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Martín-Noguerol T, Santos-Armentia E, Ramos A, Luna A. An update on susceptibility-weighted imaging in brain gliomas. Eur Radiol 2024:10.1007/s00330-024-10703-w. [PMID: 38581609 DOI: 10.1007/s00330-024-10703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/17/2024] [Accepted: 02/23/2024] [Indexed: 04/08/2024]
Abstract
Susceptibility-weighted imaging (SWI) has become a standard component of most brain MRI protocols. While traditionally used for detecting and characterising brain hemorrhages typically associated with stroke or trauma, SWI has also shown promising results in glioma assessment. Numerous studies have highlighted SWI's role in differentiating gliomas from other brain lesions, such as primary central nervous system lymphomas or metastases. Additionally, SWI aids radiologists in non-invasively grading gliomas and predicting their phenotypic profiles. Various researchers have suggested incorporating SWI as an adjunct sequence for predicting treatment response and for post-treatment monitoring. A significant focus of these studies is on the detection of intratumoural susceptibility signals (ITSSs) in gliomas, which are indicative of microhemorrhages and vessels within the tumour. The quantity, distribution, and characteristics of these ITSSs can provide radiologists with more precise information for evaluating and characterising gliomas. Furthermore, the potential benefits and added value of performing SWI after the administration of gadolinium-based contrast agents (GBCAs) have been explored. This review offers a comprehensive, educational, and practical overview of the potential applications and future directions of SWI in the context of glioma assessment. CLINICAL RELEVANCE STATEMENT: SWI has proven effective in evaluating gliomas, especially through assessing intratumoural susceptibility signal changes, and is becoming a promising, easily integrated tool in MRI protocols for both pre- and post-treatment assessments. KEY POINTS: • Susceptibility-weighted imaging is the most sensitive sequence for detecting blood and calcium inside brain lesions. • This sequence, acquired with and without gadolinium, helps with glioma diagnosis, characterisation, and grading through the detection of intratumoural susceptibility signals. • There are ongoing challenges that must be faced to clarify the role of susceptibility-weighted imaging for glioma assessment.
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Affiliation(s)
| | | | - Ana Ramos
- Department of Neuroradiology, University Hospital, 12 de Octubre, Madrid, Spain
| | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Carmelo Torres 2, 23007, Jaén, Spain
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Hilario A, Salvador E, Cardenas A, Romero J, Lechuga C, Chen Z, Martinez de Aragon A, Perez-Nuñez A, Hernandez-Lain A, Sepulveda J, Lagares A, Toldos O, Rodriguez-Gonzalez V, Ramos A. Low rCBV values in glioblastoma tumor progression under chemoradiotherapy. Neuroradiology 2024; 66:317-323. [PMID: 38183424 DOI: 10.1007/s00234-023-03279-7] [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: 08/05/2023] [Accepted: 12/26/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE After standard treatment for glioblastoma, perfusion MRI remains challenging for differentiating tumor progression from post-treatment changes. Our objectives were (1) to correlate rCBV values at diagnosis and at first tumor progression and (2) to analyze the relationship of rCBV values at tumor recurrence with enhancing volume, localization of tumor progression, and time elapsed since the end of radiotherapy in tumor recurrence. METHODS Inclusion criteria were (1) age > 18 years, (2) histologically confirmed glioblastoma treated with STUPP regimen, and (3) tumor progression according to RANO criteria > 12 weeks after radiotherapy. Co-registration of segmented enhancing tumor VOIs with dynamic susceptibility contrast perfusion MRI was performed using Olea Sphere software. For tumor recurrence, we correlated rCBV values with enhancing tumor volume, with recurrence localization, and with time elapsed from the end of radiotherapy to progression. Analyses were performed with SPSS software. RESULTS Sixty-four patients with glioblastoma were included in the study. Changes in rCBV values between diagnosis and first tumor progression were significant (p < 0.001), with a mean and median decreases of 32% and 46%, respectively. Mean rCBV values were also different (p < 0.01) when tumors progressed distally (radiation field rCBV values of 1.679 versus 3.409 distally). However, changes and, therefore, low rCBV values after radiotherapy in tumor recurrence were independent of time. CONCLUSION Chemoradiation alters tumor perfusion and rCBV values may be decreased in the setting of tumor progression. Changes in rCBV values with respect to diagnosis, with low rCBV in tumor progression, are independent of time but related to the site of recurrence.
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Affiliation(s)
- A Hilario
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain.
| | - E Salvador
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Cardenas
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - J Romero
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - C Lechuga
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - Z Chen
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Martinez de Aragon
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Perez-Nuñez
- Department of Neurosurgery, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Hernandez-Lain
- Department of Neuropathology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - J Sepulveda
- Department of Medical Oncology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Lagares
- Department of Neurosurgery, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - O Toldos
- Department of Neuropathology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - V Rodriguez-Gonzalez
- Department of Radiation Oncology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
| | - A Ramos
- Department of Radiology, Hospital 12 de Octubre, Avenida de Cordoba s/n, 28041, Madrid, Spain
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Shevelev OB, Cherkasova OP, Razumov IA, Zavjalov EL. In vivo MRS study of long-term effects of traumatic intracranial injection of a culture medium in mice. Vavilovskii Zhurnal Genet Selektsii 2023; 27:633-640. [PMID: 38223456 PMCID: PMC10784322 DOI: 10.18699/vjgb-23-74] [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: 05/16/2022] [Revised: 02/21/2023] [Accepted: 06/01/2023] [Indexed: 01/16/2024] Open
Abstract
Orthotopic transplantation of glioblastoma cells in the brain of laboratory mice is a common animal model for studying brain tumors. It was shown that 1H magnetic resonance spectroscopy (MRS) enables monitoring of the tumor's occurrence and its development during therapy based on the ratio of several metabolites. However, in studying new approaches to the therapy of glioblastoma in the model of orthotopic xenotransplantation of glioma cells into the brain of mice, it is necessary to understand which metabolites are produced by a growing tumor and which are the result of tumor cells injection along the modeling of the pathology. Currently, there are no data on the dynamic metabolic processes in the brain that occur after the introduction of glioblastoma cells into the brain of mice. In addition, there is a lack of data on the delayed effects of invasive brain damage. Therefore, this study investigates the long-term dynamics of the neurometabolic profile, assessed using 1H MRS, after intracranial injection of a culture medium used in orthotopic modeling of glioma in mice. Levels of N-acetylaspartate, N-acetylaspartylglutamic acid, myoinositol, taurine, glutathione, the sum of glycerophosphocholine and phosphocholine, glutamic acid (Glu), glutamine (Gln), and gamma aminobutyric acid (GABA) indicate patterns of neurometabolites in the early stage after intracranial injection similar to brain trauma ones. Most of the metabolites, with the exception of Gln, Glu and GABA, returned to their original values on day 28 after injection. A progressive increase in the Glu/Gln and Glu/GABA ratio up to 28 days after surgery potentially indicates an impaired turnover of these metabolites or increased neurotransmission. Thus, the data indicate that the recovery processes are largely completed on day 28 after the traumatic event in the brain tissue, leaving open the question of the neurotransmitter system impairment. Consequently, when using animal models of human glioma, researchers should clearly distinguish between which changes in neurometabolites are a response to the injection of cancer cells into the brain, and which processes may indicate the early development of a brain tumor. It is important to keep this in mind when modeling human glioblastoma in mice and monitoring new treatments. In addition, these results may be important in the development of approaches for non-invasive diagnostics of traumatic brain injury as well as recovery and rehabilitation processes of patients after certain brain surgeries.
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Affiliation(s)
- O B Shevelev
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia Institute "International Tomografic Center" of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - O P Cherkasova
- Institute of Laser Physics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia Novosibirsk State Technical University, Novosibirsk, Russia
| | - I A Razumov
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia Novosibirsk State University, Novosibirsk, Russia
| | - E L Zavjalov
- Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
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Molecular MRI-Based Monitoring of Cancer Immunotherapy Treatment Response. Int J Mol Sci 2023; 24:ijms24043151. [PMID: 36834563 PMCID: PMC9959624 DOI: 10.3390/ijms24043151] [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: 01/07/2023] [Revised: 01/29/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Immunotherapy constitutes a paradigm shift in cancer treatment. Its FDA approval for several indications has yielded improved prognosis for cases where traditional therapy has shown limited efficiency. However, many patients still fail to benefit from this treatment modality, and the exact mechanisms responsible for tumor response are unknown. Noninvasive treatment monitoring is crucial for longitudinal tumor characterization and the early detection of non-responders. While various medical imaging techniques can provide a morphological picture of the lesion and its surrounding tissue, a molecular-oriented imaging approach holds the key to unraveling biological effects that occur much earlier in the immunotherapy timeline. Magnetic resonance imaging (MRI) is a highly versatile imaging modality, where the image contrast can be tailored to emphasize a particular biophysical property of interest using advanced engineering of the imaging pipeline. In this review, recent advances in molecular-MRI based cancer immunotherapy monitoring are described. Next, the presentation of the underlying physics, computational, and biological features are complemented by a critical analysis of the results obtained in preclinical and clinical studies. Finally, emerging artificial intelligence (AI)-based strategies to further distill, quantify, and interpret the image-based molecular MRI information are discussed in terms of perspectives for the future.
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5
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Glioma radiogenomics and artificial intelligence: road to precision cancer medicine. Clin Radiol 2023; 78:137-149. [PMID: 36241568 DOI: 10.1016/j.crad.2022.08.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/19/2022] [Indexed: 01/18/2023]
Abstract
Radiogenomics refers to the study of the relationship between imaging phenotypes and gene expression patterns/molecular characteristics, which might allow improved diagnosis, decision-making, and predicting patient outcomes in the context of multiple diseases. Central nervous system (CNS) tumours contribute to significant cancer-related mortality in the present age. Although historically CNS neoplasms were classified and graded based on microscopic appearance, there was discordance between two histologically similar tumours that showed varying prognosis and behaviour, attributable to their molecular signatures. These led to the incorporation of molecular markers in the classification of CNS neoplasms. Meanwhile, advancements in imaging technology such as diffusion-based imaging (including tractography), perfusion, and spectroscopy in addition to the conventional imaging of glial neoplasms, have opened an avenue for radiogenomics. This review touches upon the schema of the current classification of gliomas, concepts behind molecular markers, and parameters that are used in radiogenomics to characterise gliomas and the role of artificial intelligence for the same. Further, the role of radiomics in the grading of brain tumours, prediction of treatment response and prognosis has been discussed. Use of automated and semi-automated tumour segmentation for radiotherapy planning and follow-up has also been discussed briefly.
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Alsulami TA, Hyare H, Thomas DL, Golay X. The value of arterial spin labelling (ASL) perfusion MRI in the assessment of post-treatment progression in adult glioma: A systematic review and meta-analysis. Neurooncol Adv 2023; 5:vdad122. [PMID: 37841694 PMCID: PMC10576519 DOI: 10.1093/noajnl/vdad122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Background The distinction between viable tumor and therapy-induced changes is crucial for the clinical management of patients with gliomas. This study aims to quantitatively assess the efficacy of arterial spin labeling (ASL) biomarkers, including relative cerebral blood flow (rCBF) and absolute cerebral blood flow (CBF), for the discrimination of progressive disease (PD) and treatment-related effects. Methods Eight articles were included in the synthesis after searching the literature systematically. Data have been extracted and a meta-analysis using the random-effect model was subsequently carried out. Diagnostic accuracy assessment was also performed. Results This study revealed that there is a significant difference in perfusion measurements between groups with PD and therapy-induced changes. The rCBF yielded a standardized mean difference (SMD) of 1.25 [95% CI 0.75, 1.75] (p < .00001). The maximum perfusion indices (rCBFmax and CBFmax) both showed equivalent discriminatory ability, with SMD of 1.35 [95% CI 0.78, 1.91] (p < .00001) and 1.56 [95% CI 0.79, 2.33] (p < .0001), respectively. Similarly, accuracy estimates were comparable among ASL-derived metrices. Pooled sensitivities [95% CI] were 0.85 [0.67, 0.94], 0.88 [0.71, 0.96], and 0.93 [0.73, 0.98], and pooled specificities [95% CI] were 0.83 [0.71, 0.91], 0.83 [0.67, 0.92], 0.84 [0.67, 0.93], for rCBF, rCBFmax and CBFmax, respectively. Corresponding HSROC area under curve (AUC) [95% CI] were 0.90 [0.87, 0.92], 0.92 [0.89, 0.94], and 0.93 [0.90, 0.95]. Conclusion These results suggest that ASL quantitative biomarkers, particularly rCBFmax and CBFmax, have the potential to discriminate between glioma progression and therapy-induced changes.
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Affiliation(s)
- Tamadur A Alsulami
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Harpreet Hyare
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - David L Thomas
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Xavier Golay
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
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Beyond Imaging and Genetic Signature in Glioblastoma: Radiogenomic Holistic Approach in Neuro-Oncology. Biomedicines 2022; 10:biomedicines10123205. [PMID: 36551961 PMCID: PMC9775324 DOI: 10.3390/biomedicines10123205] [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: 11/01/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma (GBM) is a malignant brain tumor exhibiting rapid and infiltrative growth, with less than 10% of patients surviving over 5 years, despite aggressive and multimodal treatments. The poor prognosis and the lack of effective pharmacological treatments are imputable to a remarkable histological and molecular heterogeneity of GBM, which has led, to date, to the failure of precision oncology and targeted therapies. Identification of molecular biomarkers is a paradigm for comprehensive and tailored treatments; nevertheless, biopsy sampling has proved to be invasive and limited. Radiogenomics is an emerging translational field of research aiming to study the correlation between radiographic signature and underlying gene expression. Although a research field still under development, not yet incorporated into routine clinical practice, it promises to be a useful non-invasive tool for future personalized/adaptive neuro-oncology. This review provides an up-to-date summary of the recent advancements in the use of magnetic resonance imaging (MRI) radiogenomics for the assessment of molecular markers of interest in GBM regarding prognosis and response to treatments, for monitoring recurrence, also providing insights into the potential efficacy of such an approach for survival prognostication. Despite a high sensitivity and specificity in almost all studies, accuracy, reproducibility and clinical value of radiomic features are the Achilles heel of this newborn tool. Looking into the future, investigators' efforts should be directed towards standardization and a disciplined approach to data collection, algorithms, and statistical analysis.
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Jing H, Yang F, Peng K, Qin D, He Y, Yang G, Zhang H. Multimodal MRI-Based Radiomic Nomogram for the Early Differentiation of Recurrence and Pseudoprogression of High-Grade Glioma. BIOMED RESEARCH INTERNATIONAL 2022; 2022:4667117. [PMID: 36246986 PMCID: PMC9553483 DOI: 10.1155/2022/4667117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
Objective To evaluate the diagnostic value of multimodal MRI radiomics based on T2-weighted fluid attenuated inversion recovery imaging (T2WI-FLAIR) combined with T1-weighted contrast enhanced imaging (T1WI-CE) in the early differentiation of high-grade glioma recurrence from pseudoprogression. Methods A total of one hundred eighteen patients with brain gliomas who were diagnosed from March 2014 to April 2020 were retrospectively analyzed. According to the clinical characteristics, the patients were randomly split into a training group (n = 83) and a test group (n = 35) at a 7 : 3 ratio. The region of interest (ROI) was delineated, and 2632 radiomic features were extracted. We used multiple logistic regression to establish a classification model, including the T1 model, T2 model, and T1 + T2 model, to differentiate recurrence from pseudoprogression. The diagnostic efficiency of the model was evaluated by calculating the area under the receiver operating characteristic curve (AUC) and accuracy (ACC) and by analyzing the calibration curve of the nomogram and decision curve. Results There were 75 cases of recurrence and 43 cases of pseudoprogression. The diagnostic efficacies of the multimodal MRI-based radiomic model were relatively high. The AUC values and ACC of the training group were 0.831 and 77.11%, respectively, and the AUC values and ACC of the test group were 0.829 and 88.57%, respectively. The calibration curve of the nomogram showed that the discrimination probability was consistent with the actual occurrence in the training group, and the discrimination probability was roughly the same as the actual occurrence in the test group. In the decision curve analysis, the T1 + T2 model showed greater overall net efficiency. Conclusion The multimodal MRI radiomic model has relatively high efficiency in the early differentiation of recurrence from pseudoprogression, and it could be helpful for clinicians in devising correct treatment plans so that patients can be treated in a timely and accurate manner.
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Affiliation(s)
- Hui Jing
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Radiology, The Sixth Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Fan Yang
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Kun Peng
- Department of Radiology, The Sixth Hospital, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Danlei Qin
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yexin He
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| | - Guoqiang Yang
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Hui Zhang
- College of Medical Imaging, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Department of Radiology, First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
- Shanxi Key Laboratory of Intelligent Imaging and Nanomedicine, Shanxi Medical University, Taiyuan, Shanxi Province, China
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Peritumor Edema Serves as an Independent Predictive Factor of Recurrence Patterns and Recurrence-Free Survival for High-Grade Glioma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9547166. [PMID: 35936378 PMCID: PMC9348930 DOI: 10.1155/2022/9547166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Objective. This study is aimed at analyzing the factors affecting the recurrence patterns and recurrence-free survival (RFS) of high-grade gliomas (HGG). Methods. Eligible patients admitted to the Affiliated Hospital of Xuzhou Medical University were selected. Subsequently, the effects of some clinical data including age, gender, WHO pathological grades, tumor site, tumor size, clinical treatments, and peritumoral edema (PTE) area and molecular markers (Ki-67, MGMT, IDH-1, and p53) on HGG patients’ recurrence patterns and RFS were analyzed. Results. A total number of 77 patients were enrolled into this study. After analyzing all the cases, it was determined that tumor size and tumor site had a significant influence on the recurrent patterns of HGG, and PTE was an independent predict factor of recurrence patterns. Specifically, when the PTE was mild (<1 cm), the recurrence pattern tended to be local; in contrast, HGG was more likely to progress to marginal recurrence and distant recurrence. Furthermore, age and PTE were significantly associated with RFS; the median RFS of the population with
(23.60 months) was obviously longer than the population with
(5.00 months). Conclusions. PTE is an independent predictor of recurrence patterns and RFS for HGG. Therefore, preoperative identification of PTE in HGG patients is crucially important, which is helpful to accurately estimate the recurrence pattern and RFS.
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Stumpo V, Sebök M, van Niftrik CHB, Seystahl K, Hainc N, Kulcsar Z, Weller M, Regli L, Fierstra J. Feasibility of glioblastoma tissue response mapping with physiologic BOLD imaging using precise oxygen and carbon dioxide challenge. MAGMA (NEW YORK, N.Y.) 2022; 35:29-44. [PMID: 34874499 DOI: 10.1007/s10334-021-00980-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Innovative physiologic MRI development focuses on depiction of heterogenous vascular and metabolic features in glioblastoma. For this feasibility study, we employed blood oxygenation level-dependent (BOLD) MRI with standardized and precise carbon dioxide (CO2) and oxygen (O2) modulation to investigate specific tumor tissue response patterns in patients with newly diagnosed glioblastoma. MATERIALS AND METHODS Seven newly diagnosed untreated patients with suspected glioblastoma were prospectively included to undergo a BOLD study with combined CO2 and O2 standardized protocol. %BOLD signal change/mmHg during hypercapnic, hypoxic, and hyperoxic stimulus was calculated in the whole brain, tumor lesion and segmented volumes of interest (VOI) [contrast-enhancing (CE) - tumor, necrosis and edema] to analyze their tissue response patterns. RESULTS Quantification of BOLD signal change after gas challenges can be used to identify specific responses to standardized stimuli in glioblastoma patients. Integration of this approach with automatic VOI segmentation grants improved characterization of tumor subzones and edema. Magnitude of BOLD signal change during the 3 stimuli can be visualized at voxel precision through color-coded maps overlayed onto whole brain and identified VOIs. CONCLUSIONS Our preliminary investigation shows good feasibility of BOLD with standardized and precise CO2 and O2 modulation as an emerging physiologic imaging technique to detail specific glioblastoma characteristics. The unique tissue response patterns generated can be further investigated to better detail glioblastoma lesions and gauge treatment response.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland. .,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christiaan Hendrik Bas van Niftrik
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katharina Seystahl
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolin Hainc
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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11
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He M, Han K, Zhang Y, Chen W. Hierarchical-order multimodal interaction fusion network for grading gliomas. Phys Med Biol 2021; 66. [PMID: 34663762 DOI: 10.1088/1361-6560/ac30a1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022]
Abstract
Significance. Gliomas are the most common type of primary brain tumors and have different grades. Accurate grading of a glioma is therefore significant for its clinical treatment planning and prognostic assessment with multiple-modality magnetic resonance imaging (MRI).Objective and Approach. In this study, we developed a noninvasive deep-learning method based on multimodal MRI for grading gliomas by focusing on effective multimodal fusion via leveraging collaborative and diverse high-order statistical information. Specifically, a novel high-order multimodal interaction module was designed to promote interactive learning of multimodal knowledge for more efficient fusion. For more powerful feature expression and feature correlation learning, the high-order attention mechanism is embedded in the interaction module for modeling complex and high-order statistical information to enhance the classification capability of the network. Moreover, we applied increasing orders at different levels to hierarchically recalibrate each modality stream through diverse-order attention statistics, thus encouraging all-sided attention knowledge with lesser parameters.Main results. To evaluate the effectiveness of the proposed scheme, extensive experiments were conducted on The Cancer Imaging Archive (TCIA) and Multimodal Brain Tumor Image Segmentation Benchmark 2017 (BraTS2017) datasets with five-fold cross validation to demonstrate that the proposed method can achieve high prediction performance, with area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity values of 95.2%, 94.28%, 95.24%, and 92.00% on the BraTS2017 and 93.50%, 92.86%, 97.14%, and 90.48% on TCIA datasets, respectively.
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Affiliation(s)
- Man He
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, People's Republic of China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Guangzhou, Guangdong 510515, People's Republic of China
| | - Kangfu Han
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, People's Republic of China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Guangzhou, Guangdong 510515, People's Republic of China
| | - Yu Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, People's Republic of China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Guangzhou, Guangdong 510515, People's Republic of China
| | - Wufan Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, People's Republic of China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Guangzhou, Guangdong 510515, People's Republic of China
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Strauss SB, Meng A, Ebani EJ, Chiang GC. Imaging Glioblastoma Posttreatment: Progression, Pseudoprogression, Pseudoresponse, Radiation Necrosis. Neuroimaging Clin N Am 2021; 31:103-120. [PMID: 33220823 DOI: 10.1016/j.nic.2020.09.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.
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Affiliation(s)
- Sara B Strauss
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA
| | - Alicia Meng
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA
| | - Edward J Ebani
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA
| | - Gloria C Chiang
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA.
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13
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Le Fèvre C, Constans JM, Chambrelant I, Antoni D, Bund C, Leroy-Freschini B, Schott R, Cebula H, Noël G. Pseudoprogression versus true progression in glioblastoma patients: A multiapproach literature review. Part 2 - Radiological features and metric markers. Crit Rev Oncol Hematol 2021; 159:103230. [PMID: 33515701 DOI: 10.1016/j.critrevonc.2021.103230] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/10/2021] [Accepted: 01/16/2021] [Indexed: 12/28/2022] Open
Abstract
After chemoradiotherapy for glioblastoma, pseudoprogression can occur and must be distinguished from true progression to correctly manage glioblastoma treatment and follow-up. Conventional treatment response assessment is evaluated via conventional MRI (contrast-enhanced T1-weighted and T2/FLAIR), which is unreliable. The emergence of advanced MRI techniques, MR spectroscopy, and PET tracers has improved pseudoprogression diagnostic accuracy. This review presents a literature review of the different imaging techniques and potential imaging biomarkers to differentiate pseudoprogression from true progression.
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Affiliation(s)
- Clara Le Fèvre
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Jean-Marc Constans
- Department of Radiology, Amiens-Picardie University Hospital, 1 rond-point du Professeur Christian Cabrol, 80054, Amiens Cedex 1, France.
| | - Isabelle Chambrelant
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Caroline Bund
- Department of Nuclear Medicine, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Benjamin Leroy-Freschini
- Department of Nuclear Medicine, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Roland Schott
- Departement of Medical Oncology, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Hélène Cebula
- Departement of Neurosurgery, Hautepierre University Hospital, 1, avenue Molière, 67200, Strasbourg, France.
| | - Georges Noël
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
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14
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Munir S, Khan SA, Hanif H, Khan M. Diagnostic accuracy of magnetic resonance imaging in detection of intra-axial gliomas. Pak J Med Sci 2020; 37:125-130. [PMID: 33437263 PMCID: PMC7794124 DOI: 10.12669/pjms.37.1.2489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) in detection of intra-axial gliomas in suspected cases keeping histopathology as gold standard. Methods: This cross-sectional study was conducted at Dow Institute of Radiology, DUHS from October 2017 - April 2018. Patients of either gender aged 30-70 years presenting with headache were included. Patients already diagnosed and referred for follow up were excluded. MRI was performed on 1.5T scanner by a trained MRI technician. T1, T2, FLAIR, diffusion weighted and T1 post contrast images were acquired and reviewed by two radiologists having more than five years post fellowship experience. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of MRI for intraaxial gliomas was calculated taking histopathology findings as gold standard. Results: Mean age of the patient`s was 51.71 ±10.85 years. Positive intraaxial gliomas on MRI were observed in 123 (79.90%) patients while on histopathology, positive intraaxial gliomas were observed in 131 (85.10%) patients. Diagnostic accuracy of MRI in detection of intra-axial gliomas taking histopathology findings as gold standard showed sensitivity, specificity, positive predicted value (PPV), negative predicted value (NPV) and overall diagnostic accuracy as 89.31%, 73.91%, 95.12%, 54.84% and 87.01%. Conclusions: MRI has high sensitivity, moderate specificity and high diagnostic accuracy in detection of intraaxial gliomas.
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Affiliation(s)
- Sohbia Munir
- Sohbia Munir, Resident, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Sohail Ahmed Khan
- Sohail Ahmed Khan, Assistant Professor, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Hina Hanif
- Hina Hanif, Resident, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Maria Khan
- Maria Khan, Resident, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
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15
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Le Fèvre C, Lhermitte B, Ahle G, Chambrelant I, Cebula H, Antoni D, Keller A, Schott R, Thiery A, Constans JM, Noël G. Pseudoprogression versus true progression in glioblastoma patients: A multiapproach literature review: Part 1 - Molecular, morphological and clinical features. Crit Rev Oncol Hematol 2020; 157:103188. [PMID: 33307200 DOI: 10.1016/j.critrevonc.2020.103188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/12/2020] [Accepted: 11/23/2020] [Indexed: 01/04/2023] Open
Abstract
With new therapeutic protocols, more patients treated for glioblastoma have experienced a suspicious radiologic image of progression (pseudoprogression) during follow-up. Pseudoprogression should be differentiated from true progression because the disease management is completely different. In the case of pseudoprogression, the follow-up continues, and the patient is considered stable. In the case of true progression, a treatment adjustment is necessary. Presently, a pseudoprogression diagnosis certainly needs to be pathologically confirmed. Some important efforts in the radiological, histopathological, and genomic fields have been made to differentiate pseudoprogression from true progression, and the assessment of response criteria exists but remains limited. The aim of this paper is to highlight clinical and pathological markers to differentiate pseudoprogression from true progression through a literature review.
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Affiliation(s)
- Clara Le Fèvre
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Benoît Lhermitte
- Département of Pathology, Hautepierre University Hospital, 1, Avenue Molière, 67200, Strasbourg, France
| | - Guido Ahle
- Departement of Neurology, Hôpitaux Civils de Colmar, 39 Avenue de la Liberté, 68024, Colmar, France
| | - Isabelle Chambrelant
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Hélène Cebula
- Departement of Neurosurgery, Hautepierre University Hospital, 1, Avenue Molière, 67200, Strasbourg, France
| | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Audrey Keller
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Roland Schott
- Departement of Medical Oncology, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Alicia Thiery
- Department of Public Health, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France
| | - Jean-Marc Constans
- Department of Radiology, Amiens-Pïcardie University Hospital, 1 rond point du Professeur Christian Cabrol, 80054 Amiens Cedex 1, France
| | - Georges Noël
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 Rue Albert Calmette, 67200, Strasbourg Cedex, France.
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16
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Clement P, Booth T, Borovečki F, Emblem KE, Figueiredo P, Hirschler L, Jančálek R, Keil VC, Maumet C, Özsunar Y, Pernet C, Petr J, Pinto J, Smits M, Warnert EAH. GliMR: Cross-Border Collaborations to Promote Advanced MRI Biomarkers for Glioma. J Med Biol Eng 2020; 41:115-125. [PMID: 33293909 PMCID: PMC7712600 DOI: 10.1007/s40846-020-00582-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/04/2020] [Indexed: 01/01/2023]
Abstract
Purpose There is an annual incidence of 50,000 glioma cases in Europe. The optimal treatment strategy is highly personalised, depending on tumour type, grade, spatial localization, and the degree of tissue infiltration. In research settings, advanced magnetic resonance imaging (MRI) has shown great promise as a tool to inform personalised treatment decisions. However, the use of advanced MRI in clinical practice remains scarce due to the downstream effects of siloed glioma imaging research with limited representation of MRI specialists in established consortia; and the associated lack of available tools and expertise in clinical settings. These shortcomings delay the translation of scientific breakthroughs into novel treatment strategy. As a response we have developed the network “Glioma MR Imaging 2.0” (GliMR) which we present in this article. Methods GliMR aims to build a pan-European and multidisciplinary network of experts and accelerate the use of advanced MRI in glioma beyond the current “state-of-the-art” in glioma imaging. The Action Glioma MR Imaging 2.0 (GliMR) was granted funding by the European Cooperation in Science and Technology (COST) in June 2019. Results GliMR’s first grant period ran from September 2019 to April 2020, during which several meetings were held and projects were initiated, such as reviewing the current knowledge on advanced MRI; developing a General Data Protection Regulation (GDPR) compliant consent form; and setting up the website. Conclusion The Action overcomes the pre-existing limitations of glioma research and is funded until September 2023. New members will be accepted during its entire duration.
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Affiliation(s)
- Patricia Clement
- Ghent Institute for Metabolic and Functional Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Thomas Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London, SE1 7EH UK.,Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, SE5 9RS UK
| | - Fran Borovečki
- Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Kyrre E Emblem
- Division of Radiology and Nuclear Medicine, Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Patrícia Figueiredo
- Institute for Systems and Robotics - Lisboa and Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Lydiane Hirschler
- Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, The Netherlands
| | - Radim Jančálek
- Department of Neurosurgery, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Vera C Keil
- Department of Radiology, Amsterdam University Medical Center, VUmc, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Yelda Özsunar
- Department of Radiology, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Cyril Pernet
- Centre for Clinical Brain Sciences & Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
| | - Jan Petr
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Joana Pinto
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
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17
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Lupo JM. Diffusion MRI as an early marker of response to immune checkpoint inhibitors. Neuro Oncol 2020; 22:1557-1558. [PMID: 33045738 DOI: 10.1093/neuonc/noaa224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Janine M Lupo
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
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18
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Advanced magnetic resonance imaging to support clinical drug development for malignant glioma. Drug Discov Today 2020; 26:429-441. [PMID: 33249294 DOI: 10.1016/j.drudis.2020.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/23/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022]
Abstract
Even though the treatment options and survival of patients with glioblastoma multiforme (GBM), the most common type of malignant glioma, have improved over the past decade, there is still a high unmet medical need to develop novel therapies. Complexity in pathology and therapy require biomarkers to characterize tumors, to define malignant and active areas, to assess disease prognosis, and to quantify and monitor therapy response. While conventional magnetic resonance imaging (MRI) techniques have improved these assessments, limitations remain. In this review, we evaluate the role of various non-invasive biomarkers based on advanced structural and functional MRI techniques in the context of GBM drug development over the past 5 years.
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19
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Roy S, Whitehead TD, Quirk JD, Salter A, Ademuyiwa FO, Li S, An H, Shoghi KI. Optimal co-clinical radiomics: Sensitivity of radiomic features to tumour volume, image noise and resolution in co-clinical T1-weighted and T2-weighted magnetic resonance imaging. EBioMedicine 2020; 59:102963. [PMID: 32891051 PMCID: PMC7479492 DOI: 10.1016/j.ebiom.2020.102963] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
Background Radiomics analyses has been proposed to interrogate the biology of tumour as well as to predict/assess response to therapy in vivo. The objective of this work was to assess the sensitivity of radiomics features to noise, resolution, and tumour volume in the context of a co-clinical trial. Methods Triple negative breast cancer (TNBC) patients were recruited into an ongoing co-clinical imaging trial. Sub-typed matched TNBC patient-derived tumour xenografts (PDX) were generated to investigate optimal co-clinical MR radiomic features. The MR imaging protocol included T1-weighed and T2-weighted imaging. To test the sensitivity of radiomics to resolution, PDX were imaged at three different resolutions. Multiple sets of images with varying signal-to-noise ratio (SNR) were generated, and an image independent patch-based method was implemented to measure the noise levels. Forty-eight radiomic features were extracted from manually segmented 2D and 3D segmented tumours and normal tissues of T1- and T2- weighted co-clinical MR images. Findings Sixteen radiomics features were identified as volume dependent and corrected for volume-dependency following normalization. Features from grey-level run-length matrix (GLRLM), grey-level size zone matrix (GLSZM) were identified as most sensitive to noise. Radiomic features Kurtosis and Run-length variance (RLV) from GLSZM were most sensitive to changes in resolution in both T1w and T2w MRI. In general, 3D radiomic features were more robust compared to 2D (single slice) measures, although the former exhibited higher variability between subjects. Interpretation Tumour volume, noise characteristics, and image resolution significantly impact radiomic analysis in co-clinical studies.
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Affiliation(s)
- Sudipta Roy
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Timothy D Whitehead
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - James D Quirk
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amber Salter
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO USA
| | - Foluso O Ademuyiwa
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Shunqiang Li
- Department of Internal Medicine, Division of Oncology, Washington University School of Medicine, St. Louis, MO USA
| | - Hongyu An
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO USA
| | - Kooresh I Shoghi
- Department of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University School of Medicine, St. Louis, MO USA.
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20
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Yu Y, Ma Y, Sun M, Jiang W, Yuan T, Tong D. Meta-analysis of the diagnostic performance of diffusion magnetic resonance imaging with apparent diffusion coefficient measurements for differentiating glioma recurrence from pseudoprogression. Medicine (Baltimore) 2020; 99:e20270. [PMID: 32501974 PMCID: PMC7306328 DOI: 10.1097/md.0000000000020270] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/13/2020] [Accepted: 04/15/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The accurate differentiation of glioma recurrence from pseudoprogression (PSP) after therapy remains a considerable clinical challenge. Several studies have shown that diffusion magnetic resonance imaging (MRI) has potential value in distinguishing these 2 outcomes. The current meta-analysis examined the diagnostic accuracy of diffusion MRI with the apparent diffusion coefficient (ADC) in the differentiation of glioma recurrence from PSP. METHOD PubMed, Embase, Cochrane Library, and Chinese Biomedical databases were reviewed to identify studies that fulfilled our inclusion/exclusion criteria and were published on or before May 5, 2019. Threshold effects; heterogeneity; pooled sensitivity (SENS), specificity, positive likelihood ratio, and negative likelihood ratio; and diagnostic odds ratio were calculated. The overall diagnostic usefulness of diffusion MRI-derived ADC values was assessed by calculating the area under the curve (AUC) following summary receiver operating characteristic (SROC) analysis. RESULTS Six eligible studies examined a total of 214 patients. Calculation of pooled values indicated the SENS was 0.95 (95% confidence interval [CI] = 0.89-0.98), specificity was 0.83 (95% CI = 0.72-0.91), positive likelihood ratio was 4.82 (95% CI = 2.93-7.93), negative likelihood ratio was 0.08 (95% CI = 0.04-0.17), and diagnostic odds ratio was 59.63 (95% CI = 22.63-157.37). The SROC AUC was 0.9322. Publication bias was not significant, and SENS analysis indicated the results were relatively stable. CONCLUSIONS Our meta-analysis indicated that diffusion MRI with quantitative ADC is an effective approach for differentiation of glioma recurrence from PSP, and can be used as an auxiliary tool to diagnose glioma progression.
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Affiliation(s)
| | | | - Mengyao Sun
- Department of Internal Oncology, The First Hospital of Jilin University, Changchun, Jilin, China
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21
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Improved 3-year survival rates for glioblastoma multiforme are associated with trends in treatment: analysis of the national cancer database from 2004 to 2013. J Neurooncol 2020; 148:69-79. [DOI: 10.1007/s11060-020-03469-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
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22
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Nöth U, Tichy J, Tritt S, Bähr O, Deichmann R, Hattingen E. Quantitative T1 mapping indicates tumor infiltration beyond the enhancing part of glioblastomas. NMR IN BIOMEDICINE 2020; 33:e4242. [PMID: 31880005 DOI: 10.1002/nbm.4242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 06/10/2023]
Abstract
The aim of this study was to evaluate whether maps of quantitative T1 (qT1) differences induced by a gadolinium-based contrast agent (CA) are better suited than conventional T1-weighted (T1w) MR images for detecting infiltration inside and beyond the peritumoral edema of glioblastomas. Conventional T1w images and qT1 maps were obtained before and after gadolinium-based CA administration in 33 patients with glioblastoma before therapy. The following data were calculated: (i) absolute qT1-difference maps (qT1 pre-CA - qT1 post-CA), (ii) relative qT1-difference maps, (iii) absolute and (iv) relative differences of conventional T1w images acquired pre- and post-CA. The values of these four datasets were compared in four different regions: (a) the enhancing tumor, (b) the peritumoral edema, (c) a 5 mm zone around the pathology (defined as the sum of regions a and b), and (d) the contralateral normal appearing brain tissue. Additionally, absolute qT1-difference maps (displayed with linear gray scaling) were visually compared with respective conventional difference images. The enhancing tumor was visible both in the difference of conventional pre- and post-CA T1w images and in the absolute qT1-difference maps, whereas only the latter showed elevated values in the peritumoral edema and in some cases even beyond. Mean absolute qT1-difference values were significantly higher (P < 0.01) in the enhancing tumor (838 ± 210 ms), the peritumoral edema (123 ± 74 ms) and in the 5 mm zone around the pathology (81 ± 31 ms) than in normal appearing tissue (32 ± 35 ms). In summary, absolute qT1-difference maps-in contrast to the difference of T1w images-of untreated glioblastomas appear to be able to visualize CA leakage, and thus might indicate tumor cell infiltration in the edema region and beyond. Therefore, the absolute qT1-difference maps are potentially useful for treatment planning.
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Affiliation(s)
- Ulrike Nöth
- Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Julia Tichy
- Dr Senckenberg Institute of Neurooncology, Goethe University, Frankfurt am Main, Germany
| | - Stephanie Tritt
- Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
| | - Oliver Bähr
- Dr Senckenberg Institute of Neurooncology, Goethe University, Frankfurt am Main, Germany
| | - Ralf Deichmann
- Brain Imaging Center, Goethe University, Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University, Frankfurt am Main, Germany
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23
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Müller Bark J, Kulasinghe A, Chua B, Day BW, Punyadeera C. Circulating biomarkers in patients with glioblastoma. Br J Cancer 2020; 122:295-305. [PMID: 31666668 PMCID: PMC7000822 DOI: 10.1038/s41416-019-0603-6] [Citation(s) in RCA: 119] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/23/2019] [Accepted: 09/23/2019] [Indexed: 12/28/2022] Open
Abstract
Gliomas are the most common tumours of the central nervous system and the most aggressive form is glioblastoma (GBM). Despite advances in treatment, patient survival remains low. GBM diagnosis typically relies on imaging techniques and postoperative pathological diagnosis; however, both procedures have their inherent limitations. Imaging modalities cannot differentiate tumour progression from treatment-related changes that mimic progression, known as pseudoprogression, which might lead to misinterpretation of therapy response and delay clinical interventions. In addition to imaging limitations, tissue biopsies are invasive and most of the time cannot be performed over the course of treatment to evaluate 'real-time' tumour dynamics. In an attempt to address these limitations, liquid biopsies have been proposed in the field. Blood sampling is a minimally invasive procedure for a patient to endure and could provide tumoural information to guide therapy. Tumours shed tumoural content, such as circulating tumour cells, cell-free nucleic acids, proteins and extracellular vesicles, into the circulation, and these biomarkers are reported to cross the blood-brain barrier. The use of liquid biopsies is emerging in the field of GBM. In this review, we aim to summarise the current literature on circulating biomarkers, namely circulating tumour cells, circulating tumour DNA and extracellular vesicles as potential non-invasively sampled biomarkers to manage the treatment of patients with GBM.
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Affiliation(s)
- Juliana Müller Bark
- Saliva and Liquid Biopsy Translational Research Team, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
- Translational Research Institute, Woolloongabba, QLD, 4102, Australia
| | - Arutha Kulasinghe
- Saliva and Liquid Biopsy Translational Research Team, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia
- Translational Research Institute, Woolloongabba, QLD, 4102, Australia
| | - Benjamin Chua
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
- Cancer Care Services, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Bryan W Day
- Faculty of Medicine, University of Queensland, 288 Herston Road, Herston, QLD, 4006, Australia
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Gardens Point, QLD, 4000, Australia
- Cell and Molecular Biology Department, Sid Faithfull Brain Cancer Laboratory, QIMR Berghofer MRI, Brisbane, QLD, 4006, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Research Team, The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD, 4059, Australia.
- Translational Research Institute, Woolloongabba, QLD, 4102, Australia.
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Combined analysis of MGMT methylation and dynamic-susceptibility-contrast MRI for the distinction between early and pseudo-progression in glioblastoma patients. Rev Neurol (Paris) 2019; 175:534-543. [DOI: 10.1016/j.neurol.2019.01.400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/05/2018] [Accepted: 01/21/2019] [Indexed: 01/13/2023]
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25
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Strauss SB, Meng A, Ebani EJ, Chiang GC. Imaging Glioblastoma Posttreatment: Progression, Pseudoprogression, Pseudoresponse, Radiation Necrosis. Radiol Clin North Am 2019; 57:1199-1216. [PMID: 31582045 DOI: 10.1016/j.rcl.2019.07.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Radiographic monitoring of posttreatment glioblastoma is important for clinical trials and determining next steps in management. Evaluation for tumor progression is confounded by the presence of treatment-related radiographic changes, making a definitive determination less straight-forward. The purpose of this article was to describe imaging tools available for assessing treatment response in glioblastoma, as well as to highlight the definitions, pathophysiology, and imaging features typical of true progression, pseudoprogression, pseudoresponse, and radiation necrosis.
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Affiliation(s)
- Sara B Strauss
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA
| | - Alicia Meng
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA
| | - Edward J Ebani
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA
| | - Gloria C Chiang
- Department of Radiology, Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY 10065, USA.
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26
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Arain FM, Shaikh A, Waqas M, Tariq MU, Raghib MF, Haider G, Shamim MS, Mubarak F, Hassan SH, Enam SA, Jabbar AA. Molecular and radiological characterization of glioblastoma multiforme using magnetic resonance imaging. J Neurosurg Sci 2019; 65:47-53. [PMID: 31298508 DOI: 10.23736/s0390-5616.19.04760-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is the most malignant, aggressive and common form of primary brain cancer. Currently, GBM is considered to be a homogenous mass as all its margins are treated equally at the time of resection. However, it is not known whether radiologically distinct regions of GBM are also distinct at molecular level. We conducted this study to see if radiologically distinct regions were also different at the molecular level. METHODS In 20 patients, MRI derived variance known as Apparent Diffusion Coefficient (ADC) was plotted against Contrast Enhancement (CE). Four radiologically distinct regions were identified: 1) high ADC and low CE; 2) low ADC and low CE; 3) high ADC and high CE; and 4) low ADC and high CE. Biopsy samples were collected from these four regions of interest in each patient and immunohistochemistry was conducted to characterize cellular features and identify oncogene and stem cell marker expressing cells. RESULTS Markedly increased nuclear pleomorphism, cellularity and necrosis were seen in region 2. Oncogene IDH was expressed in all regions, however, it was highest in region 4. Stem cell marker, CD44 expression was highest in region 1 and lowest in region 2 and 3. The expression of CD133 was highest in region 3. CONCLUSIONS This study shows that ADC/CE plot can divide GBM into four regions, whose heterogeneity is evidenced by differential expression of nuclear pleomorphism, necrosis, cellularity and mitotic rate as well as the expression of oncogene and stem cell markers.
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Affiliation(s)
- Fazal M Arain
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan -
| | - Anjiya Shaikh
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Muhammad Waqas
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Muhammad U Tariq
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ghulam Haider
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Fatima Mubarak
- Department of Radiology, Aga Khan University, Karachi, Pakistan
| | - Sheema H Hassan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Syed A Enam
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Adnan A Jabbar
- Department of Oncology, Aga Khan University, Karachi, Pakistan
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27
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Kasten BB, Udayakumar N, Leavenworth JW, Wu AM, Lapi SE, McConathy JE, Sorace AG, Bag AK, Markert JM, Warram JM. Current and Future Imaging Methods for Evaluating Response to Immunotherapy in Neuro-Oncology. Theranostics 2019; 9:5085-5104. [PMID: 31410203 PMCID: PMC6691392 DOI: 10.7150/thno.34415] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 04/20/2019] [Indexed: 12/28/2022] Open
Abstract
Imaging plays a central role in evaluating responses to therapy in neuro-oncology patients. The advancing clinical use of immunotherapies has demonstrated that treatment-related inflammatory responses mimic tumor growth via conventional imaging, thus spurring the development of new imaging approaches to adequately distinguish between pseudoprogression and progressive disease. To this end, an increasing number of advanced imaging techniques are being evaluated in preclinical and clinical studies. These novel molecular imaging approaches will serve to complement conventional response assessments during immunotherapy. The goal of these techniques is to provide definitive metrics of tumor response at earlier time points to inform treatment decisions, which has the potential to improve patient outcomes. This review summarizes the available immunotherapy regimens, clinical response criteria, current state-of-the-art imaging approaches, and groundbreaking strategies for future implementation to evaluate the anti-tumor and immune responses to immunotherapy in neuro-oncology applications.
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Affiliation(s)
- Benjamin B. Kasten
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Neha Udayakumar
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jianmei W. Leavenworth
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anna M. Wu
- Crump Institute for Molecular Imaging, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States
| | - Suzanne E. Lapi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jonathan E. McConathy
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Anna G. Sorace
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Asim K. Bag
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - James M. Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jason M. Warram
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, AL, United States
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28
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Hvinden IC, Berg HE, Sachse D, Skaga E, Skottvoll FS, Lundanes E, Sandberg CJ, Vik-Mo EO, Rise F, Wilson SR. Nuclear Magnetic Resonance Spectroscopy to Identify Metabolite Biomarkers of Nonresponsiveness to Targeted Therapy in Glioblastoma Tumor Stem Cells. J Proteome Res 2019; 18:2012-2020. [PMID: 30964684 DOI: 10.1021/acs.jproteome.8b00801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Glioblastoma is the most common and malignant brain tumor, and current therapies confer only modest survival benefits. A major obstacle is our ability to monitor treatment effect on tumors. Current imaging modalities are ambiguous, and repeated biopsies are not encouraged. To scout for markers of treatment response, we used NMR spectroscopy to study the effects of a survivin inhibitor on the metabolome of primary glioblastoma cancer stem cells. Applying high resolution NMR spectroscopy (1H resonance frequency: 800.03 MHz) to just 3 million cells per sample, we achieved sensitive and high resolving determinations of, e.g., amino acids, nucleosides, and constituents of the citric acid cycle. For control samples that were cultured, prepared, and measured at varying dates, peak area relative standard deviations were 15-20%. Analyses of unfractionated lysates were performed for straightforward compound identification with COLMAR and HMDB databases. Principal component analysis revealed that citrate levels were clearly upregulated in nonresponsive cells, while lactate levels substantially decreased following treatment for both responsive and nonresponsive cells. Hence, lactate and citrate may be potential markers of successful drug uptake and poor response to survivin inhibitors, respectively. Our metabolomics approach provided alternative biomarker candidates compared to spectrometry-based proteomics, underlining benefits of complementary methodologies. These initial findings make a foundation for exploring in vivo MR spectroscopy (MRS) of brain tumors, as citrate and lactate are MRS-visible. In sum, NMR metabolomics is a tool for addressing glioblastoma.
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Affiliation(s)
- Ingvild Comfort Hvinden
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway.,Department of Chemistry , Chemistry Research Laboratory, University of Oxford , 12 Mansfield Road , Oxford OX1 3TA , United Kingdom
| | - Henriette Engen Berg
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway
| | - Daniel Sachse
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway
| | - Erlend Skaga
- Vilhelm Magnus Laboratory of Neurosurgical Research, Institute for Surgical Research and Department of Neurosurgery , Oslo University Hospital , 4950 Nydalen NO-0424 , Oslo , Norway.,Institute of Clinical Medicine, Faculty of Medicine , University of Oslo , Post Box 1171, Blindern NO-0318 , Oslo , Norway
| | - Frøydis Sved Skottvoll
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway.,Hybrid Technology Hub, Centre of Excellence, Institute of Basic Medical Sciences, Faculty of Medicine , University of Oslo , PO Box 1112, Blindern NO-0317 , Oslo , Norway
| | - Elsa Lundanes
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway
| | - Cecilie J Sandberg
- Vilhelm Magnus Laboratory of Neurosurgical Research, Institute for Surgical Research and Department of Neurosurgery , Oslo University Hospital , 4950 Nydalen NO-0424 , Oslo , Norway
| | - Einar O Vik-Mo
- Vilhelm Magnus Laboratory of Neurosurgical Research, Institute for Surgical Research and Department of Neurosurgery , Oslo University Hospital , 4950 Nydalen NO-0424 , Oslo , Norway
| | - Frode Rise
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway
| | - Steven Ray Wilson
- Department of Chemistry , University of Oslo , Post Box 1033, Blindern NO-0315 , Oslo , Norway.,Hybrid Technology Hub, Centre of Excellence, Institute of Basic Medical Sciences, Faculty of Medicine , University of Oslo , PO Box 1112, Blindern NO-0317 , Oslo , Norway
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29
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Rodriguez D, Chambers T, Warmuth-Metz M, Aliaga ES, Warren D, Calmon R, Hargrave D, Garcia J, Vassal G, Grill J, Zahlmann G, Morgan PS, Jaspan T. Evaluation of the Implementation of the Response Assessment in Neuro-Oncology Criteria in the HERBY Trial of Pediatric Patients with Newly Diagnosed High-Grade Gliomas. AJNR Am J Neuroradiol 2019; 40:568-575. [PMID: 30819765 DOI: 10.3174/ajnr.a5982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/31/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE HERBY was a Phase II multicenter trial setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non-brain stem high-grade gliomas. This study evaluates the implementation of the radiologic aspects of HERBY. MATERIALS AND METHODS We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process. RESULTS Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists' responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P < .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n = 4; perfusion, n = 1). CONCLUSIONS The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression.
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Affiliation(s)
- D Rodriguez
- Medical Physics and Clinical Engineering (D.R., P.S.M.)
| | - T Chambers
- Cardiff University, School of Medicine (T.C.), Cardiff, UK
| | - M Warmuth-Metz
- Würzburg University, Institute for Diagnostic and Interventional Neuroradiology (M.W.-M.), Würzburg, Germany
| | - E Sanchez Aliaga
- VU University Medical Center, Department of Radiology & Nuclear Medicine (E.S.A.), Amsterdam, the Netherlands
| | - D Warren
- Leeds Teaching Hospital, Department of Radiology (D.W.), Leeds, UK
| | - R Calmon
- Assistance Publique-Hôpitaux de Paris, Pediatric Radiology (R.C.), Paris, France
| | - D Hargrave
- Great Ormond Street Hospital, Haematology and Oncology Department (D.H.), London, UK
| | - J Garcia
- F. Hoffmann-La Roche (J.Garcia, G.Z.), Basel, Switzerland
| | - G Vassal
- Gustave Roussy and Paris-Sud University, Pediatric and Adolescent Oncology and Unite Mixte de Recherche (G.V., J.Grill), Villejuif, France
| | - J Grill
- Gustave Roussy and Paris-Sud University, Pediatric and Adolescent Oncology and Unite Mixte de Recherche (G.V., J.Grill), Villejuif, France
| | - G Zahlmann
- F. Hoffmann-La Roche (J.Garcia, G.Z.), Basel, Switzerland
| | - P S Morgan
- Medical Physics and Clinical Engineering (D.R., P.S.M.).,Nottingham Biomedical Research Centre of the UK National Institute of Health Research (P.S.M.), Nottingham, UK
| | - T Jaspan
- From Nottingham University Hospitals, Department of Radiology (T.J.)
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30
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Qiao Z, Zhao X, Wang K, Zhang Y, Fan D, Yu T, Shen H, Chen Q, Ai L. Utility of Dynamic Susceptibility Contrast Perfusion-Weighted MR Imaging and 11C-Methionine PET/CT for Differentiation of Tumor Recurrence from Radiation Injury in Patients with High-Grade Gliomas. AJNR Am J Neuroradiol 2019; 40:253-259. [PMID: 30655259 DOI: 10.3174/ajnr.a5952] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/24/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Both 11C-methionine PET/CT and DSC-PWI could be used to differentiate radiation injury from recurrent brain tumors. Our aim was to assess the performance of MET PET/CT and DSC-PWI for differentiation of recurrence and radiation injury in patients with high-grade gliomas and to quantitatively analyze the diagnostic values of PET and PWI parameters. MATERIALS AND METHODS Forty-two patients with high-grade gliomas were enrolled in this study. The final diagnosis was determined by histopathologic analysis or clinical follow-up. PWI and PET parameters were recorded and compared between patients with recurrence and those with radiation injury using Student t tests. Receiver operating characteristic and logistic regression analyses were used to determine the diagnostic performance of each parameter. RESULTS The final diagnosis was recurrence in 33 patients and radiation injury in 9. PET/CT showed a patient-based sensitivity and specificity of 0.909 and 0.556, respectively, while PWI showed values of 0.667 and 0.778, respectively. The maximum standardized uptake value, mean standardized uptake value, tumor-to-background maximum standardized uptake value, and mean relative CBV were significantly higher for patients with recurrence than for patients with radiation injury. All these parameters showed a high discriminative power in receiver operating characteristic analysis. The optimal cutoff values for the tumor-to-background maximum standardized uptake value and mean relative CBV were 1.85 and 1.83, respectively, and corresponding sensitivities and specificities for the diagnosis of recurrence were 0.97 and 0.667 and 0.788 and 0.88, respectively. Areas under the curve for the tumor-to-background maximum standardized uptake value and mean relative CBV were 0.847 ± 0.077 and 0.845 ± 0.078, respectively. Combined assessment of the tumor-to-background maximum standardized uptake value and mean relative CBV showed the largest area under the curve (0.953 ± 0.031), with corresponding sensitivity and specificity of 0.848 and 1.0, respectively. CONCLUSIONS Both 11C-methionine PET/CT and PWI are equally accurate in the differentiation of recurrence from radiation injury in patients with high-grade gliomas, and a combination of the 2 modalities could result in increased diagnostic accuracy.
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Affiliation(s)
- Z Qiao
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
| | - X Zhao
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
| | - K Wang
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
| | - Y Zhang
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
| | - D Fan
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
| | - T Yu
- Department of Medical Imaging (T.Y.), Cancer Hospital of China Medical University, Shenyang, China.,Department of Medical Imaging (T.Y.), Liaoning Cancer Hospital and Institute, Shenyang, China
| | - H Shen
- Radiology (H.S.), Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Q Chen
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
| | - L Ai
- From the Departments of Nuclear Medicine (Z.Q., X.Z., K.W., Y.Z., D.F., Q.C., L.A.)
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31
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Breckwoldt MO, Bode J, Sahm F, Krüwel T, Solecki G, Hahn A, Wirthschaft P, Berghoff AS, Haas M, Venkataramani V, von Deimling A, Wick W, Herold-Mende C, Heiland S, Platten M, Bendszus M, Kurz FT, Winkler F, Tews B. Correlated MRI and Ultramicroscopy (MR-UM) of Brain Tumors Reveals Vast Heterogeneity of Tumor Infiltration and Neoangiogenesis in Preclinical Models and Human Disease. Front Neurosci 2019; 12:1004. [PMID: 30686972 PMCID: PMC6335617 DOI: 10.3389/fnins.2018.01004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022] Open
Abstract
Diffuse tumor infiltration into the adjacent parenchyma is an effective dissemination mechanism of brain tumors. We have previously developed correlated high field magnetic resonance imaging and ultramicroscopy (MR-UM) to study neonangiogenesis in a glioma model. In the present study we used MR-UM to investigate tumor infiltration and neoangiogenesis in a translational approach. We compare infiltration and neoangiogenesis patterns in four brain tumor models and the human disease: whereas the U87MG glioma model resembles brain metastases with an encapsulated growth and extensive neoangiogenesis, S24 experimental gliomas mimic IDH1 wildtype glioblastomas, exhibiting infiltration into the adjacent parenchyma and along white matter tracts to the contralateral hemisphere. MR-UM resolves tumor infiltration and neoangiogenesis longitudinally based on the expression of fluorescent proteins, intravital dyes or endogenous contrasts. Our study demonstrates the huge morphological diversity of brain tumor models regarding their infiltrative and neoangiogenic capacities and further establishes MR-UM as a platform for translational neuroimaging.
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Affiliation(s)
- Michael O Breckwoldt
- Neuroradiology Department, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Julia Bode
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Krüwel
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
| | - Gergely Solecki
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) Within the DKFZ, Heidelberg, Germany
| | - Artur Hahn
- Neuroradiology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Wirthschaft
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
| | - Anna S Berghoff
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) Within the DKFZ, Heidelberg, Germany
| | - Maximilian Haas
- Neuroradiology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Varun Venkataramani
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) Within the DKFZ, Heidelberg, Germany.,Institute for Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) Within the DKFZ, Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Experimental Neurosurgery, Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Sabine Heiland
- Neuroradiology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Platten
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neurology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Bendszus
- Neuroradiology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix T Kurz
- Neuroradiology Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Frank Winkler
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK) Within the DKFZ, Heidelberg, Germany.,Neurology Clinic and National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Björn Tews
- Schaller Research Group at the University of Heidelberg and the German Cancer Research Center (DKFZ), Molecular Mechanisms of Tumor Invasion, Heidelberg, Germany
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32
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Alfonso JCL, Talkenberger K, Seifert M, Klink B, Hawkins-Daarud A, Swanson KR, Hatzikirou H, Deutsch A. The biology and mathematical modelling of glioma invasion: a review. J R Soc Interface 2018; 14:rsif.2017.0490. [PMID: 29118112 DOI: 10.1098/rsif.2017.0490] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/17/2017] [Indexed: 12/13/2022] Open
Abstract
Adult gliomas are aggressive brain tumours associated with low patient survival rates and limited life expectancy. The most important hallmark of this type of tumour is its invasive behaviour, characterized by a markedly phenotypic plasticity, infiltrative tumour morphologies and the ability of malignant progression from low- to high-grade tumour types. Indeed, the widespread infiltration of healthy brain tissue by glioma cells is largely responsible for poor prognosis and the difficulty of finding curative therapies. Meanwhile, mathematical models have been established to analyse potential mechanisms of glioma invasion. In this review, we start with a brief introduction to current biological knowledge about glioma invasion, and then critically review and highlight future challenges for mathematical models of glioma invasion.
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Affiliation(s)
- J C L Alfonso
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
| | - K Talkenberger
- Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
| | - M Seifert
- Institute for Medical Informatics and Biometry, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany
| | - B Klink
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Germany.,National Center for Tumor Diseases (NCT), Dresden, Germany.,German Cancer Consortium (DKTK), partner site, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A Hawkins-Daarud
- Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, USA
| | - K R Swanson
- Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, USA
| | - H Hatzikirou
- Department of Systems Immunology and Braunschweig Integrated Centre of Systems Biology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
| | - A Deutsch
- Centre for Information Services and High Performance Computing, Technische Universität Dresden, Germany
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33
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Pope WB, Brandal G. Conventional and advanced magnetic resonance imaging in patients with high-grade glioma. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:239-253. [PMID: 29696946 DOI: 10.23736/s1824-4785.18.03086-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Magnetic resonance imaging is integral to the care of patients with high-grade gliomas. Anatomic detail can be acquired with conventional structural imaging, but newer approaches also add capabilities to interrogate image-derived physiologic and molecular characteristics of central nervous system neoplasms. These advanced imaging techniques are increasingly employed to generate biomarkers that better reflect tumor burden and therapy response. The following is an overview of current strategies based on advanced magnetic resonance imaging that are used in the assessment of high-grade glioma patients with an emphasis on how novel imaging biomarkers can potentially advance patient care.
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Affiliation(s)
- Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA -
| | - Garth Brandal
- Department of Radiological Sciences, David Geffen School of Medicine, University of California - Los Angeles, Los Angeles, CA, USA
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34
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Zhang X, Liu X, Zhou W, Yang M, Ding Y, Wang Q, Hu R. Fasudil increases temozolomide sensitivity and suppresses temozolomide-resistant glioma growth via inhibiting ROCK2/ABCG2. Cell Death Dis 2018; 9:190. [PMID: 29416017 PMCID: PMC5833824 DOI: 10.1038/s41419-017-0251-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/30/2017] [Accepted: 12/05/2017] [Indexed: 12/11/2022]
Abstract
Resistance to temozolomide (TMZ) is a major clinical challenge in glioma treatment, but the mechanisms of TMZ resistance are poorly understood. Here, we provided evidence that ROCK2 acted redundantly to maintain resistance of TMZ in TMZ-resistant gliomas, and as a ROCK2 phosphorylation inhibitor, fasudil significantly suppressed proliferation of TMZ-resistant gliomas in vivo and vitro via enhancing the chemosensitivity of TMZ. Additionally, the membrane translocation of ABCG2 was decreased with fasudil by ROCK2/moesin pathway. We also showed that fasudil suppressed the expression of ABCG2 via ROCK2/moesin/β-catenin pathway. Our results reveal an indispensable role for ROCK2 and provide strong evidence for the therapeutic use of fasudil in the clinical setting for TMZ-resistant gliomas.
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Affiliation(s)
- Xin Zhang
- State Key Laboratory of Natural Medicines, Department of Physiology, China Pharmaceutical University, Nanjing, Jiangsu, 210009, China
| | - Xiuting Liu
- State Key Laboratory of Natural Medicines, Department of Physiology, China Pharmaceutical University, Nanjing, Jiangsu, 210009, China
| | - Wei Zhou
- State Key Laboratory of Natural Medicines, Department of Physiology, China Pharmaceutical University, Nanjing, Jiangsu, 210009, China
| | - Mengdi Yang
- State Key Laboratory of Natural Medicines, Department of Physiology, China Pharmaceutical University, Nanjing, Jiangsu, 210009, China
| | - Yang Ding
- State Key Laboratory of Natural Medicines, Department of Physiology, China Pharmaceutical University, Nanjing, Jiangsu, 210009, China
| | - Qing Wang
- Department of Neurosurgery, Wuxi Second Hospital Affiliated Nanjing Medical University, Wuxi, Jiangsu, 214002, China.
| | - Rong Hu
- State Key Laboratory of Natural Medicines, Department of Physiology, China Pharmaceutical University, Nanjing, Jiangsu, 210009, China.
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Suh CH, Kim HS, Jung SC, Choi CG, Kim SJ. Multiparametric MRI as a potential surrogate endpoint for decision-making in early treatment response following concurrent chemoradiotherapy in patients with newly diagnosed glioblastoma: a systematic review and meta-analysis. Eur Radiol 2018; 28:2628-2638. [PMID: 29374321 DOI: 10.1007/s00330-017-5262-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/09/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the value of multiparametric MRI for determination of early treatment response following concurrent chemoradiotherapy in patients with newly diagnosed glioblastoma. METHODS A computerized search of Ovid-MEDLINE and EMBASE up to 1 October 2017 was performed to find studies on the diagnostic performance of multiparametric MRI for differentiating true progression from pseudoprogression. The beginning search date was not specified. Pooled estimates of sensitivity and specificity were obtained using hierarchical logistic regression modeling. We performed meta-regression and sensitivity analyses to explain the effects of the study heterogeneity. RESULTS Nine studies including 456 patients were included. Pooled sensitivity and specificity were 84 % (95 % CI 74-91) and 95 % (95 % CI 83-99), respectively. Area under the hierarchical summary receiver operating characteristic curve was 0.95 (95 % CI 0.92-0.96). Meta-regression showed true progression in the study population, the mean age and the reference standard were significant factors affecting heterogeneity. CONCLUSION Multiparametric MRI may be used as a potential surrogate endpoint for assessment of early treatment response, especially in the differentiation of true progression from pseudoprogression. However, based on the current evidence, monoparametric and multiparametric MRI perform equally in the clinical context. Further evaluation will be needed. KEY POINTS • Multiparametric MRI shows high diagnostic performance for early treatment response in glioblastoma. • Multiparametric MRI could differentiate true progression from pseudoprogression in newly diagnosed glioblastoma. • The normalized rCBV derived from DSC was the most commonly used parameter.
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
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Cai X, Sughrue ME. Glioblastoma: new therapeutic strategies to address cellular and genomic complexity. Oncotarget 2017; 9:9540-9554. [PMID: 29507709 PMCID: PMC5823664 DOI: 10.18632/oncotarget.23476] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/08/2017] [Indexed: 01/19/2023] Open
Abstract
Glioblastoma (GBM) is the most invasive and devastating primary brain tumor with a median overall survival rate about 18 months with aggressive multimodality therapy. Its unique characteristics of heterogeneity, invasion, clonal populations maintaining stem cell-like cells and recurrence, have limited responses to a variety of therapeutic approaches, and have made GBM the most difficult brain cancer to treat. A great effort and progress has been made to reveal promising molecular mechanisms to target therapeutically. Especially with the emerging of new technologies, the mechanisms underlying the pathology of GBM are becoming more clear. The purpose of this review is to summarize the current knowledge of molecular mechanisms of GBM and highlight the novel strategies and concepts for the treatment of GBM.
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Affiliation(s)
- Xue Cai
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Michael E Sughrue
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
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Razek AAKA, El-Serougy L, Abdelsalam M, Gaballa G, Talaat M. Differentiation of residual/recurrent gliomas from postradiation necrosis with arterial spin labeling and diffusion tensor magnetic resonance imaging-derived metrics. Neuroradiology 2017; 60:169-177. [PMID: 29218370 DOI: 10.1007/s00234-017-1955-3] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/27/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim of this study is to differentiate recurrent/residual gliomas from postradiation changes using arterial spin labeling (ASL) perfusion and diffusion tensor imaging (DTI)-derived metrics. METHODS Prospective study was conducted upon 42 patients with high-grade gliomas after radiotherapy only or prior to other therapies that underwent routine MR imaging, ASL, and DTI. The tumor blood flow (TBF), fractional anisotropy (FA), and mean diffusivity (MD) of the enhanced lesion and related edema were calculated. The lesion was categorized as recurrence/residual or postradiation changes. RESULTS There was significant differences between residual/recurrent gliomas and postradiation changes of TBF (P = 0.001), FA (P = 0.001 and 0.04), and MD (P = 0.001) of enhanced lesion and related edema respectively. The area under the curve (AUC) of TBF of enhanced lesion and related edema used to differentiate residual/recurrent gliomas from postradiation changes were 0.95 and 0.93 and of MD were 0.95 and 0.81 and of FA were 0.81 and 0.695, respectively. Combined ASL and DTI metrics of the enhanced lesion revealed AUC of 0.98, accuracy of 95%, sensitivity of 93.8%, specificity of 95.8%, positive predictive value (PPV) of 93.8%, and negative predictive value (NPV) of 95.8%. Combined metrics of ASL and DTI of related edema revealed AUC of 0.97, accuracy of 92.5%, sensitivity of 93.8%, specificity of 91.7%, PPV of 88.2%, and NPV of 95.7. CONCLUSION Combined ASL and DTI metrics of enhanced lesion and related edema are valuable noninvasive tools in differentiating residual/recurrent gliomas from postradiation changes.
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Affiliation(s)
| | - Lamiaa El-Serougy
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt
| | | | - Gada Gaballa
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt
| | - Mona Talaat
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, 13551, Egypt
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Xiong YJ, Zhao XL, Wang XY, Pan DJ, Tian DS. Multiple cerebral gliomas mimicking central nervous system inflammatory demyelinating diseases: A rare case with review of literature. Medicine (Baltimore) 2017; 96:e9456. [PMID: 29384930 PMCID: PMC6392929 DOI: 10.1097/md.0000000000009456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Multiple cerebral gliomas (MCGs), usually classified into multifocal and multicentric subtypes, represent major diagnostic challenges as their clinical, radiologic, and pathohistological features are not uniform, often mimicking brain metastatic tumors or central nervous system inflammatory demyelinating diseases (IDD). PATIENT CONCERNS Here, we report a rare case of MCGs with isolated seizures and 4 lesions in the brain, that was initially misdiagnosed as IDD during treatment. DIAGNOSIS The pathological diagnosis was astrocytoma, which was classified as a World Health Organization grade II glioma. INTERVENTIONS The patient was treated with dexamethasone and sodium valproate when he was misdiagnosed as having IDD. After the pathological diagnosis was obtained, he was treated with temozolomide and radiotherapy. OUTCOMES Three months after the above treatment, the health of the patient had improved; he was asymptomatic, and presented with better radiological manifestations. LESSONS Diagnostic imaging is valuable in differential diagnosis. Magnetic resonance spectroscopy is a promising technique for the assessment and characterization of lesions, though its role in definitive diagnosis is not yet defined. Brain tissue biopsy remains the golden standard for definitive diagnosis. In China, for various reasons, craniotomy biopsy is not performed routinely in patients with multiple intracranial lesions, and stereotactic cranial biopsy may be a more viable option because of its safety and cost-effectiveness. In summary, this case demonstrates that MCGs need to be included in the differential diagnosis of unknown intracranial multiple lesions.
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Affiliation(s)
| | | | - Xiao-Yan Wang
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Xie T, Chen X, Fang J, Kang H, Xue W, Tong H, Cao P, Wang S, Yang Y, Zhang W. Textural features of dynamic contrast-enhanced MRI derived model-free and model-based parameter maps in glioma grading. J Magn Reson Imaging 2017; 47:1099-1111. [PMID: 28845594 DOI: 10.1002/jmri.25835] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/25/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Presurgical glioma grading by dynamic contrast-enhanced MRI (DCE-MRI) has unresolved issues. PURPOSE The aim of this study was to investigate the ability of textural features derived from pharmacokinetic model-based or model-free parameter maps of DCE-MRI in discriminating between different grades of gliomas, and their correlation with pathological index. STUDY TYPE Retrospective. SUBJECTS Forty-two adults with brain gliomas. FIELD STRENGTH/SEQUENCE 3.0T, including conventional anatomic sequences and DCE-MRI sequences (variable flip angle T1-weighted imaging and three-dimensional gradient echo volumetric imaging). ASSESSMENT Regions of interest on the cross-sectional images with maximal tumor lesion. Five commonly used textural features, including Energy, Entropy, Inertia, Correlation, and Inverse Difference Moment (IDM), were generated. RESULTS All textural features of model-free parameters (initial area under curve [IAUC], maximal signal intensity [Max SI], maximal up-slope [Max Slope]) could effectively differentiate between grade II (n = 15), grade III (n = 13), and grade IV (n = 14) gliomas (P < 0.05). Two textural features, Entropy and IDM, of four DCE-MRI parameters, including Max SI, Max Slope (model-free parameters), vp (Extended Tofts), and vp (Patlak) could differentiate grade III and IV gliomas (P < 0.01) in four measurements. Both Entropy and IDM of Patlak-based Ktrans and vp could differentiate grade II (n = 15) from III (n = 13) gliomas (P < 0.01) in four measurements. No textural features of any DCE-MRI parameter maps could discriminate between subtypes of grade II and III gliomas (P < 0.05). Both Entropy and IDM of Extended Tofts- and Patlak-based vp showed highest area under curve in discriminating between grade III and IV gliomas. However, intraclass correlation coefficient (ICC) of these features revealed relatively lower inter-observer agreement. No significant correlation was found between microvascular density and textural features, compared with a moderate correlation found between cellular proliferation index and those features. DATA CONCLUSION Textural features of DCE-MRI parameter maps displayed a good ability in glioma grading. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1099-1111.
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Affiliation(s)
- Tian Xie
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Xiao Chen
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Jingqin Fang
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Houyi Kang
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Wei Xue
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Haipeng Tong
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Peng Cao
- GE HealthCare (China), Pudong, Shanghai, China
| | - Sumei Wang
- Department of Radiology, Division of Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yizeng Yang
- Department of Medicine, Gastroenterology Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Weiguo Zhang
- Department of Radiology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing, China.,Chongqing Clinical Research Center of Imaging and Nuclear Medicine, Chongqing, China
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