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Bruschi M, Midjek L, Ajlil Y, Vairy S, Lancien M, Ghermaoui S, Kergrohen T, Verreault M, Idbaih A, de Biagi CAO, Liu I, Filbin MG, Beccaria K, Blauwblomme T, Puget S, Tauziede-Espariat A, Varlet P, Dangouloff-Ros V, Boddaert N, Le Teuff G, Grill J, Montagnac G, Elkhatib N, Debily MA, Castel D. Diffuse midline glioma invasion and metastasis rely on cell-autonomous signaling. Neuro Oncol 2024; 26:553-568. [PMID: 37702430 PMCID: PMC10912010 DOI: 10.1093/neuonc/noad161] [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: 03/21/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Diffuse midline gliomas (DMG) are pediatric tumors with negligible 2-year survival after diagnosis characterized by their ability to infiltrate the central nervous system. In the hope of controlling the local growth and slowing the disease, all patients receive radiotherapy. However, distant progression occurs frequently in DMG patients. Current clues as to what causes tumor infiltration circle mainly around the tumor microenvironment, but there are currently no known determinants to predict the degree of invasiveness. METHODS In this study, we use patient-derived glioma stem cells (GSCs) to create patient-specific 3D avatars to model interindividual invasion and elucidate the cellular supporting mechanisms. RESULTS We show that GSC models in 3D mirror the invasive behavior of the parental tumors, thus proving the ability of DMG to infiltrate as an autonomous characteristic of tumor cells. Furthermore, we distinguished 2 modes of migration, mesenchymal and ameboid-like, and associated the ameboid-like modality with GSCs derived from the most invasive tumors. Using transcriptomics of both organoids and primary tumors, we further characterized the invasive ameboid-like tumors as oligodendrocyte progenitor-like, with highly contractile cytoskeleton and reduced adhesion ability driven by crucial over-expression of bone morphogenetic pathway 7 (BMP7). Finally, we deciphered MEK, ERK, and Rho/ROCK kinases activated downstream of the BMP7 stimulation as actionable targets controlling tumor cell motility. CONCLUSIONS Our findings identify 2 new therapeutic avenues. First, patient-derived GSCs represent a predictive tool for patient stratification in order to adapt irradiation strategies. Second, autocrine and short-range BMP7-related signaling becomes a druggable target to prevent DMG spread and metastasis.
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Affiliation(s)
- Marco Bruschi
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Lilia Midjek
- Inserm U1279, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Yassine Ajlil
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Stephanie Vairy
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Manon Lancien
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Samia Ghermaoui
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Thomas Kergrohen
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Maite Verreault
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, DMU Neurosciences, Service de Neurologie 2-Mazarin, Paris, France
| | - Ahmed Idbaih
- Sorbonne Université, AP-HP, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, DMU Neurosciences, Service de Neurologie 2-Mazarin, Paris, France
| | - Carlos Alberto Oliveira de Biagi
- Department of Pediatric Oncology, Dana-Farber Boston Children’s Cancer and Blood Disorders Center, Boston, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - Ilon Liu
- Department of Pediatric Oncology, Dana-Farber Boston Children’s Cancer and Blood Disorders Center, Boston, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - Mariella G Filbin
- Department of Pediatric Oncology, Dana-Farber Boston Children’s Cancer and Blood Disorders Center, Boston, USA
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - Kevin Beccaria
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Thomas Blauwblomme
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Stephanie Puget
- Department of Pediatric Neurosurgery, Necker Enfants Malades Hospital, APHP, Université Paris Cité, Paris, France
| | - Arnault Tauziede-Espariat
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, ParisFrance
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR 1266, INSERM, IMA-BRAIN, Université de Paris, Paris, France
| | - Pascale Varlet
- Department of Neuropathology, GHU Paris-Psychiatrie et Neurosciences, Sainte-Anne Hospital, ParisFrance
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR 1266, INSERM, IMA-BRAIN, Université de Paris, Paris, France
| | - Volodia Dangouloff-Ros
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, ParisFrance
| | - Nathalie Boddaert
- Paediatric Radiology Department, AP-HP, Hôpital Necker Enfants Malades, Université Paris Cité, Institut Imagine INSERM U1163, ParisFrance
| | - Gwenael Le Teuff
- Department of Biostatistics and Epidemiology, Gustave Roussy and Paris-Saclay University, Villejuif, France
| | - Jacques Grill
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Département de Cancérologie de l’Enfant et de l’Adolescent, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Guillaume Montagnac
- Inserm U1279, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Nadia Elkhatib
- Inserm U1279, Gustave Roussy Institute, Université Paris-Saclay, Villejuif, France
| | - Marie-Anne Debily
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Département de Biologie, Université Evry Paris-Saclay, Evry, France
| | - David Castel
- Inserm U981, Molecular Predictors and New Targets in Oncology, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy, Université Paris-Saclay, Villejuif, France
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2
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Yang ZC, Yin CD, Yeh FC, Xue BW, Song XY, Li G, Deng ZH, Sun SJ, Hou ZG, Xie J. A preliminary study on corticospinal tract morphology in incidental and symptomatic insular low-grade glioma: implications for post-surgical motor outcomes. Neuroimage Clin 2023; 40:103521. [PMID: 37857233 PMCID: PMC10598056 DOI: 10.1016/j.nicl.2023.103521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/11/2023] [Accepted: 09/30/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Our study aimed to investigate the shape and diffusion properties of the corticospinal tract (CST) in patients with insular incidental and symptomatic low-grade gliomas (LGGs), especially those in the incidental group, and evaluate their association with post-surgical motor function. METHODS We performed automatic fiber tracking on 41 LGG patients, comparing macroscopic shape and microscopic diffusion properties of CST between ipsilateral and contralateral tracts in both incidental and symptomatic groups. A correlation analysis was conducted between properties of CST and post-operative motor strength grades. RESULTS In the incidental group, no significant differences in mean diffusion properties were found between bilateral CST. While decreased anisotropy of the CST around the superior limiting sulcus and increased axial diffusivity of the CST near the midbrain level were noted, there was no significant correlation between pre-operative diffusion metrics and post-operative motor strength. In comparison, we found significant correlations between the elongation of the affected CST in the preoperative scans and post-operative motor strength in short-term and long-term follow ups (p = 1.810 × 10-4 and p = 9.560 × 10-4, respectively). CONCLUSIONS We found a significant correlation between CST shape measures and post-operative motor function outcomes in patients with incidental insular LGGs. CST morphology shows promise as a potential prognostic factor for identifying functional deficits in this patient population.
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Affiliation(s)
- Zuo-Cheng Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuan-Dong Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bo-Wen Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin-Yu Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Gen Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zheng-Hai Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Sheng-Jun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zong-Gang Hou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Jian Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Su X, Liu Y, Wang H, Chen N, Sun H, Yang X, Wang W, Zhang S, Wan X, Tan Q, Yue Q, Gong Q. Multimodal MR imaging signatures to identify brain diffuse midline gliomas with H3 K27M mutation. Cancer Med 2021; 11:1048-1058. [PMID: 34953060 PMCID: PMC8855915 DOI: 10.1002/cam4.4500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/05/2021] [Accepted: 11/28/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xiaorui Su
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Huaxi Glioma Center West China Hospital of Sichuan University Chengdu China
- Research Unit of Psychoradiology Chinese Academy of Medical Sciences Chengdu China
| | - Yanhui Liu
- Huaxi Glioma Center West China Hospital of Sichuan University Chengdu China
- Department of Neurosurgery West China Hospital of Sichuan University Chengdu China
| | - Haoyu Wang
- Huaxi Glioma Center West China Hospital of Sichuan University Chengdu China
- Department of Neurosurgery West China Hospital of Sichuan University Chengdu China
| | - Ni Chen
- Huaxi Glioma Center West China Hospital of Sichuan University Chengdu China
- Department of Pathology West China Hospital of Sichuan University Chengdu China
| | - Huaiqiang Sun
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province Chengdu China
| | - Xibiao Yang
- Department of Radiology West China Hospital of Sichuan University Chengdu China
| | - Weina Wang
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Department of Radiology The First Affiliated Hospital College of Medicine Zhejiang University Hangzhou Zhejiang China
| | - Simin Zhang
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province Chengdu China
| | - Xinyue Wan
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Research Unit of Psychoradiology Chinese Academy of Medical Sciences Chengdu China
| | - Qiaoyue Tan
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Department of Radiotherapy West China Hospital of Sichuan University Chengdu China
| | - Qiang Yue
- Huaxi Glioma Center West China Hospital of Sichuan University Chengdu China
- Research Unit of Psychoradiology Chinese Academy of Medical Sciences Chengdu China
- Department of Radiology West China Hospital of Sichuan University Chengdu China
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC) Department of Radiology West China Hospital of Sichuan University Chengdu China
- Research Unit of Psychoradiology Chinese Academy of Medical Sciences Chengdu China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province Chengdu China
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Halawani AM, Tohyama S, Hung PSP, Behan B, Bernstein M, Kalia S, Zadeh G, Cusimano M, Schwartz M, Gentili F, Mikulis DJ, Laperriere NJ, Hodaie M. Correlation between Cranial Nerve Microstructural Characteristics and Vestibular Schwannoma Tumor Volume. AJNR. AMERICAN JOURNAL OF NEURORADIOLOGY 2021; 42:1853-1858. [PMID: 34615646 DOI: 10.3174/ajnr.a7257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 05/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Vestibular schwannomas are common cerebellopontine angle tumors arising from the vestibulocochlear nerve and can result in cranial nerve dysfunction. Conventional MR imaging does not provide information that could correlate with cranial nerve compression symptoms of hearing loss or imbalance. We used multitensor tractography to evaluate the relationship between the WM microstructural properties of cranial nerves and tumor volume in a cohort of patients with vestibular schwannomas. MATERIALS AND METHODS A retrospective study was performed in 258 patients with vestibular schwannomas treated at the Gamma Knife clinic at Toronto Western Hospital between 2014 and 2018. 3T MR images were analyzed in 160 surgically naïve patients with unilateral vestibular schwannomas. Multitensor tractography was used to extract DTI-derived metrics (fractional anisotropy and radial, axial, and mean diffusivities of the bilateral facial and vestibulocochlear nerves [cranial nerves VII/VIII]). ROIs were placed in the transition between cisternal and intracanalicular segments, and images were analyzed using the eXtended Streamline Tractography reconstruction method. Diffusion metrics were correlated with 3D tumor volume derived from the Gamma Knife clinic. RESULTS DTI analyses revealed significantly higher fractional anisotropy values and a reduction in axial diffusivity, radial diffusivity, and mean diffusivity (all P < .001) within the affected cranial nerves VII and VIII compared with unaffected side. All specific diffusivities (axial, radial, and mean diffusivity) demonstrated an inverse correlation with tumor volume (axial, radial, and mean diffusivity, P < .01). CONCLUSIONS Multitensor tractography allows the quantification of cranial nerve VII and VIII WM microstructural alterations in patients with vestibular schwannomas. Our findings support the hypothesis that tumor volume may cause microstructural alterations of the affected cranial nerves VII and VIII. This type of advanced imaging may represent a possible avenue to correlate diffusivities with cranial nerve function.
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Affiliation(s)
- A M Halawani
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging (A.M.H., D.J.M.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology (A.M.H., D.J.M.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - S Tohyama
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, (S.T., P.S.-P.H., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P S-P Hung
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Institute of Medical Science, (S.T., P.S.-P.H., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - B Behan
- Ontario Brain Institute (B.B.), Toronto, Ontario, Canada
| | - M Bernstein
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - S Kalia
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - G Zadeh
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,The Arthur and Sonia Labatt Brain Tumor Research Centre (G.Z.), Hospital for Sick Children, Toronto, Ontario, Canada
| | - M Cusimano
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.C.), Saint Michael's Hospital, Toronto, Ontario, Canada
| | - M Schwartz
- Division of Neurosurgery (M.S.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - F Gentili
- Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - D J Mikulis
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Department of Medical Imaging (A.M.H., D.J.M.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neuroradiology (A.M.H., D.J.M.), Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - N J Laperriere
- Department of Radiation Oncology (N.J.L.), University of Toronto, Toronto, Ontario, Canada.,Division of Radiation Oncology (N.J.L.), Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada
| | - M Hodaie
- From the Division of Brain Imaging, and Behaviour-Systems Neuroscience (A.M.H., S.T., P.S.-P.H., D.J.M., M.H.), Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada .,Institute of Medical Science, (S.T., P.S.-P.H., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Surgery (M.B., S.K., G.Z., M.C., F.G., M.H.), Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosurgery (M.B., S.K., F.G., M.H.), Krembil Neuroscience Centre, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
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Jütten K, Weninger L, Mainz V, Gauggel S, Binkofski F, Wiesmann M, Merhof D, Clusmann H, Na CH. Dissociation of structural and functional connectomic coherence in glioma patients. Sci Rep 2021; 11:16790. [PMID: 34408195 PMCID: PMC8373888 DOI: 10.1038/s41598-021-95932-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/31/2021] [Indexed: 01/21/2023] Open
Abstract
With diffuse infiltrative glioma being increasingly recognized as a systemic brain disorder, the macroscopically apparent tumor lesion is suggested to impact on cerebral functional and structural integrity beyond the apparent lesion site. We investigated resting-state functional connectivity (FC) and diffusion-MRI-based structural connectivity (SC) (comprising edge-weight (EW) and fractional anisotropy (FA)) in isodehydrogenase mutated (IDHmut) and wildtype (IDHwt) patients and healthy controls. SC and FC were determined for whole-brain and the Default-Mode Network (DMN), mean intra- and interhemispheric SC and FC were compared across groups, and partial correlations were analyzed intra- and intermodally. With interhemispheric EW being reduced in both patient groups, IDHwt patients showed FA decreases in the ipsi- and contralesional hemisphere, whereas IDHmut patients revealed FA increases in the contralesional hemisphere. Healthy controls showed strong intramodal connectivity, each within the structural and functional connectome. Patients however showed a loss in structural and reductions in functional connectomic coherence, which appeared to be more pronounced in IDHwt glioma patients. Findings suggest a relative dissociation of structural and functional connectomic coherence in glioma patients at the time of diagnosis, with more structural connectomic aberrations being encountered in IDHwt glioma patients. Connectomic profiling may aid in phenotyping and monitoring prognostically differing tumor types.
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Affiliation(s)
- Kerstin Jütten
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
| | - Leon Weninger
- Imaging and Computer Vision, RWTH Aachen University, Templergraben 55, 52074, Aachen, Germany
| | - Verena Mainz
- Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstraße 19, 52074, Aachen, Germany
| | - Siegfried Gauggel
- Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstraße 19, 52074, Aachen, Germany
| | - Ferdinand Binkofski
- Division of Clinical Cognitive Sciences, RWTH Aachen University, Pauwelsstraße 17, 52074, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Dorit Merhof
- Imaging and Computer Vision, RWTH Aachen University, Templergraben 55, 52074, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
| | - Chuh-Hyoun Na
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany
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Diffusion Weighted and Diffusion Tensor MRI in Pediatric Neuroimaging Including Connectomics: Principles and Applications. Semin Pediatr Neurol 2020; 33:100797. [PMID: 32331613 DOI: 10.1016/j.spen.2020.100797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diffusion weighted MRI (DWI) including diffusion tensor imaging (DTI) are unique imaging techniques that render qualitative and quantitative information of the central nervous system white matter (WM) ultrastructure. It uses the Brownian movement of water molecules to probe tissue microstructure. It is a noninvasive method, with superb sensitivity to the differential mobility of water molecules within various components of the brain without the necessity to inject contrast agents. By sampling the 3 dimensional shape, direction and magnitude of the water diffusion, DWI/DTI generates unique tissue contrasts that can be used to study the axonal WM organization of the central nervous system. Its application allows to study the normal and anomalous brain development including connectivity, as well as a multitude of WM diseases. This article discusses/summarizes the principles of DWI/DTI and its applications in pediatric neuroscience research.
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A New Treatment Opportunity for DIPG and Diffuse Midline Gliomas: 5-ALA Augmented Irradiation, the 5aai Regimen. Brain Sci 2020; 10:brainsci10010051. [PMID: 31963414 PMCID: PMC7016657 DOI: 10.3390/brainsci10010051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/19/2022] Open
Abstract
Prognosis for diffuse intrinsic pontine glioma (DIPG) and generally for diffuse midline gliomas (DMG) has only marginally improved over the last ~40 years despite dozens of chemotherapy and other therapeutic trials. The prognosis remains invariably fatal. We present here the rationale for a planned study of adding 5-aminolevulinic acid (5-ALA) to the current irradiation of DIPG or DMG: the 5aai regimen. In a series of recent papers, oral 5-ALA was shown to enhance standard therapeutic ionizing irradiation. 5-ALA is currently used in glioblastoma surgery to enable demarcation of overt tumor margins by virtue of selective uptake of 5-ALA by neoplastic cells and selective conversion to protoporphyrin IX (PpIX), which fluoresces after excitation by 410 nm (blue) light. 5-ALA is also useful in treating glioblastomas by virtue of PpIX's transfer of energy to O2 molecules, producing a singlet oxygen that in turn oxidizes intracellular DNA, lipids, and proteins, resulting in selective malignant cell cytotoxicity. This is called photodynamic treatment (PDT). Shallow penetration of light required for PpIX excitation and resultant energy transfer to O2 and cytotoxicity results in the inaccessibility of central structures like the pons or thalamus to sufficient light. The recent demonstration that keV and MeV photons can also excite PpIX and generate singlet O2 allows for reconsideration of 5-ALA PDT for treating DMG and DIPG. 5-ALA has an eminently benign side effect profile in adults and children. A pilot study in DIPG/DMG of slow uptitration of 5-ALA prior to each standard irradiation session-the 5aai regimen-is warranted.
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Jütten K, Mainz V, Gauggel S, Patel HJ, Binkofski F, Wiesmann M, Clusmann H, Na CH. Diffusion Tensor Imaging Reveals Microstructural Heterogeneity of Normal-Appearing White Matter and Related Cognitive Dysfunction in Glioma Patients. Front Oncol 2019; 9:536. [PMID: 31293974 PMCID: PMC6606770 DOI: 10.3389/fonc.2019.00536] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
Immunohistochemical data based on isocitrate–dehydrogenase (IDH) mutation status have redefined glioma as a whole-brain disease, while occult tumor cell invasion along white matter fibers is inapparent in conventional magnetic resonance imaging (MRI). The functional and prognostic impact of focal glioma may however relate to the extent of white matter involvement. We used diffusion tensor imaging (DTI) to investigate microstructural characteristics of whole-brain normal-appearing white matter (NAWM) in relation to cognitive functions as potential surrogates for occult white matter involvement in glioma. Twenty patients (12 IDH-mutated) and 20 individually matched controls were preoperatively examined using DTI combined with a standardized neuropsychological examination. Tumor lesions including perifocal edema were masked, and fractional anisotropy (FA) as well as mean, radial, and axial diffusivity (MD, RD, and AD, respectively) of the remaining whole-brain NAWM were determined by using Tract-Based Spatial Statistics and histogram analyses. The relationship between extratumoral white matter integrity and cognitive performance was examined using partial correlation analyses controlling for age, education, and lesion volumes. In patients, mean FA and AD were decreased as compared to controls, which agrees with the notion of microstructural impairment of NAWM in glioma patients. Patients performed worse in all cognitive domains tested, and higher anisotropy and lower MD and RD values of NAWM were associated with better cognitive performance. In additional analyses, IDH-mutated and IDH-wildtype patients were compared. Patients with IDH-mutation showed higher FA, but lower MD, AD, and RD values as compared to IDH-wildtype patients, suggesting a better preserved microstructural integrity of NAWM, which may relate to a less infiltrative nature of IDH-mutated gliomas. Diffusion-based phenotyping and monitoring microstructural integrity of extratumoral whole-brain NAWM may aid in estimating occult white matter involvement and should be considered as a complementary biomarker in glioma.
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Affiliation(s)
- Kerstin Jütten
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany.,Faculty of Medicine, Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Aachen, Germany
| | - Verena Mainz
- Faculty of Medicine, Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Aachen, Germany
| | - Siegfried Gauggel
- Faculty of Medicine, Institute of Medical Psychology and Medical Sociology, RWTH Aachen University, Aachen, Germany
| | - Harshal Jayeshkumar Patel
- Division of Clinical Cognitive Sciences, RWTH Aachen University, Aachen, Germany.,Research Center Jülich GmbH, Institute of Neuroscience and Medicine (INM-4), Jülich, Germany
| | - Ferdinand Binkofski
- Division of Clinical Cognitive Sciences, RWTH Aachen University, Aachen, Germany.,Research Center Jülich GmbH, Institute of Neuroscience and Medicine (INM-4), Jülich, Germany.,Jülich Aachen Research Alliance, Translational Brain Medicine, Aachen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | - Chuh-Hyoun Na
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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Moscote-Salazar L, Padilla-Zambrano H, Garcia-Ballestas E, Agrawal A, Paez-Nova M, Pacheco-Hernandez A. Pediatric diffuse intrinsic pontine gliomas. GLIOMA 2019. [DOI: 10.4103/glioma.glioma_50_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Essayed WI, Zhang F, Unadkat P, Cosgrove GR, Golby AJ, O'Donnell LJ. White matter tractography for neurosurgical planning: A topography-based review of the current state of the art. Neuroimage Clin 2017; 15:659-672. [PMID: 28664037 PMCID: PMC5480983 DOI: 10.1016/j.nicl.2017.06.011] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 06/08/2017] [Indexed: 12/13/2022]
Abstract
We perform a review of the literature in the field of white matter tractography for neurosurgical planning, focusing on those works where tractography was correlated with clinical information such as patient outcome, clinical functional testing, or electro-cortical stimulation. We organize the review by anatomical location in the brain and by surgical procedure, including both supratentorial and infratentorial pathologies, and excluding spinal cord applications. Where possible, we discuss implications of tractography for clinical care, as well as clinically relevant technical considerations regarding the tractography methods. We find that tractography is a valuable tool in variable situations in modern neurosurgery. Our survey of recent reports demonstrates multiple potentially successful applications of white matter tractography in neurosurgery, with progress towards overcoming clinical challenges of standardization and interpretation.
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Affiliation(s)
- Walid I Essayed
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Fan Zhang
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Prashin Unadkat
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - G Rees Cosgrove
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Lauren J O'Donnell
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
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