/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary PET using radiolabelled amino acids has become an essential tool for diagnosing brain tumours in addition to MRI. O-(2-[18F]fluoroethyl)-L-tyrosine (FET) is one of the most successful tracers in the field. We analysed our database of 6534 FET PET examinations regarding the diagnostic needs and preferences of the referring physicians for FET PET in the clinical decision-making process. The demand for FET PET increased considerably in the last decade, especially for differentiating tumour progress from treatment-related changes in gliomas. Accordingly, referring physicians rated the diagnostics of recurrent glioma and recurrent brain metastases as the most relevant indication for FET PET. The analysis and survey results confirm the high relevance of FET PET in the clinical diagnosis of brain tumours and support the need for approval for routine use. Abstract O-(2-[18F]fluoroethyl)-L-tyrosine (FET) is a widely used amino acid tracer for positron emission tomography (PET) imaging of brain tumours. This retrospective study and survey aimed to analyse our extensive database regarding the development of FET PET investigations, indications, and the referring physicians’ rating concerning the role of FET PET in the clinical decision-making process. Between 2006 and 2019, we performed 6534 FET PET scans on 3928 different patients against a backdrop of growing demand for FET PET. In 2019, indications for the use of FET PET were as follows: suspected recurrent glioma (46%), unclear brain lesions (20%), treatment monitoring (19%), and suspected recurrent brain metastasis (13%). The referring physicians were neurosurgeons (60%), neurologists (19%), radiation oncologists (11%), general oncologists (3%), and other physicians (7%). Most patients travelled 50 to 75 km, but 9% travelled more than 200 km. The role of FET PET in decision-making in clinical practice was evaluated by a questionnaire consisting of 30 questions, which was filled out by 23 referring physicians with long experience in FET PET. Fifty to seventy per cent rated FET PET as being important for different aspects of the assessment of newly diagnosed gliomas, including differential diagnosis, delineation of tumour extent for biopsy guidance, and treatment planning such as surgery or radiotherapy, 95% for the diagnosis of recurrent glioma, and 68% for the diagnosis of recurrent brain metastases. Approximately 50% of the referring physicians rated FET PET as necessary for treatment monitoring in patients with glioma or brain metastases. All referring physicians stated that the availability of FET PET is essential and that it should be approved for routine use. Although the present analysis is limited by the fact that only physicians who frequently referred patients for FET PET participated in the survey, the results confirm the high relevance of FET PET in the clinical diagnosis of brain tumours and support the need for its approval for routine use.
Collapse
|
7
|
Li AY, Iv M. Conventional and Advanced Imaging Techniques in Post-treatment Glioma Imaging. FRONTIERS IN RADIOLOGY 2022; 2:883293. [PMID: 37492665 PMCID: PMC10365131 DOI: 10.3389/fradi.2022.883293] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/06/2022] [Indexed: 07/27/2023]
Abstract
Despite decades of advancement in the diagnosis and therapy of gliomas, the most malignant primary brain tumors, the overall survival rate is still dismal, and their post-treatment imaging appearance remains very challenging to interpret. Since the limitations of conventional magnetic resonance imaging (MRI) in the distinction between recurrence and treatment effect have been recognized, a variety of advanced MR and functional imaging techniques including diffusion-weighted imaging (DWI), diffusion tensor imaging (DTI), perfusion-weighted imaging (PWI), MR spectroscopy (MRS), as well as a variety of radiotracers for single photon emission computed tomography (SPECT) and positron emission tomography (PET) have been investigated for this indication along with voxel-based and more quantitative analytical methods in recent years. Machine learning and radiomics approaches in recent years have shown promise in distinguishing between recurrence and treatment effect as well as improving prognostication in a malignancy with a very short life expectancy. This review provides a comprehensive overview of the conventional and advanced imaging techniques with the potential to differentiate recurrence from treatment effect and includes updates in the state-of-the-art in advanced imaging with a brief overview of emerging experimental techniques. A series of representative cases are provided to illustrate the synthesis of conventional and advanced imaging with the clinical context which informs the radiologic evaluation of gliomas in the post-treatment setting.
Collapse
Affiliation(s)
- Anna Y. Li
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael Iv
- Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, CA, United States
| |
Collapse
|
8
|
Wu C, Blunck Y, Johnston LA. The "Spin-3/2 Bloch Equation": System matrix formalism of excitation, relaxation, and off-resonance effects in biological tissue. Magn Reson Med 2022; 88:1370-1379. [PMID: 35608214 DOI: 10.1002/mrm.29276] [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: 11/29/2021] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE This work proposes "Spin-3/2 Bloch Equation" (SBE), a consolidated formalism for spin-3/2 dynamics in biological environments. The formalism encapsulates excitation, relaxation, and off-resonance with accessible matrix representation for a straightforward implementation with high computational efficiency. THEORY The SBE is derived using spherical tensor operators to encapsulate the spin-3/2 dynamics in biological systems in a single system matrix, a formalism akin to the well-known Bloch Equations (BE). METHODS Using the proposed SBE, simulations of three classical 23 Na pulse sequences were performed to demonstrate the versatility and applicability of the model, returning the evolution of the 23 Na spin system during these experiments: soft rectangular and adiabatic inversion recovery (IR) and triple-quantum filtering. IR simulations were compared with two existing spin-3/2 simulators and the adaptive BE as a first-order approximation. RESULTS The proposed SBE is straightforward to implement and facilitates accurate and fast simulations of the underlying higher order coherence in sodium experiments of biological tissues. SBE simulations and comparison spin-3/2 simulators outperform the BE simulations as expected, with the SBE offering superior computational efficiency achieved by the single system matrix formalism. CONCLUSION The proposed SBE enables comprehensive and accurate simulations for spin-3/2 systems in biological tissue. With a one-line call to an ordinary differential equation solver, it offers a computationally efficient and accessible method for use in 23 Na pulse sequence design.
Collapse
Affiliation(s)
- Chengchuan Wu
- Melbourne Brain Centre Imaging Unit, The University of Melbourne, Parkville, Victoria, Australia.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Yasmin Blunck
- Melbourne Brain Centre Imaging Unit, The University of Melbourne, Parkville, Victoria, Australia.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - Leigh A Johnston
- Melbourne Brain Centre Imaging Unit, The University of Melbourne, Parkville, Victoria, Australia.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
9
|
Handa P, Samkaria A, Sharma S, Arora Y, Mandal PK. Comprehensive Account of Sodium Imaging and Spectroscopy for Brain Research. ACS Chem Neurosci 2022; 13:859-875. [PMID: 35324144 DOI: 10.1021/acschemneuro.2c00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Sodium (23Na) is a vital component of neuronal cells and plays a key role in various signal transmission processes. Hence, information on sodium distribution in the brain using magnetic resonance imaging (MRI) provides useful information on neuronal health. 23Na MRI and MR spectroscopy (MRS) improve the diagnosis, prognosis, and clinical monitoring of neurological diseases but confront some inherent limitations that lead to low signal-to-noise ratio, longer scan time, and diminished partial volume effects. Recent advancements in multinuclear MR technology have helped in further exploration in this domain. We aim to provide a comprehensive description of 23Na MRI and MRS for brain research including the following aspects: (a) theoretical background for understanding 23Na MRI and MRS fundamentals; (b) technological advancements of 23Na MRI with respect to pulse sequences, RF coils, and sodium compartmentalization; (c) applications of 23Na MRI in the early diagnosis and prognosis of various neurological disorders; (d) structural-chronological evolution of sodium spectroscopy in terms of its numerous applications in human studies; (e) the data-processing tools utilized in the quantitation of sodium in the respective anatomical regions.
Collapse
Affiliation(s)
- Palak Handa
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon 122051, India
| | - Avantika Samkaria
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon 122051, India
| | - Shallu Sharma
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon 122051, India
| | - Yashika Arora
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon 122051, India
| | - Pravat K. Mandal
- Neuroimaging and Neurospectroscopy (NINS) Laboratory, National Brain Research Centre, Gurgaon 122051, India
- Florey Institute of Neuroscience and Mental Health, Melbourne School of Medicine Campus, Melbourne 3010, Australia
| |
Collapse
|
10
|
Chen Q, Shah NJ, Worthoff WA. Compressed Sensing in Sodium Magnetic Resonance Imaging: Techniques, Applications, and Future Prospects. J Magn Reson Imaging 2021; 55:1340-1356. [PMID: 34918429 DOI: 10.1002/jmri.28029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/06/2022] Open
Abstract
Sodium (23 Na) yields the second strongest nuclear magnetic resonance (NMR) signal in biological tissues and plays a vital role in cell physiology. Sodium magnetic resonance imaging (MRI) can provide insights into cell integrity and tissue viability relative to pathologies without significant anatomical alternations, and thus it is considered to be a potential surrogate biomarker that provides complementary information for standard hydrogen (1 H) MRI in a noninvasive and quantitative manner. However, sodium MRI suffers from a relatively low signal-to-noise ratio and long acquisition times due to its relatively low NMR sensitivity. Compressed sensing-based (CS-based) methods have been shown to accelerate sodium imaging and/or improve sodium image quality significantly. In this manuscript, the basic concepts of CS and how CS might be applied to improve sodium MRI are described, and the historical milestones of CS-based sodium MRI are briefly presented. Representative advanced techniques and evaluation methods are discussed in detail, followed by an expose of clinical applications in multiple anatomical regions and diseases as well as thoughts and suggestions on potential future research prospects of CS in sodium MRI. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Qingping Chen
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, Jülich, Germany.,Faculty of Medicine, RWTH Aachen University, Aachen, Germany.,Department of Biomedical Engineering, The University of Melbourne, Parkville, Victoria, Australia
| | - N Jon Shah
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, Jülich, Germany.,Institute of Neuroscience and Medicine 11, INM-11, JARA, Forschungszentrum Jülich GmbH, Jülich, Germany.,JARA-BRAIN-Translational Medicine, Aachen, Germany.,Department of Neurology, RWTH Aachen University, Aachen, Germany
| | - Wieland A Worthoff
- Institute of Neuroscience and Medicine 4, INM-4, Forschungszentrum Jülich GmbH, Jülich, Germany
| |
Collapse
|
11
|
Hagiwara A, Bydder M, Oughourlian TC, Yao J, Salamon N, Jahan R, Villablanca JP, Enzmann DR, Ellingson BM. Sodium MR Neuroimaging. AJNR Am J Neuroradiol 2021; 42:1920-1926. [PMID: 34446457 PMCID: PMC8583254 DOI: 10.3174/ajnr.a7261] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/28/2021] [Indexed: 12/26/2022]
Abstract
Sodium MR imaging has the potential to complement routine proton MR imaging examinations with the goal of improving diagnosis, disease characterization, and clinical monitoring in neurologic diseases. In the past, the utility and exploration of sodium MR imaging as a valuable clinical tool have been limited due to the extremely low MR signal, but with recent improvements in imaging techniques and hardware, sodium MR imaging is on the verge of becoming clinically realistic for conditions that include brain tumors, ischemic stroke, and epilepsy. In this review, we briefly describe the fundamental physics of sodium MR imaging tailored to the neuroradiologist, focusing on the basics necessary to understand factors that play into making sodium MR imaging feasible for clinical settings and describing current controversies in the field. We will also discuss the current state of the field and the potential future clinical uses of sodium MR imaging in the diagnosis, phenotyping, and therapeutic monitoring in neurologic diseases.
Collapse
Affiliation(s)
- A Hagiwara
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - M Bydder
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - T C Oughourlian
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Neuroscience Interdepartmental Program (T.C.O., B.M.E.)
| | - J Yao
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Bioengineering (J.Y., B.M.E.), Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - N Salamon
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - R Jahan
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - J P Villablanca
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - D R Enzmann
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
| | - B M Ellingson
- From the UCLA Brain Tumor Imaging Laboratory (A.H., M.B., T.C.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers
- Department of Bioengineering (J.Y., B.M.E.), Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California
- Department of Radiological Sciences (A.H., M.B., J.Y., N.S., R.J., J.P.V., D.R.E., B.M.E.)
- Neuroscience Interdepartmental Program (T.C.O., B.M.E.)
- Department of Psychiatry and Biobehavioral Sciences (B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
12
|
Comparison of Amino Acid PET to Advanced and Emerging MRI Techniques for Neurooncology Imaging: A Systematic Review of the Recent Studies. Mol Imaging 2021; 2021:8874078. [PMID: 34194287 PMCID: PMC8205602 DOI: 10.1155/2021/8874078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Standard neuroimaging protocols for brain tumors have well-known limitations. The clinical use of additional modalities including amino acid PET (aaPET) and advanced MRI (aMRI) techniques (including DWI, PWI, and MRS) is emerging in response to the need for more accurate detection of brain tumors. In this systematic review of the past 2 years of the literature, we discuss the most recent studies that directly compare or combine aaPET and aMRI for brain tumor imaging. Methods A PubMed search was conducted for human studies incorporating both aaPET and aMRI and published between July 2018 and August 2020. Results A total of 22 studies were found in the study period. Recent studies of aaPET with DWI showed a superiority of MET, FET, FDOPA, and AMT PET for detecting tumor, predicting recurrence, diagnosing progression, and predicting survival. Combining modalities further improved performance. Comparisons of aaPET with PWI showed mixed results about spatial correlation. However, both modalities were able to detect high-grade tumors, identify tumor recurrence, differentiate recurrence from treatment effects, and predict survival. aaPET performed better on these measures than PWI, but when combined, they had the strongest results. Studies of aaPET with MRS demonstrated that both modalities have diagnostic potential but MET PET and FDOPA PET performed better than MRS. MRS suffered from some data quality issues that limited analysis in two studies, and, in one study that combined modalities, overall performance actually decreased. Four recent studies compared aaPET with emerging MRI approaches (such as CEST imaging, MR fingerprinting, and SISTINA), but the initial results remain inconclusive. Conclusions aaPET outperformed the aMRI imaging techniques in most recent studies. DWI and PWI added meaningful complementary data, and the combination of aaPET with aMRI yielded the best results in most studies.
Collapse
|
13
|
Worthoff WA, Shymanskaya A, Lindemeyer J, Langen KJ, Shah NJ. Relaxometry and quantification in sodium MRI of cerebral gliomas: A FET-PET and MRI small-scale study. NMR IN BIOMEDICINE 2020; 33:e4361. [PMID: 32696547 DOI: 10.1002/nbm.4361] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 06/05/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Sodium MRI is a promising method for assessing the metabolic properties of brain tumours. In a recent study, a strong relationship between semi-quantitative abnormalities in sodium MRI and the mutational status of the isocitrate dehydrogenase enzyme (IDH) with untreated cerebral gliomas was observed. Here, sodium relaxometry in brain tumour tissue was investigated in relation to molecular markers in order to reveal quantitative sodium tissue parameters and the differences between healthy tissue and brain tumour. The previous semi-quantitative approach is extended by use of suitable relaxometry methods accompanied by numerical simulation to achieve detailed quantitative analysis of intra- and extracellular sodium concentration using an enhanced SISTINA sequence at 4 T. Using optimised techniques, biexponential sodium relaxation times in tumour (T*2f , T*2s ) and in healthy contralateral brain tissue (T*2f,CL , T*2s,CL ) were estimated in 10 patients, along with intracellular sodium molar fractions (χ, χCL ), volume fractions (η, ηCL ) and concentrations (ρin , ρin,CL ). The total sodium tissue concentrations (ρT , ρT,CL ) were also estimated. The ratios T*2f /T*2f,CL (P = .05), η/ηCL (P = .02) and χ/χCL (P = .02) were significantly lower in IDH mutated than in IDH wildtype gliomas (n = 4 and n = 5 patients, respectively). The Wilcoxon rank-sum test was used to compare sodium MRI parameters in patients with and without IDH mutation. Thus, quantitative analysis of relaxation rates, intra- and extracellular sodium concentrations, intracellular molar and volume fractions based on enhanced SISTINA confirmed a relationship between abnormalities in sodium parameters and the IDH mutational status in cerebral gliomas, hence catering for the potential to provide further insights into the status of the disease.
Collapse
Affiliation(s)
- Wieland A Worthoff
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
| | | | - Johannes Lindemeyer
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
- Department of Nuclear Medicine, RWTH Aachen University, JARA, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine - 4, Forschungszentrum Jülich, Jülich, Germany
- Institute of Neuroscience and Medicine - 11, Forschungszentrum Jülich, Jülich, Germany
- Department of Neurology, RWTH Aachen University, JARA, Aachen, Germany
| |
Collapse
|
14
|
Regnery S, Behl NGR, Platt T, Weinfurtner N, Windisch P, Deike-Hofmann K, Sahm F, Bendszus M, Debus J, Ladd ME, Schlemmer HP, Rieken S, Adeberg S, Paech D. Ultra-high-field sodium MRI as biomarker for tumor extent, grade and IDH mutation status in glioma patients. Neuroimage Clin 2020; 28:102427. [PMID: 33002860 PMCID: PMC7527584 DOI: 10.1016/j.nicl.2020.102427] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/21/2020] [Accepted: 09/08/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This prospective clinical trial investigated sodium (23Na) MRI at 7 Tesla (T) field strength as biomarker for tumor extent, isocitrate dehydrogenase (IDH) mutation and O6-methylguanine DNA methyltransferase (MGMT) promotor methylation in glioma patients. METHODS 28 glioma patients underwent 23Na MRI on a 7T scanner (Siemens Healthcare, Erlangen, Germany) parallel to standard 3T MRI before chemoradiation. Areas of Gadolinium-contrast enhancement (gdce), non-enhancing T2-hyperintensity (regarded as edema), necrosis, and normal-appearing white matter (nawm) were segmented on 3T MRI imaging and were co-registered with the 23Na images. The median total 23Na concentrations of all areas were compared by pairwise t-tests. Furthermore, areas of gdce and edema were merged to yield the whole tumor area without necrosis. Subsequently, the difference in median of the 23Na concentration of this whole tumor area was compared between IDH-mutated and IDH wild-type gliomas as well as MGMT methylated and MGMT not-methylated glioblastomas using Whitney-Mann U-tests. All p-values were corrected after the Bonferroni-Holm procedure. RESULTS The 23Na concentration increased successively from nawm to necrotic areas (mean ± sd: nawm = 37.84 ± 5.87 mM, edema = 54.69 ± 10.64 mM, gdce = 61.72 ± 12.95 mM, necrosis = 81.88 ± 17.53 mM) and the concentrations differed statistically significantly between all regarded areas (adjusted p-values for all pairwise comparisons < 0.05). Furthermore, IDH-mutated gliomas showed significantly higher 23Na concentrations than IDH wild-type gliomas (median [interquartile range]: IDH wild-type = 52.37 mM [45.98 - 58.56 mM], IDH mutated = 65.02 mM [58.87-67.05 mM], p = 0.039). Among the glioblastomas, there was a trend towards increased 23Na concentration in MGMT methylated tumors that did not reach statistical significance (median [interquartile range]: MGMT methylated = 57.59 mM [50.70 - 59.17 mM], MGMT not methylated = 48.78 mM [45.88 - 53.91 mM], p = 1.0). CONCLUSIONS 23Na MRI correlates with the IDH mutation status and could therefore enhance image guidance towards biopsy sites as wells as image-guided surgery and radiotherapy. Furthermore, the successive decrease of 23Na concentration from central necrosis to normal-appearing white matter suggests a correlation with tumor infiltration.
Collapse
Affiliation(s)
- Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Nicolas G R Behl
- Siemens Healthcare GmbH, Erlangen, Germany; Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Tanja Platt
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Nina Weinfurtner
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Paul Windisch
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Katerina Deike-Hofmann
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Im Neuenheimer Feld 224, 69120 Heidelberg, Germany; CCU Neuropathology, German Consortium for Translational Cancer Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
| |
Collapse
|
15
|
Choi CH, Stegmayr C, Shymanskaya A, Worthoff WA, da Silva NA, Felder J, Langen KJ, Shah NJ. An in vivo multimodal feasibility study in a rat brain tumour model using flexible multinuclear MR and PET systems. EJNMMI Phys 2020; 7:50. [PMID: 32728773 PMCID: PMC7391464 DOI: 10.1186/s40658-020-00319-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background In addition to the structural information afforded by 1H MRI, the use of X-nuclei, such as sodium-23 (23Na) or phosphorus-31 (31P), offers important complementary information concerning physiological and biochemical parameters. By then combining this technique with PET, which provides valuable insight into a wide range of metabolic and molecular processes by using of a variety of radioactive tracers, the scope of medical imaging and diagnostics can be significantly increased. While the use of multimodal imaging is undoubtedly advantageous, identifying the optimal combination of these parameters to diagnose a specific dysfunction is very important and is advanced by the use of sophisticated imaging techniques in specific animal models. Methods In this pilot study, rats with intracerebral 9L gliosarcomas were used to explore a combination of sequential multinuclear MRI using a sophisticated switchable coil set in a small animal 9.4 T MRI scanner and, subsequently, a small animal PET with the tumour tracer O-(2-[18F]-fluoroethyl)-L-tyrosine ([18F]FET). This made it possible for in vivo multinuclear MR-PET experiments to be conducted without compromising the performance of either multinuclear MR or PET. Results High-quality in vivo images and spectra including high-resolution 1H imaging, 23Na-weighted imaging, detection of 31P metabolites and [18F]FET uptake were obtained, allowing the characterisation of tumour tissues in comparison to a healthy brain. It has been reported in the literature that these parameters are useful in the identification of the genetic profile of gliomas, particularly concerning the mutation of the isocitrate hydrogenase gene, which is highly relevant for treatment strategy. Conclusions The combination of multinuclear MR and PET in, for example, brain tumour models with specific genetic mutations will enable the physiological background of signal alterations to be explored and the identification of the optimal combination of imaging parameters for the non-invasive characterisation of the molecular profile of tumours.
Collapse
Affiliation(s)
- Chang-Hoon Choi
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany
| | - Carina Stegmayr
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany
| | | | - Wieland A Worthoff
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany
| | - Nuno A da Silva
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany
| | - Jörg Felder
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany.,Department of Nuclear Medicine, RWTH Aachen University Hospital, Aachen, Germany.,Jülich-Aachen Research Alliance (JARA)-Section JARA-BRAIN, Aachen, Germany
| | - N Jon Shah
- Institute of Neuroscience and Medicine-4, INM-4, Forschungszentrum Jülich, Germany. .,Institute of Neuroscience and Medicine-11, INM-11, JARA, Forschungszentrum Jülich, Germany. .,JARA-BRAIN-Translational Medicine, Aachen, Germany. .,Department of Neurology, RWTH Aachen University, Aachen, Germany.
| |
Collapse
|
16
|
Poku LO, Phil M, Cheng Y, Wang K, Sun X. 23 Na-MRI as a Noninvasive Biomarker for Cancer Diagnosis and Prognosis. J Magn Reson Imaging 2020; 53:995-1014. [PMID: 32219933 PMCID: PMC7984266 DOI: 10.1002/jmri.27147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/06/2020] [Accepted: 03/07/2020] [Indexed: 12/11/2022] Open
Abstract
The influx of sodium (Na+) ions into a resting cell is regulated by Na+ channels and by Na+/H+ and Na+/Ca2+ exchangers, whereas Na+ ion efflux is mediated by the activity of Na+/K+‐ATPase to maintain a high transmembrane Na+ ion gradient. Dysfunction of this system leads to changes in the intracellular sodium concentration that promotes cancer metastasis by mediating invasion and migration. In addition, the accumulation of extracellular Na+ ions in cancer due to inflammation contributes to tumor immunogenicity. Thus, alterations in the Na+ ion concentration may potentially be used as a biomarker for malignant tumor diagnosis and prognosis. However, current limitations in detection technology and a complex tumor microenvironment present significant challenges for the in vivo assessment of Na+ concentration in tumor. 23Na‐magnetic resonance imaging (23Na‐MRI) offers a unique opportunity to study the effects of Na+ ion concentration changes in cancer. Although challenged by a low signal‐to‐noise ratio, the development of ultrahigh magnetic field scanners and specialized sodium acquisition sequences has significantly advanced 23Na‐MRI. 23Na‐MRI provides biochemical information that reflects cell viability, structural integrity, and energy metabolism, and has been shown to reveal rapid treatment response at the molecular level before morphological changes occur. Here we review the basis of 23Na‐MRI technology and discuss its potential as a direct noninvasive in vivo diagnostic and prognostic biomarker for cancer therapy, particularly in cancer immunotherapy. We propose that 23Na‐MRI is a promising method with a wide range of applications in the tumor immuno‐microenvironment research field and in cancer immunotherapy monitoring. Level of Evidence 2 Technical Efficacy Stage 2
Collapse
Affiliation(s)
| | - M Phil
- NHC and CAMS Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China.,Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Yongna Cheng
- NHC and CAMS Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China.,Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Kai Wang
- NHC and CAMS Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China.,Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, China
| | - Xilin Sun
- NHC and CAMS Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China.,Molecular Imaging Research Center (MIRC), Harbin Medical University, Harbin, China.,TOF-PET/CT/MR Center, The Fourth Hospital of Harbin Medical University, Harbin, China
| |
Collapse
|