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Jiang S, Chai H, Tang Q. Advances in the intraoperative delineation of malignant glioma margin. Front Oncol 2023; 13:1114450. [PMID: 36776293 PMCID: PMC9909013 DOI: 10.3389/fonc.2023.1114450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 01/27/2023] Open
Abstract
Surgery plays a critical role in the treatment of malignant glioma. However, due to the infiltrative growth and brain shift, it is difficult for neurosurgeons to distinguish malignant glioma margins with the naked eye and with preoperative examinations. Therefore, several technologies were developed to determine precise tumor margins intraoperatively. Here, we introduced four intraoperative technologies to delineate malignant glioma margin, namely, magnetic resonance imaging, fluorescence-guided surgery, Raman histology, and mass spectrometry. By tracing their detecting principles and developments, we reviewed their advantages and disadvantages respectively and imagined future trends.
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Freidel L, Li S, Choffart A, Kuebler L, Martins AF. Imaging Techniques in Pharmacological Precision Medicine. Handb Exp Pharmacol 2023; 280:213-235. [PMID: 36907970 DOI: 10.1007/164_2023_641] [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] [Indexed: 03/14/2023]
Abstract
Biomedical imaging is a powerful tool for medical diagnostics and personalized medicines. Examples of commonly used imaging modalities include Positron Emission Tomography (PET), Ultrasound (US), Single Photon Emission Computed Tomography (SPECT), and hybrid imaging. By combining these modalities, scientists can gain a comprehensive view and better understand physiology and pathology at the preclinical, clinical, and multiscale levels. This can aid in the accuracy of medical diagnoses and treatment decisions. Moreover, biomedical imaging allows for evaluating the metabolic, functional, and structural details of living tissues. This can be particularly useful for the early diagnosis of diseases such as cancer and for the application of personalized medicines. In the case of hybrid imaging, two or more modalities are combined to produce a high-resolution image with enhanced sensitivity and specificity. This can significantly improve the accuracy of diagnosis and offer more detailed treatment plans. In this book chapter, we showcase how continued advancements in biomedical imaging technology can potentially revolutionize medical diagnostics and personalized medicine.
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Affiliation(s)
- Lucas Freidel
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Sixing Li
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Anais Choffart
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Laura Kuebler
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - André F Martins
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, University of Tübingen, Tübingen, Germany.
- Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany.
- German Cancer Consortium (DKTK), Partner Site Tübingen, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Tian M, He X, Jin C, He X, Wu S, Zhou R, Zhang X, Zhang K, Gu W, Wang J, Zhang H. Transpathology: molecular imaging-based pathology. Eur J Nucl Med Mol Imaging 2021; 48:2338-2350. [PMID: 33585964 PMCID: PMC8241651 DOI: 10.1007/s00259-021-05234-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/01/2021] [Indexed: 12/27/2022]
Abstract
Pathology is the medical specialty concerned with the study of the disease nature and causes, playing a key role in bridging basic researches and clinical medicine. In the course of development, pathology has significantly expanded our understanding of disease, and exerted enormous impact on the management of patients. However, challenges facing pathology, the inherent invasiveness of pathological practice and the persistent concerns on the sample representativeness, constitute its limitations. Molecular imaging is a noninvasive technique to visualize, characterize, and measure biological processes at the molecular level in living subjects. With the continuous development of equipment and probes, molecular imaging has enabled an increasingly precise evaluation of pathophysiological changes. A new pathophysiology visualization system based on molecular imaging is forming and shows the great potential to reform the pathological practice. Several improvements in "trans-," including trans-scale, transparency, and translation, would be driven by this new kind of pathological practice. Pathological changes could be evaluated in a trans-scale imaging mode; tissues could be transparentized to better present the underlying pathophysiological information; and the translational processes of basic research to the clinical practice would be better facilitated. Thus, transpathology would greatly facilitate in deciphering the pathophysiological events in a multiscale perspective, and supporting the precision medicine in the future.
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Affiliation(s)
- Mei Tian
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
| | - Xuexin He
- Department of Medical Oncology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chentao Jin
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Xiao He
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Shuang Wu
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Rui Zhou
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Xiaohui Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Kai Zhang
- Laboratory for Pathophysiological and Health Science, RIKEN Center for Biosystems Dynamics Research, Kobe, Hyogo, Japan
| | - Weizhong Gu
- Department of Pathology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Wang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China
| | - Hong Zhang
- Department of Nuclear Medicine and PET Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
- Institute of Nuclear Medicine and Molecular Imaging of Zhejiang University, Hangzhou, China.
- Key Laboratory of Medical Molecular Imaging of Zhejiang Province, Hangzhou, China.
- College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.
- Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China.
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Fujita Y, Kohta M, Sasayama T, Tanaka K, Hashiguchi M, Nagashima H, Kyotani K, Nakai T, Ito T, Kohmura E. Intraoperative 3-T Magnetic Resonance Spectroscopy for Detection of Proliferative Remnants of Glioma. World Neurosurg 2020; 137:149-157. [PMID: 32035198 DOI: 10.1016/j.wneu.2020.01.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Few studies have examined the usefulness of intraoperative magnetic resonance spectroscopy (iMRS) for identifying abnormal signals at the resection margin during glioma surgery. The aim of this study was to assess the value of iMRS for detecting proliferative remnants of glioma at the resection margin. METHODS Fifteen patients with newly diagnosed glioma underwent single-voxel 3-T iMRS concurrently with intraoperative magnetic resonance imaging-assisted surgery. Volumes of interest (VOIs) were placed at T2-hyperintense or contrast-enhancing lesions at the resection margin. In addition to technical verification, the correlation between the MIB-1 labeling index (a pathologic feature) and metabolites measured using iMRS (N-acetyl-L-aspartate [NAA], choline [Cho], and Cho/NAA ratio) was analyzed. RESULTS iMRS was performed for 20 VOIs in 15 patients. Fourteen (70%) of these VOIs were confirmed to be MIB-1-positive. There was a significant positive correlation between the Cho/NAA ratio and MIB-1 index (r = 0.46, P = 0.04). Cho level (P = 0.003) and Cho/NAA ratio (P = 0.002) were significantly higher in VOIs that were MIB-1-positive than in those that were MIB-1-negative. Detection of a Cho level >1.074 mM and a Cho/NAA ratio >0.48 using iMRS resulted in high diagnostic accuracy for MIB-1-positive remnants (Cho level: sensitivity 86%, specificity 100%; Cho/NAA ratio: sensitivity 79%, specificity 100%). CONCLUSIONS This study provides evidence that 3-T iMRS can detect proliferative remnants of glioma at the resection margin using the Cho level and Cho/NAA ratio, suggesting that intraoperative magnetic resonance imaging-assisted surgery with iMRS would be practicable in glioma.
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Affiliation(s)
- Yuichi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Masaaki Kohta
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazuhiro Tanaka
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Mitsuru Hashiguchi
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hiroaki Nagashima
- Department of Neurosurgery, Massachusetts General Hospital Research Institute, Boston, Massachusetts, USA
| | - Katsusuke Kyotani
- Center for Radiology and Radiation Oncology, Kobe University Graduate School of Medicine and Kobe University Hospital, Kobe, Hyogo, Japan
| | - Tomoaki Nakai
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoo Ito
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Roder C, Haas P, Tatagiba M, Ernemann U, Bender B. Technical limitations and pitfalls of diffusion-weighted imaging in intraoperative high-field MRI. Neurosurg Rev 2019; 44:327-334. [PMID: 31732818 DOI: 10.1007/s10143-019-01206-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 10/15/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Image quality in high-field intraoperative MRI (iMRI) is often influenced negatively by susceptibility artifacts. While routine sequences are rather robust, advanced imaging such as diffusion-weighted imaging (DWI) is very sensitive to susceptibility resulting in insufficient imaging data. This study aims to analyze intraoperatively acquired DWI to identify the main factors for susceptibility, to compare results with postoperative images and to identify technical aspects for improvement of intraoperative DWI. METHODS 100 patients with intraaxial lesions operated in a high-field iMRI were analyzed retrospectively for the quality of intraoperative DWI in comparison to the postoperative scan. General quality of the MR scan, individual diffusion restrictions, artifacts, and their causes were analyzed. RESULTS Inclusion criteria were met in 78 patients, 124 diffusion restrictions were included in the comparative analysis. PPV and NPV for the detection of DWI changes intraoperatively were 0.94 and 0.56, respectively (SEN 0.94; SPE 0.56). Image quality was rated significantly (p < 0.0001) worse intraoperatively compared to the postoperative MRI. The main reasons for reduced image quality intraoperatively were air (64%) and artificial material (e.g., compress) (38%) in the resection cavity, as well as positioning of patient's head outside the MR's isocenter 37%. Analysis of surgical approaches showed that frontal craniotomies have the highest risk of limited image quality (40%), whereat better results (15% limited image quality) were seen for all other approaches (p = 0.059). CONCLUSION Intraoperative DWI showed reliable results in this analysis. However, image-quality was limited severely in many cases leading to uncertainty in the interpretation. Susceptibility-causing factors might be prevented in many cases, if the surgical team is aware of them. The most important factors are good filling of the resection cavity with irrigation fluid, not placing artificial materials in the resection cavity and adequate positioning of patient's head according to the MR isocenter.
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Affiliation(s)
- Constantin Roder
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany
| | - Patrick Haas
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany.
| | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
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Mikhail M, Mithani K, Ibrahim GM. Presurgical and Intraoperative Augmented Reality in Neuro-Oncologic Surgery: Clinical Experiences and Limitations. World Neurosurg 2019; 128:268-276. [PMID: 31103764 DOI: 10.1016/j.wneu.2019.04.256] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
Abstract
Virtual reality (VR) and augmented reality (AR) represent novel adjuncts for neurosurgical planning in neuro-oncology. In addition to established use in surgical and medical training, VR/AR are gaining traction for clinical use preoperatively and intraoperatively. To understand the utility of VR/AR in the clinical setting, we conducted a literature search in Ovid MEDLINE and EMBASE with various search terms designed to capture the use of VR/AR in neurosurgical procedures for resection of cranial tumors. The search retrieved 302 articles, of which 35 were subjected to full-text review; 19 full-text articles were included in the review. Key findings highlighted by the individual authors were extracted and summarized into themes to present the value of VR/AR in the clinical setting. These studies included various VR/AR systems applied to surgeries involving heterogeneous pathologies and outcome measures. Overall, VR/AR were found to be qualitatively advantageous due to enhanced visualization of complex anatomy and improved intraoperative lesion localization. When these technologies were compared with existing neuronavigation systems, quantitative clinical benefits were also reported. The capacity to visualize three-dimensional images superimposed on patient anatomy is a potentially valuable tool in complex neurosurgical environments. Surgical limitations may be addressed through future advances in image registration and tracking as well as intraoperatively acquired imaging with the ability to yield real-time virtual models.
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Affiliation(s)
- Mirriam Mikhail
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Karim Mithani
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - George M Ibrahim
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Coburger J, Wirtz CR. Fluorescence guided surgery by 5-ALA and intraoperative MRI in high grade glioma: a systematic review. J Neurooncol 2018; 141:533-546. [PMID: 30488293 DOI: 10.1007/s11060-018-03052-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/13/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Fluorescence guided surgery by 5-aminolevulinic acid (5-ALA) and intraoperative MRI (iMRI) are currently the most important intraoperative imaging techniques in high grade glioma (HGG) surgery. Few comparative studies exist for these techniques. This review aims to systematically compare 5-ALA and iMRI assisted surgery based on the current literature and discuss the potential impact of a combined use of both techniques. METHODS A systematic literature search based on preferred reporting items for systematic reviews and meta-analysis was performed concerning accuracy of tumor detection; extent of resection; neurological deficits (ND); Quality of life (QoL); usability and combined use of both techniques. Original clinical articles on HGG published until March 31st were screened. RESULTS 169 publications were screened, 81 were eligible and 22 were finally included in the review using. Overall, there is evidence that both imaging techniques improve gross total resection rate in non-eloquent lesions. Imaging results do not correlate at the border zone of a HGG. 5-ALA and contrast-enhanced iMRI seem to have a supplementary effect in tumor detection. Overall, both imaging techniques alone or combined do not seem to increase rate of permanent ND or decrease QoL in HGG surgery when used with intraoperative monitoring/mapping. CONCLUSION Based on the currently available literature no superiority of one technique over the other can be found in the most important outcome parameters. Based on the available information a combined use of 5-ALA and iMRI seems very promising to achieve a resection beyond gadolinium-enhancement. However, only low quality of evidence exists for this approach.
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Affiliation(s)
- Jan Coburger
- Department of Neurosurgery, University of Ulm, Campus Günzburg, Ludwig-Heilmeyerstr. 2, 89321, Günzburg, Germany.
| | - Christian Rainer Wirtz
- Department of Neurosurgery, University of Ulm, Campus Günzburg, Ludwig-Heilmeyerstr. 2, 89321, Günzburg, Germany
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Coburger J, Scheuerle A, Pala A, Thal D, Wirtz CR, König R. Histopathological Insights on Imaging Results of Intraoperative Magnetic Resonance Imaging, 5-Aminolevulinic Acid, and Intraoperative Ultrasound in Glioblastoma Surgery. Neurosurgery 2018; 81:165-174. [PMID: 28204539 DOI: 10.1093/neuros/nyw143] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND For appropriate use of available intraoperative imaging techniques in glioblastoma (GB) surgery, it is crucial to know the potential of the respective techniques in tumor detection. OBJECTIVE To assess histopathological basis of imaging results of intraoperative magnetic resonance imaging (iMRI), 5-aminolevulinic acid (5-ALA), and linear array intraoperative ultrasound (lioUS). METHODS We prospectively compared the imaging findings of iMRI, 5-ALA, and lioUS at 99 intraoperative biopsy sites in 33 GB patients during resection control. Histological classification of specimens, tumor load, presence of necrosis, presence of vascular malformations, and O6-methylguanin-DNA methyltransferase (MGMT) promoter state was correlated with imaging findings. RESULTS Solid tumor was found in 57%, infiltration zone in 42%, and no tumor in 1% of specimens. However, imaging was negative in iMRI in 49%, using 5-ALA in 17%, and in lioUS in 21%. In positive imaging results, share of solid tumor was highest in 5-ALA (65%) followed by lioUS (60%) and lowest in iMRI (55%). In comparison to 5-ALA, iMRI had a high share of solid tumor in specimens when showing intermediate results. Sensitivity for invasive tumor was higher in 5-ALA (84%) and lioUS (80%) than in iMRI (50%). We found a significant correlation of 5-ALA with classification of specimen, presence of necrosis, and microproliferations. Methylated MGMT promoter correlated with positive findings in 5-ALA. lioUS and iMRI showed no correlations with histopathological findings. CONCLUSION All of the assessed established imaging techniques detect infiltrating tumor only to a certain extent. Only 5-ALA showed a significant correlation with histopathological findings. Interestingly, tumor remnants in an MGMT-methylated tumor are more likely to be visible using 5-ALA as in unmethylated tumors.
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Affiliation(s)
- Jan Coburger
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | | | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | - Dietmar Thal
- Research Group Experimental Neurology, Leuven, Belgium
| | | | - Ralph König
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
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Abstract
Maximal safe resection is the cornerstone of treatment for low-grade and high-grade gliomas. In addition to high-resolution anatomic MRI studies that highlight tumor architecture, it is important to determine the relationship of the tumor to the eloquent cortical and subcortical areas to avoid introducing or exacerbating a neurologic deficit. The goal of this review was to highlight imaging modalities that provide functional information and can be integrated with intraoperative MRI navigation to maximize the extent of resection while preserving a patient's neurologic function.
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Rapalino O, Ratai EM. Multiparametric Imaging Analysis: Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2016; 24:671-686. [PMID: 27742109 DOI: 10.1016/j.mric.2016.06.001] [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] [Indexed: 11/29/2022]
Abstract
Magnetic resonance spectroscopy (MRS) is a magnetic resonance-based imaging modality that allows noninvasive sampling of metabolic changes in normal and abnormal brain parenchyma. MRS is particularly useful in the differentiation of developmental or non-neoplastic disorders from neoplastic processes. MRS is also useful during routine imaging follow-up after radiation treatment or during antiangiogenic treatment and for predicting outcomes and treatment response. The objective of this article is to provide a concise but thorough review of the basic physical principles, important applications of MRS in brain tumor imaging, and future directions.
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Affiliation(s)
- O Rapalino
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - E M Ratai
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; MGH/HST Athinoula A. Martinos Center for Biomedical Imaging, Building 149, 13th Street, Room 2301, Charlestown, MA 02129, USA.
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12
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Roder C, Charyasz-Leks E, Breitkopf M, Decker K, Ernemann U, Klose U, Tatagiba M, Bisdas S. Resting-state functional MRI in an intraoperative MRI setting: proof of feasibility and correlation to clinical outcome of patients. J Neurosurg 2016; 125:401-9. [PMID: 26722852 DOI: 10.3171/2015.7.jns15617] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' aim in this paper is to prove the feasibility of resting-state (RS) functional MRI (fMRI) in an intraoperative setting (iRS-fMRI) and to correlate findings with the clinical condition of patients pre- and postoperatively. METHODS Twelve patients underwent intraoperative MRI-guided resection of lesions in or directly adjacent to the central region and/or pyramidal tract. Intraoperative RS (iRS)-fMRI was performed pre- and intraoperatively and was correlated with patients' postoperative clinical condition, as well as with intraoperative monitoring results. Independent component analysis (ICA) was used to postprocess the RS-fMRI data concerning the sensorimotor networks, and the mean z-scores were statistically analyzed. RESULTS iRS-fMRI in anesthetized patients proved to be feasible and analysis revealed no significant differences in preoperative z-scores between the sensorimotor areas ipsi- and contralateral to the tumor. A significant decrease in z-score (p < 0.01) was seen in patients with new neurological deficits postoperatively. The intraoperative z-score in the hemisphere ipsilateral to the tumor had a significant negative correlation with the degree of paresis immediately after the operation (r = -0.67, p < 0.001) and on the day of discharge from the hospital (r = -0.65, p < 0.001). Receiver operating characteristic curve analysis demonstrated moderate prognostic value of the intraoperative z-score (area under the curve 0.84) for the paresis score at patient discharge. CONCLUSIONS The use of iRS-fMRI with ICA-based postprocessing and functional activity mapping is feasible and the results may correlate with clinical parameters, demonstrating a significant negative correlation between the intensity of the iRS-fMRI signal and the postoperative neurological changes.
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Affiliation(s)
| | - Edyta Charyasz-Leks
- Neuroradiology, and.,Department of Biomedical Magnetic Resonance, University of Tübingen, and Eberhard Karls University, Tübingen, Germany; and
| | | | | | | | | | | | - Sotirios Bisdas
- Neuroradiology, and.,Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
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Pun WK, Chow SP, Fang D, Cheng CL, Leong JC, Ng C. Post-traumatic oedema of the foot after tibial fracture. Expert Rev Mol Diagn 1990; 15:735-47. [PMID: 2592102 DOI: 10.1586/14737159.2015.1039515] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
A total of 97 patients with diaphyseal tibial fractures treated with functional bracing were studied prospectively. Persistent ipsilateral foot swelling was present in 84.5 per cent of the patients. Most of the swellings subsided with time, but a small percentage of them persisted for a duration of 2 years or more after injury. The time for disappearance of the swelling in 50 per cent of the patients was 18.6 weeks. The development of oedema is not related to the age and sex of the patients, the configuration, type and level of the fractures, or the association of a fibular fracture. The bone healed quicker in those who did not have swelling of the foot. Once the swelling has developed, it seems to run its own course and its disappearance is not related to the age and sex, the configuration, type and level of fractures, the association of a fibular fracture, or the time for fracture healing. This complication does not have any adverse effect on the functional recovery of the patients.
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Affiliation(s)
- W K Pun
- Department of Orthopaedic Surgery, University of Hong Kong, Queen Mary Hospital
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