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Wang L, Shi Y, Jiang J, Li C, Zhang H, Zhang X, Jiang T, Wang L, Wang Y, Feng L. Micro-Nanocarriers Based Drug Delivery Technology for Blood-Brain Barrier Crossing and Brain Tumor Targeting Therapy. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2022; 18:e2203678. [PMID: 36103614 DOI: 10.1002/smll.202203678] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/04/2022] [Indexed: 06/15/2023]
Abstract
The greatest obstacle to using drugs to treat brain tumors is the blood-brain barrier (BBB), making it difficult for conventional drug molecules to enter the brain. Therefore, how to safely and effectively penetrate the BBB to achieve targeted drug delivery to brain tumors has been a challenging research problem. With the intensive research in micro- and nanotechnology in recent years, nano drug-targeted delivery technologies have shown great potential to overcome this challenge, such as inorganic nanocarriers, organic polymer-carriers, liposomes, and biobased carriers, which can be designed in different sizes, shapes, and surface functional groups to enhance their ability to penetrate the BBB and targeted drug delivery for brain tumors. In this review, the composition and overcoming patterns of the BBB are detailed, and then the hot research topics of drug delivery carriers for brain tumors in recent years are summarized, and their mechanisms of action on the BBB and the factors affecting drug delivery are described in detail, and the effectiveness of targeted therapy for brain tumors is evaluated. Finally, the challenges and dilemmas in developing brain tumor drug delivery systems are discussed, which will be promising in the future for targeted drug delivery to brain tumors based on micro-nanocarriers technology.
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Affiliation(s)
- Luyao Wang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Youyuan Shi
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Jingzhen Jiang
- Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Chan Li
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Hengrui Zhang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Xinhui Zhang
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
| | - Tao Jiang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Liang Wang
- Department of Hematology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yinyan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Lin Feng
- School of Mechanical Engineering & Automation, Beihang University, Beijing, 100191, China
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100191, China
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Haddad AF, Young JS, Morshed RA, Josephson SA, Cha S, Berger MS. Pseudo-insular glioma syndrome: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21481. [PMID: 35854917 PMCID: PMC9281470 DOI: 10.3171/case21481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lower-grade insular gliomas often appear as expansile and infiltrative masses on magnetic resonance imaging (MRI). However, there are nonneoplastic lesions of the insula, such as demyelinating disease and vasculopathies, that can mimic insular gliomas. OBSERVATIONS The authors report two patients who presented with headaches and were found to have mass lesions concerning for lower-grade insular glioma based on MRI obtained at initial presentation. However, on the immediate preoperative MRI obtained a few weeks later, both patients had spontaneous and complete resolution of the insular lesions. LESSONS Tumor mimics should always be in the differential diagnosis of brain masses, including those involving the insula. The immediate preoperative MRI (within 24–48 hours of surgery) must be compared carefully with the initial presentation MRI to assess interval change that suggests tumor mimics to avoid unnecessary surgical intervention.
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Affiliation(s)
| | | | | | | | - Soonmee Cha
- Radiology, University of California, San Francisco, San Francisco, California
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Elchoufi D, Duszak R, Balthazar P, Hanna TN, Sadigh G. Increasing emergency department utilization of brain imaging in patients with primary brain cancer. Emerg Radiol 2020; 28:223-231. [PMID: 32803458 DOI: 10.1007/s10140-020-01836-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To study changing emergency department (ED) brain imaging utilization in patients with primary brain cancers. METHODS Using 2006-2014 data from the Nationwide Emergency Department Sample (NEDS), we identified all patients with primary brain cancers visiting EDs and evaluated trends of head CT and brain MRI utilization. Multivariable logistic regression analyses were used to determine patient- and hospital-specific factors associated with brain imaging utilization. RESULTS A weighted cohort of 40,862 ED visits were included (mean age 55; 54% male), increasing from 3932 in 2006 to 5625 in 2014 (+ 43%). A total of 14.4% underwent brain imaging, with 13.2% undergoing CT, 2.3% undergoing MRI, and 1.1% undergoing both modalities. Between 2006 and 2014, there was a 104% increase in the rate of ED brain imaging (from 9.7% in 2006 to 19.8% in 2014). Factors associated with higher utilization of ED brain imaging in adults were non-teaching hospital status and Midwest and Northeast hospital regions (compared with the West). In pediatric patients, higher utilization was associated with older age, higher median household income of patient's ZIP code, and visits in rural, non-teaching hospitals located in the Midwest, South, and Northeast (compared with the West). CONCLUSION In US patients with primary brain cancer, the number of ED visits increased annually, and the utilization of ED head imaging examinations doubled in a recent 9-year period. A variety of sociodemographic characteristics are associated with a higher likelihood of imaging in both adult and pediatric patients.
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Affiliation(s)
- Deema Elchoufi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Patricia Balthazar
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Tarek N Hanna
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd, Suite BG27, Atlanta, GA, 30322, USA.
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Bae K, Zheng W, Lin K, Lim SW, Chong YK, Tang C, King NK, Ti Ang CB, Huang Z. Epi-Detected Hyperspectral Stimulated Raman Scattering Microscopy for Label-Free Molecular Subtyping of Glioblastomas. Anal Chem 2018; 90:10249-10255. [PMID: 30070837 DOI: 10.1021/acs.analchem.8b01677] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We report the development and implementation of an epi-detected spectral-focusing hyperspectral stimulated Raman scattering (SRS) imaging technique for label-free biomolecular subtyping of glioblastomas (GBMs). The hyperspectral SRS imaging technique developed generates SRS image stacks (from 2800 to 3020 cm-1 at 7 cm-1 intervals) within 30 s through controlling the time delay between the chirped pump and Stokes beams. SRS images at representative Raman shifts (e.g., 2845, 2885, and 2935 cm-1) delineate the biochemical variations and morphological differences between proneural and mesenchymal subtypes of GBMs. Multivariate curve resolution (MCR) analysis on hyperspectral SRS images enables the quantification of major biomolecule distributions in mesenchymal and proneural GBMs. Further principal component analysis (PCA) and linear discriminant analysis (LDA) together with leave-one SRS spectrum-out, cross-validation (LOOCV) yields a diagnostic sensitivity of 96.7% (29/30) and specificity of 88.9% (28/36) for differentiation between mesenchymal and proneural subtypes of GBMs. This study shows great potential of applying hyperspectral SRS imaging technique developed for rapid, label-free molecular subtyping of GBMs in neurosurgery.
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Affiliation(s)
- Kideog Bae
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore 117576
| | - Wei Zheng
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore 117576.,Department of Medicine, Yong Loo Lin School of Medicine , National University of Singapore , Singapore 119260
| | - Kan Lin
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore 117576.,Department of Medicine, Yong Loo Lin School of Medicine , National University of Singapore , Singapore 119260
| | - See Wee Lim
- National Neuroscience Institute , Singapore 308433
| | | | - Carol Tang
- National Neuroscience Institute , Singapore 308433.,Duke-National University of Singapore Medical School , Singapore 169857.,Division of Cellular and Molecular Research , Humphrey Oei Institute of Cancer Research, National Cancer Centre , Singapore 169610
| | - Nicolas K King
- National Neuroscience Institute , Singapore 308433.,Duke-National University of Singapore Medical School , Singapore 169857
| | - Christopher Beng Ti Ang
- National Neuroscience Institute , Singapore 308433.,Duke-National University of Singapore Medical School , Singapore 169857.,Department of Physiology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore 117597.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR) , Singapore 117609
| | - Zhiwei Huang
- Optical Bioimaging Laboratory, Department of Biomedical Engineering, Faculty of Engineering , National University of Singapore , Singapore 117576
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Zabad RK, Stewart R, Healey KM. Pattern Recognition of the Multiple Sclerosis Syndrome. Brain Sci 2017; 7:brainsci7100138. [PMID: 29064441 PMCID: PMC5664065 DOI: 10.3390/brainsci7100138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/29/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022] Open
Abstract
During recent decades, the autoimmune disease neuromyelitis optica spectrum disorder (NMOSD), once broadly classified under the umbrella of multiple sclerosis (MS), has been extended to include autoimmune inflammatory conditions of the central nervous system (CNS), which are now diagnosable with serum serological tests. These antibody-mediated inflammatory diseases of the CNS share a clinical presentation to MS. A number of practical learning points emerge in this review, which is geared toward the pattern recognition of optic neuritis, transverse myelitis, brainstem/cerebellar and hemispheric tumefactive demyelinating lesion (TDL)-associated MS, aquaporin-4-antibody and myelin oligodendrocyte glycoprotein (MOG)-antibody NMOSD, overlap syndrome, and some yet-to-be-defined/classified demyelinating disease, all unspecifically labeled under MS syndrome. The goal of this review is to increase clinicians’ awareness of the clinical nuances of the autoimmune conditions for MS and NMSOD, and to highlight highly suggestive patterns of clinical, paraclinical or imaging presentations in order to improve differentiation. With overlay in clinical manifestations between MS and NMOSD, magnetic resonance imaging (MRI) of the brain, orbits and spinal cord, serology, and most importantly, high index of suspicion based on pattern recognition, will help lead to the final diagnosis.
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Affiliation(s)
- Rana K Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE 68198-8440, USA.
| | - Renee Stewart
- University of Nebraska Medical Center College of Nursing, Omaha, NE 68198-5330, USA.
| | - Kathleen M Healey
- Department of Neurological Sciences, University of Nebraska Medical Center College of Medicine, Omaha, NE 68198-8440, USA.
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6
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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Tosi U, Marnell CS, Chang R, Cho WC, Ting R, Maachani UB, Souweidane MM. Advances in Molecular Imaging of Locally Delivered Targeted Therapeutics for Central Nervous System Tumors. Int J Mol Sci 2017; 18:ijms18020351. [PMID: 28208698 PMCID: PMC5343886 DOI: 10.3390/ijms18020351] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 12/19/2016] [Accepted: 01/26/2017] [Indexed: 12/24/2022] Open
Abstract
Thanks to the recent advances in the development of chemotherapeutics, the morbidity and mortality of many cancers has decreased significantly. However, compared to oncology in general, the field of neuro-oncology has lagged behind. While new molecularly targeted chemotherapeutics have emerged, the impermeability of the blood–brain barrier (BBB) renders systemic delivery of these clinical agents suboptimal. To circumvent the BBB, novel routes of administration are being applied in the clinic, ranging from intra-arterial infusion and direct infusion into the target tissue (convection enhanced delivery (CED)) to the use of focused ultrasound to temporarily disrupt the BBB. However, the current system depends on a “wait-and-see” approach, whereby drug delivery is deemed successful only when a specific clinical outcome is observed. The shortcomings of this approach are evident, as a failed delivery that needs immediate refinement cannot be observed and corrected. In response to this problem, new theranostic agents, compounds with both imaging and therapeutic potential, are being developed, paving the way for improved and monitored delivery to central nervous system (CNS) malignancies. In this review, we focus on the advances and the challenges to improve early cancer detection, selection of targeted therapy, and evaluation of therapeutic efficacy, brought forth by the development of these new agents.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA.
| | - Christopher S Marnell
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA.
| | - Raymond Chang
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA.
| | - William C Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
| | - Richard Ting
- Department of Radiology, Molecular Imaging Innovations Institute, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Uday B Maachani
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA.
| | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY 10065, USA.
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Tustison NJ, Shrinidhi KL, Wintermark M, Durst CR, Kandel BM, Gee JC, Grossman MC, Avants BB. Optimal Symmetric Multimodal Templates and Concatenated Random Forests for Supervised Brain Tumor Segmentation (Simplified) with ANTsR. Neuroinformatics 2016; 13:209-25. [PMID: 25433513 DOI: 10.1007/s12021-014-9245-2] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Segmenting and quantifying gliomas from MRI is an important task for diagnosis, planning intervention, and for tracking tumor changes over time. However, this task is complicated by the lack of prior knowledge concerning tumor location, spatial extent, shape, possible displacement of normal tissue, and intensity signature. To accommodate such complications, we introduce a framework for supervised segmentation based on multiple modality intensity, geometry, and asymmetry feature sets. These features drive a supervised whole-brain and tumor segmentation approach based on random forest-derived probabilities. The asymmetry-related features (based on optimal symmetric multimodal templates) demonstrate excellent discriminative properties within this framework. We also gain performance by generating probability maps from random forest models and using these maps for a refining Markov random field regularized probabilistic segmentation. This strategy allows us to interface the supervised learning capabilities of the random forest model with regularized probabilistic segmentation using the recently developed ANTsR package--a comprehensive statistical and visualization interface between the popular Advanced Normalization Tools (ANTs) and the R statistical project. The reported algorithmic framework was the top-performing entry in the MICCAI 2013 Multimodal Brain Tumor Segmentation challenge. The challenge data were widely varying consisting of both high-grade and low-grade glioma tumor four-modality MRI from five different institutions. Average Dice overlap measures for the final algorithmic assessment were 0.87, 0.78, and 0.74 for "complete", "core", and "enhanced" tumor components, respectively.
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Affiliation(s)
- Nicholas J Tustison
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA,
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Li Y, Shi X, Rong X, Peng Y, Tang Y. Neurosurgery and prognosis in patients with radiation-induced brain injury after nasopharyngeal carcinoma radiotherapy: a follow-up study. Radiat Oncol 2013; 8:88. [PMID: 23578338 PMCID: PMC3653741 DOI: 10.1186/1748-717x-8-88] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 03/20/2013] [Indexed: 02/08/2023] Open
Abstract
Background Radiotherapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) and may cause radiation-induced brain injury (RI). Treatment for RI remains a challenge. We conducted this study to investigate the indications of neurosurgery, operation time and prognosis of patients with RI after NPC radiotherapy who underwent neurosurgical management. Methods This was a follow-up study between January 2005 and July 2011. Fifteen NPC cases of RI who underwent neurosurgery were collected. Brain Magnetic resonance imaging (MRI), surgery and histology were studied. The outcome was assessed by LENT/SOMA scales and modified Rankin scale. Results Brain lesion resection (86.7%) was more common than decompressive craniotomy (13.3%). According to LENT/SOMA scale before and six months after surgery, 13 of 15, 12 of 15, 14 of 15, and 14 of 15 cases showed improvement at subjective, objective, management and analytic domains, respectively. 12 of 15 patients showed improvement of modified Rankin scale after surgery. Three patients who underwent emergency surgery showed significant improvement (average score increment of 2, 2.7, 2.7, 3 and 2 at LENT/SOMA scale subjective, objective, management, analytic, and modified Rankin scale, respectively), as compared with 12 cases underwent elective surgery (average score increment of 1, 1, 1.4, 1.8 and 1 at LENT SOMA scale subjective, objective, management, analytic, and modified Rankin scale, respectively). Conclusions Neurosurgery, including brain necrotic tissue resection and decompressive craniotomy, improves the prognosis for RI patients, especially for those with indications of emergency surgery.
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Affiliation(s)
- Yi Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Tsai WC, Lee HS, Lin CK, Chen A, Nieh S, Ma HI. The association of osteopontin and LMX1A expression with World Health Organization grade in meningiomas and gliomas. Histopathology 2012; 61:844-56. [PMID: 22882568 DOI: 10.1111/j.1365-2559.2012.04277.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AIMS Osteopontin (OPN) and LIM homeobox transcription factor 1, alpha (LMX1A) are important factors related to tumour progression, invasion and metastasis in human cancers. The aim of this study was to test the hypothesis that expression of OPN and of LMX1A correlate with the World Health Organization (WHO) grading system of primary brain tumours. METHODS AND RESULTS Immunohistochemical analyses of OPN and LMX1A expression were performed in 139 cases of brain tumour, including 65 meningiomas, 71 gliomas, and three central neurocytomas. More than 90% of WHO grade I meningiomas showed negative or weak staining for OPN and LMX1A. However, among all WHO grade II and III meningiomas, 100% and 66.7% showed moderate or strong staining for OPN and LMX1A, respectively. Similarly, higher percentages of WHO grade I and II gliomas than of WHO grade III and IV gliomas showed negative or weak staining for OPN. A higher intensity of immunoreactivity for LMX1A correlated with more advanced grade in WHO grade I-III gliomas, but not in WHO grade IV tumours. CONCLUSIONS Higher immunostaining intensity for OPN and LMX1A correlated with WHO grades for meningiomas and some gliomas. Contrary to our expectations, LMX1A staining in WHO grade IV gliomas was shown to be weaker than in WHO grade III tumours.
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Affiliation(s)
- Wen-Chiuan Tsai
- Departments of Pathology Neurosurgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Diepenbrock S, Prassni JS, Lindemann F, Bothe HW, Ropinski T. 2010 IEEE Visualization Contest Winner: interactive planning for brain tumor resections. IEEE COMPUTER GRAPHICS AND APPLICATIONS 2011; 31:6-13. [PMID: 25252372 DOI: 10.1109/mcg.2011.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Agar NYR, Golby AJ, Ligon KL, Norton I, Mohan V, Wiseman JM, Tannenbaum A, Jolesz FA. Development of stereotactic mass spectrometry for brain tumor surgery. Neurosurgery 2011; 68:280-89; discussion 290. [PMID: 21135749 DOI: 10.1227/neu.0b013e3181ff9cbb] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Surgery remains the first and most important treatment modality for the majority of solid tumors. Across a range of brain tumor types and grades, postoperative residual tumor has a great impact on prognosis. The principal challenge and objective of neurosurgical intervention is therefore to maximize tumor resection while minimizing the potential for neurological deficit by preserving critical tissue. OBJECTIVE To introduce the integration of desorption electrospray ionization mass spectrometry into surgery for in vivo molecular tissue characterization and intraoperative definition of tumor boundaries without systemic injection of contrast agents. METHODS Using a frameless stereotactic sampling approach and by integrating a 3-dimensional navigation system with an ultrasonic surgical probe, we obtained image-registered surgical specimens. The samples were analyzed with ambient desorption/ionization mass spectrometry and validated against standard histopathology. This new approach will enable neurosurgeons to detect tumor infiltration of the normal brain intraoperatively with mass spectrometry and to obtain spatially resolved molecular tissue characterization without any exogenous agent and with high sensitivity and specificity. RESULTS Proof of concept is presented in using mass spectrometry intraoperatively for real-time measurement of molecular structure and using that tissue characterization method to detect tumor boundaries. Multiple sampling sites within the tumor mass were defined for a patient with a recurrent left frontal oligodendroglioma, World Health Organization grade II with chromosome 1p/19q codeletion, and mass spectrometry data indicated a correlation between lipid constitution and tumor cell prevalence. CONCLUSION The mass spectrometry measurements reflect a complex molecular structure and are integrated with frameless stereotaxy and imaging, providing 3-dimensional molecular imaging without systemic injection of any agents, which can be implemented for surgical margins delineation of any organ and with a rapidity that allows real-time analysis.
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Affiliation(s)
- Nathalie Y R Agar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Intracranial neoplasm. Headache 2010. [DOI: 10.1017/cbo9780511750472.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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14
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McConville P, Hambardzumyan D, Moody JB, Leopold WR, Kreger AR, Woolliscroft MJ, Rehemtulla A, Ross BD, Holland EC. Magnetic resonance imaging determination of tumor grade and early response to temozolomide in a genetically engineered mouse model of glioma. Clin Cancer Res 2007; 13:2897-904. [PMID: 17504989 DOI: 10.1158/1078-0432.ccr-06-3058] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The median survival for patients diagnosed with glioblastoma multiforme, the most common type of brain tumor, is less than 1 year. Animal glioma models that are more predictive of therapeutic response in human patients than traditional models and that are genetically and histologically accurate are an unmet need. The nestin tv-a (Ntv-a) genetically engineered mouse spontaneously develops glioma when infected with ALV-A expressing platelet-derived growth factor, resulting in autocrine platelet-derived growth factor signaling. EXPERIMENTAL DESIGN In the Ntv-a genetically engineered mouse model, T2-weighted and T1-weighted, contrast-enhanced magnetic resonance images were correlated with histology, glioma grade (high or low), and survival. Magnetic resonance imaging (MRI) was therefore used to enroll mice with high-grade gliomas into a second study that tested efficacy of the current standard of care for glioma, temozolomide (100 mg/kg qdx5 i.p., n=13). RESULTS The Ntv-a model generated a heterogeneous group of gliomas, some with high-grade growth rate and histologic characteristics and others with characteristics of lower-grade gliomas. We showed that MRI could be used to predict tumor grade and survival. Temozolomide treatment of high-grade tv-a gliomas provided a 14-day growth delay compared with vehicle controls. Diffusion MRI measurement of the apparent diffusion coefficient showed an early decrease in cellularity with temozolomide, similar to that observed in humans. CONCLUSIONS The use of MRI in the Ntv-a model allows determination of glioma grade and survival prediction, distribution of mice with specific tumor types into preclinical trials, and efficacy determination both by tumor growth and early apparent diffusion coefficient response.
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Wolf RL, Detre JA. Clinical neuroimaging using arterial spin-labeled perfusion magnetic resonance imaging. Neurotherapeutics 2007; 4:346-59. [PMID: 17599701 PMCID: PMC2031222 DOI: 10.1016/j.nurt.2007.04.005] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The two most common methods for measuring perfusion with MRI are based on dynamic susceptibility contrast (DSC) and arterial spin labeling (ASL). Although clinical experience to date is much more extensive with DSC perfusion MRI, ASL methods offer several advantages. The primary advantages are that completely noninvasive absolute cerebral blood flow (CBF) measurements are possible with relative insensitivity to permeability, and that multiple repeated measurements can be obtained to evaluate one or more interventions or to perform perfusion-based functional MRI. ASL perfusion and perfusion-based functional MRI methods have been applied in many clinical settings, including acute and chronic cerebrovascular disease, CNS neoplasms, epilepsy, aging and development, neurodegenerative disorders, and neuropsychiatric diseases. Recent technical advances have improved the sensitivity of ASL perfusion MRI, and increasing use is expected in the coming years. The present review focuses on ASL perfusion MRI and applications in clinical neuroimaging.
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Affiliation(s)
- Ronald L Wolf
- Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA.
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Butowski NA, Sneed PK, Chang SM. Diagnosis and treatment of recurrent high-grade astrocytoma. J Clin Oncol 2006; 24:1273-80. [PMID: 16525182 DOI: 10.1200/jco.2005.04.7522] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
High-grade gliomas represent a significant source of cancer-related death, and usually recur despite treatment. In this analysis of current brain tumor medicine, we review diagnosis, standard treatment, and emerging therapies for recurrent astrocytomas. Difficulties in interpreting radiographic evidence, especially with regard to differentiating between tumor and necrosis, present a formidable challenge. The most accurate diagnoses come from tissue confirmation of recurrent tumor, but a combination of imaging techniques, such as magnetic resonance spectroscopy imaging, may also be relevant for diagnosis. Repeat resection can prolong life, but repeat irradiation of the brain poses serious risks and results in necrosis of healthy brain tissue; therefore, reirradiation is usually not offered to patients with recurrent tumors. We describe the use of conventional radiotherapy, intensity-modulated radiotherapy, brachytherapy, radiosurgery, and photodynamic therapy for recurrent high-grade glioma. The use of chemotherapy is limited by drug distribution and toxicity, but the development of new drug-delivery techniques such as convection-enhanced delivery, which delivers therapeutic molecules at an effective concentration directly to the brain, may provide a way to reduce systemic exposure to cytotoxic agents. We also discuss targeted therapies designed to inhibit aberrant cell-signaling pathways, as well as new experimental therapies such as immunotherapy. The treatment of this devastating disease has so far been met with limited success, but emerging knowledge of neuroscience and the development of novel therapeutic agents will likely give patients new options and require the neuro-oncology community to redefine clinical trial design and strategy continually.
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Affiliation(s)
- Nicholas A Butowski
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143-0350, USA
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Abstract
Diffusely infiltrating low-grade gliomas (LGGs) include astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas (WHO grade 2). Due to the routine use of magnetic resonance imaging, there is an increasing need to formulate treatment guidelines for patients with LGGs. However, there is little consensus about the optimal treatment strategy for diffusely infiltrative LGGs, and the clinical management of LGGs is one of the most controversial areas in neurooncology. Although the standard of care has not been established, several randomized trials are beginning to provide some answers. Furthermore, laboratory correlative studies are defining subsets of LGG that may identify patients with better prognoses and increased chance of responding to therapy. This article reviews the most recent data regarding the treatment of LGG, emphasizing evidenced based approaches from current clinical trials.
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Affiliation(s)
- Frederick F Lang
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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