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Singh T, Joshi S, Kershaw LE, Dweck MR, Semple SI, Newby DE. Manganese-Enhanced Magnetic Resonance Imaging of the Heart. J Magn Reson Imaging 2023; 57:1011-1028. [PMID: 36314991 PMCID: PMC10947173 DOI: 10.1002/jmri.28499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 02/23/2023] Open
Abstract
Manganese-based contrast media were the first in vivo paramagnetic agents to be used in magnetic resonance imaging (MRI). The uniqueness of manganese lies in its biological function as a calcium channel analog, thus behaving as an intracellular contrast agent. Manganese ions are taken up by voltage-gated calcium channels in viable tissues, such as the liver, pancreas, kidneys, and heart, in response to active calcium-dependent cellular processes. Manganese-enhanced magnetic resonance imaging (MEMRI) has therefore been used as a surrogate marker for cellular calcium handling and interest in its potential clinical applications has recently re-emerged, especially in relation to assessing cellular viability and myocardial function. Calcium homeostasis is central to myocardial contraction and dysfunction of myocardial calcium handling is present in various cardiac pathologies. Recent studies have demonstrated that MEMRI can detect the presence of abnormal myocardial calcium handling in patients with myocardial infarction, providing clear demarcation between the infarcted and viable myocardium. Furthermore, it can provide more subtle assessments of abnormal myocardial calcium handling in patients with cardiomyopathies and being excluded from areas of nonviable cardiomyocytes and severe fibrosis. As such, MEMRI offers exciting potential to improve cardiac diagnoses and provide a noninvasive measure of myocardial function and contractility. This could be an invaluable tool for the assessment of both ischemic and nonischemic cardiomyopathies as well as providing a measure of functional myocardial recovery, an accurate prediction of disease progression and a method of monitoring treatment response. EVIDENCE LEVEL: 5: TECHNICAL EFFICACY: STAGE 5.
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Affiliation(s)
- Trisha Singh
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Shruti Joshi
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Lucy E Kershaw
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - Scott I Semple
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
| | - David E Newby
- BHF/University Centre for Cardiovascular ScienceUniversity of EdinburghUK
- Edinburgh Heart CentreRoyal Infirmary of EdinburghUK
- Edinburgh ImagingUniversity of EdinburghUK
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Salehi O, Vega EA, Kutlu OC, Lunsford K, Freeman R, Ladin K, Alarcon SV, Kazakova V, Conrad C. Poorly differentiated hepatocellular carcinoma: resection is equivalent to transplantation in patients with low liver fibrosis. HPB (Oxford) 2022; 24:1100-1109. [PMID: 34969618 DOI: 10.1016/j.hpb.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Organ allocation criteria for liver transplantation focus on tumor size and multifocality while tumor differentiation and existing liver damage are omitted. This study analyzes the impact of hepatocellular carcinoma (HCC) grade and liver fibrosis comparing resection (SX) to transplantation (LT). METHODS The National Cancer Database was queried between 2004 and 2016 for solitary HCC meeting Milan criteria undergoing SX vs LT. Two groups were created: low fibrosis (LF) vs high fibrosis (HF) and stratified by grade. Cox multivariable regression models, Kaplan-Meier survival analyses and log-rank tests were performed. RESULTS 1515 patients were identified; 780 had LT and 735 had SX. Median overall survival (mOS) was 39.7 months; LT mOS was 47.9 months vs SX mOS of 34.9 months (P < .001). Multivariate analysis revealed SX, no chemotherapy, longer hospital stays, and age to be associated with worse survival. However, while transplantation conferred survival benefit for well-moderately differentiated tumors, SX vs LT did not impact survival for poorly differentiated HCC in LF patients, independent of tumor size. DISCUSSION HCC differentiation and liver fibrosis, but not size, synergistically determine efficacy of SX vs LT. Therefore, current HCC transplantation criteria should incorporate tumor grade or liver fibrosis for optimal organ allocation.
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Affiliation(s)
- Omid Salehi
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Eduardo A Vega
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Onur C Kutlu
- Department of Surgery, University of Miami Health System, Miller School of Medicine, Miami, FL, USA
| | - Keri Lunsford
- Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Richard Freeman
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Keren Ladin
- Department of Occupational Therapy and Community Health, Tufts University, Boston, MA, USA
| | - Sylvia V Alarcon
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA
| | - Vera Kazakova
- Department of Medical Oncology, Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Harvard Medical School, Boston, MA, USA
| | - Claudius Conrad
- Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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Spath NB, Singh T, Papanastasiou G, Baker A, Janiczek RJ, McCann GP, Dweck MR, Kershaw L, Newby DE, Semple S. Assessment of stunned and viable myocardium using manganese-enhanced MRI. Open Heart 2021; 8:openhrt-2021-001646. [PMID: 34099530 PMCID: PMC8186753 DOI: 10.1136/openhrt-2021-001646] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/14/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE In a proof-of-concept study, to quantify myocardial viability in patients with acute myocardial infarction using manganese-enhanced MRI (MEMRI), a measure of intracellular calcium handling. METHODS Healthy volunteers (n=20) and patients with ST-elevation myocardial infarction (n=20) underwent late gadolinium enhancement (LGE) using gadobutrol and MEMRI using manganese dipyridoxyl diphosphate. Patients were scanned ≤7 days after reperfusion and rescanned after 3 months. Differential manganese uptake was described using a two-compartment model. RESULTS After manganese administration, healthy control and remote non-infarcted myocardium showed a sustained 25% reduction in T1 values (mean reductions, 288±34 and 281±12 ms). Infarcted myocardium demonstrated less T1 shortening than healthy control or remote myocardium (1157±74 vs 859±36 and 835±28 ms; both p<0.0001) with intermediate T1 values (1007±31 ms) in peri-infarct regions. Compared with LGE, MEMRI was more sensitive in detecting dysfunctional myocardium (dysfunctional fraction 40.5±11.9 vs 34.9%±13.9%; p=0.02) and tracked more closely with abnormal wall motion (r2=0.72 vs 0.55; p<0.0001). Kinetic modelling showed reduced myocardial manganese influx between remote, peri-infarct and infarct regions, enabling absolute discrimination of infarcted myocardium. After 3 months, manganese uptake increased in peri-infarct regions (16.5±3.5 vs 22.8±3.5 mL/100 g/min, p<0.0001), but not the remote (23.3±2.8 vs 23.0±3.2 mL/100 g/min, p=0.8) or infarcted (11.5±3.7 vs 14.0±1.2 mL/100 g/min, p>0.1) myocardium. CONCLUSIONS Through visualisation of intracellular calcium handling, MEMRI accurately differentiates infarcted, stunned and viable myocardium, and correlates with myocardial dysfunction better than LGE. MEMRI holds major promise in directly assessing myocardial viability, function and calcium handling across a range of cardiac diseases. TRIAL REGISTRATION NUMBERS NCT03607669; EudraCT number 2016-003782-25.
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Affiliation(s)
- Nick B Spath
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Trisha Singh
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Andrew Baker
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | | | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Lucy Kershaw
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - David E Newby
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Scott Semple
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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Spath NB, Singh T, Papanastasiou G, Kershaw L, Baker AH, Janiczek RL, Gulsin GS, Dweck MR, McCann G, Newby DE, Semple SI. Manganese-enhanced magnetic resonance imaging in dilated cardiomyopathy and hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020:jeaa273. [PMID: 33200175 DOI: 10.1093/ehjci/jeaa273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/17/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS The aim of this study is to quantify altered myocardial calcium handling in non-ischaemic cardiomyopathy using magnetic resonance imaging. METHODS AND RESULTS Patients with dilated cardiomyopathy (n = 10) or hypertrophic cardiomyopathy (n = 17) underwent both gadolinium and manganese contrast-enhanced magnetic resonance imaging and were compared with healthy volunteers (n = 20). Differential manganese uptake (Ki) was assessed using a two-compartment Patlak model. Compared with healthy volunteers, reduction in T1 with manganese-enhanced magnetic resonance imaging was lower in patients with dilated cardiomyopathy [mean reduction 257 ± 45 (21%) vs. 288 ± 34 (26%) ms, P < 0.001], with higher T1 at 40 min (948 ± 57 vs. 834 ± 28 ms, P < 0.0001). In patients with hypertrophic cardiomyopathy, reductions in T1 were less than healthy volunteers [mean reduction 251 ± 86 (18%) and 277 ± 34 (23%) vs. 288 ± 34 (26%) ms, with and without fibrosis respectively, P < 0.001]. Myocardial manganese uptake was modelled, rate of uptake was reduced in both dilated and hypertrophic cardiomyopathy in comparison with healthy volunteers (mean Ki 19 ± 4, 19 ± 3, and 23 ± 4 mL/100 g/min, respectively; P = 0.0068). In patients with dilated cardiomyopathy, manganese uptake rate correlated with left ventricular ejection fraction (r2 = 0.61, P = 0.009). Rate of myocardial manganese uptake demonstrated stepwise reductions across healthy myocardium, hypertrophic cardiomyopathy without fibrosis and hypertrophic cardiomyopathy with fibrosis providing absolute discrimination between the healthy myocardium and fibrosed myocardium (mean Ki 23 ± 4, 19 ± 3, and 13 ± 4 mL/100 g/min, respectively; P < 0.0001). CONCLUSION The rate of manganese uptake in both dilated and hypertrophic cardiomyopathy provides a measure of altered myocardial calcium handling. This holds major promise for the detection and monitoring of dysfunctional myocardium, with the potential for early intervention and prognostication.
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Affiliation(s)
- N B Spath
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - T Singh
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - G Papanastasiou
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - L Kershaw
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - A H Baker
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
| | - R L Janiczek
- Department of Clinical Imaging, GlaxoSmithKline, Gunnels Wood Road, Stevenage, Hertfordshire, SG1 2NY, UK
| | - G S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - M R Dweck
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - G McCann
- Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, LE3 9QP, UK
| | - D E Newby
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - S I Semple
- BHF/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, EH16 4SA, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, EH16 4TJ, UK
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Suto DJ, Nair G, Sudarshana DM, Steele SU, Dwyer J, Beck ES, Ohayon J, McFarland H, Koretsky AP, Cortese ICM, Reich DS. Manganese-Enhanced MRI in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2020; 41:1569-1576. [PMID: 32763897 DOI: 10.3174/ajnr.a6665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/31/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Cellular uptake of the manganese ion, when administered as a contrast agent for MR imaging, can noninvasively highlight cellular activity and disease processes in both animals and humans. The purpose of this study was to explore the enhancement profile of manganese in patients with multiple sclerosis. MATERIALS AND METHODS Mangafodipir is a manganese chelate that was clinically approved for MR imaging of liver lesions. We present a case series of 6 adults with multiple sclerosis who were scanned at baseline with gadolinium, then injected with mangafodipir, and followed at variable time points thereafter. RESULTS Fourteen new lesions formed during or shortly before the study, of which 10 demonstrated manganese enhancement of varying intensity, timing, and spatial pattern. One gadolinium-enhancing extra-axial mass, presumably a meningioma, also demonstrated enhancement with manganese. Most interesting, manganese enhancement was detected in lesions that formed in the days after mangafodipir injection, and this enhancement persisted for several weeks, consistent with contrast coming from intracellular uptake of manganese. Some lesions demonstrated a diffuse pattern of manganese enhancement in an area larger than that of both gadolinium enhancement and T2-FLAIR signal abnormality. CONCLUSIONS This work demonstrates the first use of a manganese-based contrast agent to enhance MS lesions on MR imaging. Multiple sclerosis lesions were enhanced with a temporal and spatial profile distinct from that of gadolinium. Further experiments are necessary to uncover the mechanism of manganese contrast enhancement as well as cell-specific uptake.
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Affiliation(s)
- D J Suto
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - G Nair
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D M Sudarshana
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - S U Steele
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - J Dwyer
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - E S Beck
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - J Ohayon
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - H McFarland
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - A P Koretsky
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - I C M Cortese
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - D S Reich
- From the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland.
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Spath NB, Thompson G, Baker AH, Dweck MR, Newby DE, Semple SIK. Manganese-enhanced MRI of the myocardium. Heart 2019; 105:1695-1700. [PMID: 31337670 PMCID: PMC6855794 DOI: 10.1136/heartjnl-2019-315227] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 01/12/2023] Open
Abstract
Gadolinium-based contrast media are widely used in cardiovascular MRI to identify and to highlight the intravascular and extracellular space. After gadolinium, manganese has the second highest paramagnetic moment and was one of the first MRI contrast agents assessed in humans. Over the last 50 years, manganese-enhanced MRI (MEMRI) has emerged as a complementary approach enabling intracellular myocardial contrast imaging that can identify functional myocardium through its ability to act as a calcium analogue. Early progress was limited by its potential to cause myocardial depression. To overcome this problem, two clinical formulations of manganese were developed using either chelation (manganese dipyridoxyl diphosphate) or coadministration with a calcium compound (EVP1001-1, Eagle Vision Pharmaceuticals). Preclinical studies have demonstrated the efficacy of MEMRI in quantifying myocardial infarction and detecting myocardial viability as well as tracking altered contractility and calcium handling in cardiomyopathy. Recent clinical data suggest that MEMRI has exciting potential in the quantification of myocardial viability in ischaemic cardiomyopathy, the early detection of abnormalities in myocardial calcium handling, and ultimately, in the development of novel therapies for myocardial infarction or heart failure by actively quantifying viable myocardium. The stage is now set for wider clinical translational study of this novel and promising non-invasive imaging modality.
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Affiliation(s)
- Nick B Spath
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Gerard Thompson
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Andrew H Baker
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Scott I K Semple
- BHF/University Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Imaging, University of Edinburgh, Edinburgh, UK
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Deng W, Faiq MA, Liu C, Adi V, Chan KC. Applications of Manganese-Enhanced Magnetic Resonance Imaging in Ophthalmology and Visual Neuroscience. Front Neural Circuits 2019; 13:35. [PMID: 31156399 PMCID: PMC6530364 DOI: 10.3389/fncir.2019.00035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 04/26/2019] [Indexed: 12/21/2022] Open
Abstract
Understanding the mechanisms of vision in health and disease requires knowledge of the anatomy and physiology of the eye and the neural pathways relevant to visual perception. As such, development of imaging techniques for the visual system is crucial for unveiling the neural basis of visual function or impairment. Magnetic resonance imaging (MRI) offers non-invasive probing of the structure and function of the neural circuits without depth limitation, and can help identify abnormalities in brain tissues in vivo. Among the advanced MRI techniques, manganese-enhanced MRI (MEMRI) involves the use of active manganese contrast agents that positively enhance brain tissue signals in T1-weighted imaging with respect to the levels of connectivity and activity. Depending on the routes of administration, accumulation of manganese ions in the eye and the visual pathways can be attributed to systemic distribution or their local transport across axons in an anterograde fashion, entering the neurons through voltage-gated calcium channels. The use of the paramagnetic manganese contrast in MRI has a wide range of applications in the visual system from imaging neurodevelopment to assessing and monitoring neurodegeneration, neuroplasticity, neuroprotection, and neuroregeneration. In this review, we present four major domains of scientific inquiry where MEMRI can be put to imperative use — deciphering neuroarchitecture, tracing neuronal tracts, detecting neuronal activity, and identifying or differentiating glial activity. We deliberate upon each category studies that have successfully employed MEMRI to examine the visual system, including the delivery protocols, spatiotemporal characteristics, and biophysical interpretation. Based on this literature, we have identified some critical challenges in the field in terms of toxicity, and sensitivity and specificity of manganese enhancement. We also discuss the pitfalls and alternatives of MEMRI which will provide new avenues to explore in the future.
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Affiliation(s)
- Wenyu Deng
- NYU Langone Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY, United States
| | - Muneeb A Faiq
- NYU Langone Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY, United States
| | - Crystal Liu
- NYU Langone Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY, United States
| | - Vishnu Adi
- NYU Langone Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY, United States
| | - Kevin C Chan
- NYU Langone Eye Center, Department of Ophthalmology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY, United States.,Department of Radiology, NYU School of Medicine, NYU Langone Health, New York University, New York, NY, United States.,Center for Neural Science, Faculty of Arts and Science, New York University, New York, NY, United States
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Han JH, Kim DG, Na GH, Kim EY, Lee SH, Hong TH, You YK. Evaluation of prognostic factors on recurrence after curative resections for hepatocellular carcinoma. World J Gastroenterol 2014; 20:17132-17140. [PMID: 25493027 PMCID: PMC4258583 DOI: 10.3748/wjg.v20.i45.17132] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/16/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To select appropriate patients before surgical resection for hepatocellular carcinoma (HCC), especially those with advanced tumors.
METHODS: From January 2000 to December 2012, we retrospectively analyzed the medical records of 298 patients who had undergone surgical resections for HCC with curative intent at our hospital. We evaluated preoperative prognostic factors associated with histologic grade of tumor, recurrence and survival, especially the findings of pre-operative imaging studies such as positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI). And then, we established a scoring system to predict recurrence and survival after surgery dividing the patients into two groups based on a tumor size of 5 cm.
RESULTS: Of the 298 patients, 129 (43.3%) developed recurrence during the follow-up period. The 5 year disease free survival and overall survival were 47.0% and 58.7% respectively. In multivariate analysis, a serum alpha-fetoprotein (AFP) level of > 100 ng/mL and a standardized uptake value (SUV) of PET-CT of > 3.5 were predictive factors for histologic grade of tumor, recurrence, and survival. Tumor size of > 5 cm and a relative enhancement ratio (RER) calculated from preoperative MRI were also significantly associated with prognosis in univariate analysis. We established a scoring system to predict prognosis using AFP, SUV, and RER. In those with tumors of > 5 cm, it showed predicted both recurrence (P = 0.005) and survival (P = 0.001).
CONCLUSION: The AFP, tumor size, SUV and RER are useful for prognosis preoperatively. An accurate prediction of prognosis is possible using our scoring system in large size tumors.
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Metronomic chemotherapy: possible clinical application in advanced hepatocellular carcinoma. Transl Oncol 2013; 6:511-9. [PMID: 24151531 DOI: 10.1593/tlo.13481] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 07/22/2013] [Accepted: 07/24/2013] [Indexed: 12/15/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a hypervascular highly angiogenic tumor usually associated with liver cirrhosis. Vascular endothelial growth factor plays a critical role in vascular development in HCC. In contrast to the treatment of early-stage HCC, the treatment options for advanced HCC are limited and prognosis is often poor, which contributes to this tumor type being the third leading cause of cancer-related deaths worldwide. Metronomic chemotherapy, which was originally designed to inhibit angiogenesis, involves low-dose chemotherapeutic agents administered in a frequent regular schedule with no prolonged breaks and minimizes severe toxicities. We reviewed the potential effects and impact of metronomic chemotherapy in preclinical studies with HCC models and in patients with advanced HCC, especially when combined with a molecular targeted agent. Metronomic chemotherapy involves multiple mechanisms that include antiangiogenesis and antivasculogenesis, immune stimulation by reducing regulatory T cells and inducing dendritic cell maturation, and possibly some direct tumor cell targeting effects, including the cancer stem cell subpopulation. The total number of preclinical studies with HCC models shows impressive results using metronomic chemotherapy-based protocols, especially in conjunction with molecular targeted agents. Four clinical trials and two case reports evaluating metronomic chemotherapy for HCC indicate it to be a safe and potentially useful treatment for HCC. Several preclinical and clinical HCC studies suggest that metronomic chemotherapy may become an alternative type of chemotherapy for advanced unresectable HCC and postsurgical adjuvant treatment of HCC.
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