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Al-Rubaiey S, Senger C, Bukatz J, Krantchev K, Janas A, Eitner C, Nieminen-Kelhä M, Brandenburg S, Zips D, Vajkoczy P, Acker G. Determinants of cerebral radionecrosis in animal models: A systematic review. Radiother Oncol 2024:110444. [PMID: 39067705 DOI: 10.1016/j.radonc.2024.110444] [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: 11/26/2023] [Revised: 06/13/2024] [Accepted: 07/11/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Radionecrosis is a common complication in radiation oncology, while mechanisms and risk factors have yet to be fully explored. We therefore conducted a systematic review to understand the pathogenesis and identify factors that significantly affect the development. METHODS We performed a systematic literature search based on the PRISMA guidelines using PubMed, Ovid, and Web of Science databases. The complete search strategy can be found as a preregistered protocol on PROSPERO (CRD42023361662). RESULTS We included 83 studies, most involving healthy animals (n = 72, 86.75 %). High doses of hemispherical irradiation of 30 Gy in rats and 50 Gy in mice led repeatedly to radionecrosis among different studies and set-ups. Higher dose and larger irradiated volume were associated with earlier onset. Fractionated schedules proved limited effectiveness in the prevention of radionecrosis. Distinct anatomical brain structures respond to irradiation in various ways. White matter appears to be more vulnerable than gray matter. Younger age, more evolved animal species, and genetic background were also significant factors, whereas sex was irrelevant. Only 13.25 % of the studies were performed on primary brain tumor bearing animals, no studies on brain metastases are currently available. CONCLUSION This systematic review identified various factors that significantly affect the induction of radionecrosis. The current state of research neglects the utilization of animal models of brain tumors, even though patients with brain malignancies constitute the largest group receiving brain irradiation. This latter aspect should be primarily addressed when developing an experimental radionecrosis model for translational implementation.
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Affiliation(s)
- Sanaria Al-Rubaiey
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany
| | - Jan Bukatz
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany
| | - Kiril Krantchev
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany
| | - Anastasia Janas
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1 10117, Berlin, Germany
| | - Chiara Eitner
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany
| | - Melina Nieminen-Kelhä
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany
| | - Susan Brandenburg
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany
| | - Güliz Acker
- Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 10117, Berlin, Germany; Berlin Institute of Health at Charité, Universitätsmedizin Berlin, Charitéplatz 1 10117, Berlin, Germany; Department of Radiation Oncology, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1 13353, Berlin, Germany.
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Bao Z, Zhang T, Pan T, Zhang W, Zhao S, Liu H, Nie B. Automatic method for individual parcellation of manganese-enhanced magnetic resonance imaging of rat brain. Front Neurosci 2022; 16:954237. [PMID: 35968388 PMCID: PMC9365988 DOI: 10.3389/fnins.2022.954237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
Aims To construct an automatic method for individual parcellation of manganese-enhanced magnetic resonance imaging (MEMRI) of rat brain with high accuracy, which could preserve the inherent voxel intensity and Regions of interest (ROI) morphological characteristics simultaneously. Methods and results The transformation relationship from standardized space to individual space was obtained by firstly normalizing individual image to the Paxinos space and then inversely transformed. On the other hand, all the regions defined in the atlas image were separated and resaved as binary mask images. Then, transforming the mask images into individual space via the inverse transformations and reslicing using the 4th B-spline interpolation algorithm. The boundary of these transformed regions was further refined by image erosion and expansion operator, and finally combined together to generate the individual parcellations. Moreover, two groups of MEMRI images were used for evaluation. We found that the individual parcellations were satisfied, and the inherent image intensity was preserved. The statistical significance of case-control comparisons was further optimized. Conclusions We have constructed a new automatic method for individual parcellation of rat brain MEMRI images, which could preserve the inherent voxel intensity and further be beneficial in case-control statistical analyses. This method could also be extended to other imaging modalities, even other experiments species. It would facilitate the accuracy and significance of ROI-based imaging analyses.
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Affiliation(s)
- Zhiguo Bao
- First Affiliated Hospital of Henan University, Kaifeng, China
| | - Tianhao Zhang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Tingting Pan
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- Physical Science and Technology College, Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Shilun Zhao
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Hua Liu
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
| | - Binbin Nie
- Beijing Engineering Research Center of Radiographic Techniques and Equipment, Institute of High Energy Physics, Chinese Academy of Sciences, Beijing, China
- School of Nuclear Science and Technology, University of Chinese Academy of Sciences, Beijing, China
- *Correspondence: Binbin Nie
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Evaluation of Temozolomide Treatment for Glioblastoma Using Amide Proton Transfer Imaging and Diffusion MRI. Cancers (Basel) 2022; 14:cancers14081907. [PMID: 35454814 PMCID: PMC9031574 DOI: 10.3390/cancers14081907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/06/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary Glioblastoma (GBM), the most frequent and malignant histological type of glioma, is associated with a very high mortality rate. MRI is a useful method for the evaluation of tumor growth. However, there are few studies that have quantitatively evaluated the changes in disease state after TMZ treatment against GBM, and it is not fully understood how the effects of treatment are reflected in the quantitative values measured on MRI. We used the C6 glioma rat model to evaluate the tumor changes due to chemotherapy at different doses of TMZ in terms of quantitative values measured by neurite orientation dispersion and density imaging (NODDI) and amide proton transfer (APT) imaging using 7T-MRI. These methods can evaluate the microstructural changes caused by TMZ-induced tumor growth inhibition. Abstract This study aimed to evaluate tumor changes due to chemotherapy with temozolomide (TMZ) in terms of quantitative values measured by APT imaging and NODDI. We performed TMZ treatment (administered orally by gavage to the TMZ-40 mg and TMZ-60 mg groups) on 7-week-old male Wistar rats with rat glioma C6 implanted in the right brain. T2WI, APT imaging, diffusion tensor imaging (DTI), and NODDI were performed on days 7 and 14 after implantation using 7T-MRI, and the calculated quantitative values were statistically compared. Then, HE staining was performed on brain tissue at day 7 and day 14 for each group to compare the results with the MR images. TMZ treatment inhibited tumor growth and necrotic area formation. The necrotic areas observed upon hematoxylin and eosin (HE) staining were consistent with the MTR low-signal areas observed upon APT imaging. The intracellular volume fraction (ICVF) map of the NODDI could best show the microstructure of the tumor, and its value could significantly highlight the difference in treatment effects at different TMZ doses. APT imaging and NODDI can be used to detect the microstructural changes caused by TMZ-induced tumor growth inhibition. The ICVF may be useful as a parameter for determining the effect of TMZ.
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Molecular Imaging of Brain Tumors and Drug Delivery Using CEST MRI: Promises and Challenges. Pharmaceutics 2022; 14:pharmaceutics14020451. [PMID: 35214183 PMCID: PMC8880023 DOI: 10.3390/pharmaceutics14020451] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) detects molecules in their natural forms in a sensitive and non-invasive manner. This makes it a robust approach to assess brain tumors and related molecular alterations using endogenous molecules, such as proteins/peptides, and drugs approved for clinical use. In this review, we will discuss the promises of CEST MRI in the identification of tumors, tumor grading, detecting molecular alterations related to isocitrate dehydrogenase (IDH) and O-6-methylguanine-DNA methyltransferase (MGMT), assessment of treatment effects, and using multiple contrasts of CEST to develop theranostic approaches for cancer treatments. Promising applications include (i) using the CEST contrast of amide protons of proteins/peptides to detect brain tumors, such as glioblastoma multiforme (GBM) and low-grade gliomas; (ii) using multiple CEST contrasts for tumor stratification, and (iii) evaluation of the efficacy of drug delivery without the need of metallic or radioactive labels. These promising applications have raised enthusiasm, however, the use of CEST MRI is not trivial. CEST contrast depends on the pulse sequences, saturation parameters, methods used to analyze the CEST spectrum (i.e., Z-spectrum), and, importantly, how to interpret changes in CEST contrast and related molecular alterations in the brain. Emerging pulse sequence designs and data analysis approaches, including those assisted with deep learning, have enhanced the capability of CEST MRI in detecting molecules in brain tumors. CEST has become a specific marker for tumor grading and has the potential for prognosis and theranostics in brain tumors. With increasing understanding of the technical aspects and associated molecular alterations detected by CEST MRI, this young field is expected to have wide clinical applications in the near future.
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Song Q, Chen P, Chen X, Sun C, Wang J, Tan B, Liu H, Cheng Y. Dynamic Change of Amide Proton Transfer Imaging in Irradiated Nasopharyngeal Carcinoma and Related Histopathological Mechanism. Mol Imaging Biol 2021; 23:846-853. [PMID: 33876335 DOI: 10.1007/s11307-021-01607-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate the dynamic change of amide proton transfer (APT) imaging before and after irradiation in nasopharyngeal carcinoma (NPC) and the underlying histopathological mechanism. MATERIALS AND METHODS Tumor-bearing BALB/C nude mouse models were established and randomly divided into three groups: high-dose group (20 Gy/2 fractions), low-dose group (10 Gy/2 fractions), and control group (0 Gy). MRI scanning was performed before irradiation and 3rd, 6th, and 9th day post-irradiation. Scanning sequence included T1 weighted, T2 weighted, and APT. HE staining and TUNEL immunofluorescence detection were performed to detect necrosis and apoptosis. RESULTS After high-dose irradiation, the mean tumor APT values decreased significantly on the 3rd day and 6th day (from 3.83 before radiotherapy to 2.41%, P < 0.001, 3rd day; from 2.41 to 1.80%, P = 0.001, 6th day). For low-dose irradiation, the mean tumor APT values decreased slightly on the 3rd day and 6th day (from 3.52 to 3.13%, P = 0.109, 3rd day; from 3.13 to 3.05%, P = 0.64, 6th day). The mean APT values of nonirradiated tumor changed slightly. In contrast, the average volume of high-dose irradiated tumors did not decrease obviously until the 9th day post-irradiation (from 290 before radiotherapy to 208 mm3 on the 9th day). The low-dose irradiated tumors showed slow growth, and the nonirradiated tumors showed rapid growth. Subsequent HE staining and TUNEL staining showed obvious necrosis characteristics and higher proportion of positive apoptotic cell nucleus in high-dose irradiated tumors, but not nonirradiated tumors. CONCLUSION The APT signal intensity decreased after irradiation, which is earlier than the change of tumor volume. What is more, the decrease of APT signal intensity is more significant in high-dose group. Histological analysis showed obvious apoptosis and necrosis histological characteristic in irradiated tumor, which may explain the decrease of APT signal intensity. These results indicate that APT imaging has the potential to serve as a reliable biomarker for response assessment in NPC.
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Affiliation(s)
- Qingxu Song
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Pengxiang Chen
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Xin Chen
- Department of MR, Shandong Medical Imaging Research Institute, Jinan, Shandong, People's Republic of China
| | - Cong Sun
- Department of MR, Shandong Medical Imaging Research Institute, Jinan, Shandong, People's Republic of China
| | - Jianbo Wang
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Bingxu Tan
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Hong Liu
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Yufeng Cheng
- Department of Radiation Oncology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
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Huang X, Zhang X, Wang X, Rong X, Li Y, Li H, Jiang J, Cai J, Zhuo X, Pi Y, Lin J, Chua MLK, Argyriou AA, Lattanzi S, Simone CB, Glass J, Palmer JD, Chow E, Brown PD, Yue Z, Tang Y. A nomogram to predict symptomatic epilepsy in patients with radiation-induced brain necrosis. Neurology 2020; 95:e1392-e1403. [PMID: 32631922 DOI: 10.1212/wnl.0000000000010190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/11/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To develop and validate a nomogram to predict epilepsy in patients with radiation-induced brain necrosis (RN). METHODS The nomogram was based on a retrospective analysis of 302 patients who were diagnosed with symptomatic RN from January 2005 to January 2016 in Sun Yat-sen Memorial Hospital using the Cox proportional hazards model. Discrimination of the nomogram was assessed by the concordance index (C index) and the calibration curve. The results were internally validated using bootstrap resampling and externally validated using 128 patients with RN from 2 additional hospitals. RESULTS A total of 302 patients with RN with a median follow-up of 3.43 years (interquartile range 2.54-5.45) were included in the training cohort; 65 (21.5%) developed symptomatic epilepsy during follow-up. Seven variables remained significant predictors of epilepsy after multivariable analyses: MRI lesion volume, creatine phosphokinase, the maximum radiation dose to the temporal lobe, RN treatment, history of hypertension and/or diabetes, sex, and total cholesterol level. In the validation cohort, 28 out of 128 (21.9%) patients had epilepsy after RN within a median follow-up of 3.2 years. The nomogram showed comparable discrimination between the training and validation cohort (corrected C index 0.76 [training] vs 0.72 [95% confidence interval 0.62-0.81; validation]). CONCLUSION Our study developed an easily applied nomogram for the prediction of RN-related epilepsy in a large RN cohort. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that a nomogram predicts post-RN epilepsy.
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Affiliation(s)
- Xiaolong Huang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xiaoni Zhang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xicheng Wang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xiaoming Rong
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Yi Li
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Honghong Li
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jingru Jiang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jinhua Cai
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Xiaohuang Zhuo
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Yaxuan Pi
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jinpeng Lin
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Melvin L K Chua
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Andreas A Argyriou
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Simona Lattanzi
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Charles B Simone
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Jon Glass
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Joshua D Palmer
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Edward Chow
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Paul D Brown
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Zongwei Yue
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN
| | - Yamei Tang
- From the Department of Neurology Bioland Laboratory (X.H., X. Zhang, X.R., Y.L., H.L., J.J., J.C., X. Zhuo, X.P., J.L., Z.Y., Y.T.) and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center (Y.T.), Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University; Guangdong Province Key Laboratory of Brain Function and Disease (Y.T.), Zhongshan School of Medicine, Sun Yat-Sen University; Department of Oncology (X.W.), The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China; Division of Radiation Oncology and Medical Sciences (M.L.K.C.), National Cancer Centre Singapore; Oncology Academic Programme (M.L.K.C.), Duke-NUS Medical School, Singapore; Department of Neurology (A.A.A.), Saint Andrew's State General Hospital of Patras, Greece; Neurological Clinic, Department of Experimental and Clinical Medicine (S.L.), Marche Polytechnic University, Italy; New York Proton Center (C.B.S.), New York; Thomas Jefferson University (J.G.), Philadelphia, PA; Departments of Radiation Oncology (J.D.P.) and Neurosurgery (J.D.P.), The James Cancer Hospital at The Ohio State University Comprehensive Cancer Center, Columbus; Sunnybrook Health Sciences Centre (E.C.), University of Toronto, Canada; and Radiation Oncology (P.D.B.), Mayo Clinic, Rochester, MN.
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7
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Lin Y, Luo X, Yu L, Zhang Y, Zhou J, Jiang Y, Zhang C, Zhang J, Li C, Chen M. Amide proton transfer-weighted MRI for predicting histological grade of hepatocellular carcinoma: comparison with diffusion-weighted imaging. Quant Imaging Med Surg 2019; 9:1641-1651. [PMID: 31728308 DOI: 10.21037/qims.2019.08.07] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver, preoperative grading of HCC is of great clinical significance. Amide proton transfer-weighted (APTw) imaging, as a novel contrast mechanism in the field of molecular imaging, provided new diagnostic ideas for the grading of HCC. Methods Between May 2017 and April 2018, 32 consecutive patients with pathologically confirmed HCC were enrolled, including 19 high-grade HCCs and 13 low-grade HCCs. DWI and APTw scanning was performed on a 3T MRI scanner. Two observers drew regions of interest independently by referring to the axial T2-weighted imaging, and APTw and apparent diffusion coefficient (ADC) values were obtained. Inter- and intra-observer agreements were assessed with the intraclass correlation coefficients (ICCs). The independent sample t test was used to compare the APTw and ADC values between the high- and low-grade HCC tumor parenchyma. The receiver operating characteristic curve was used to analyze the diagnostic efficacy of high- from low-grade HCC tumors. Spearman correlation analysis was used to assess the relationship between APTw and ADC values and HCC histological grades. Results There were significant differences between the APTw or ADC values for the high- and low-grade HCCs (P=0.034 and 0.010). Both APTw and DWI had good diagnostic performance in differentiating the high- from the low-grade HCCs, with areas under the curves of 0.814 and 0.745, respectively. Moderate correlations existed between APTw values and histological grades (r=0.534; P=0.002), as well as ADC values and histological grades (r=-0.417; P=0.018). Conclusions The APTw imaging is a useful imaging biomarker that complements DWI for the more accurate and comprehensive HCC characterization.
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Affiliation(s)
- Yue Lin
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.,Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Xiaojie Luo
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Lu Yu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.,Graduate School of Peking Union Medical College, Beijing 100730, China
| | - Yi Zhang
- Center for Brain Imaging Science and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou 310058, China
| | - Jinyuan Zhou
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Yuwei Jiang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Chen Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Jintao Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Chunmei Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China.,Graduate School of Peking Union Medical College, Beijing 100730, China
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8
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Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques. Radiother Oncol 2019; 140:41-53. [PMID: 31176207 DOI: 10.1016/j.radonc.2019.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Abstract
Microvascular changes are increasingly recognised not only as primary drivers of radiotherapy treatment response in brain tumours, but also as an important contributor to short- and long-term (cognitive) side effects arising from irradiation of otherwise healthy brain tissue. As overall survival of patients with brain tumours is increasing, monitoring long-term sequels of radiotherapy-induced microvascular changes in the context of their potential predictive power for outcome, such as cognitive disability, has become increasingly relevant. Ideally, radiotherapy-induced significant microvascular changes in otherwise healthy brain tissue should be identified as early as possible to facilitate adaptive radiotherapy and to proactively start treatment to minimise the influence on these side-effects on the final outcome. Although MRI is already known to be able to detect significant long-term radiotherapy induced microvascular effects, more recently advanced MR imaging biomarkers reflecting microvascular integrity and function have been reported and might provide a more accurate and earlier detection of microvascular changes. However, the use and validation of both established and new techniques in the context of monitoring early and late radiotherapy-induced microvascular changes in both target-tissue and healthy tissue currently are minimal at best. This review aims to summarise the performance and limitations of existing methods and future opportunities for detection and quantification of radiotherapy-induced microvascular changes, as well as the relation of these findings with key clinical parameters.
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9
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Zhou J, Heo HY, Knutsson L, van Zijl PCM, Jiang S. APT-weighted MRI: Techniques, current neuro applications, and challenging issues. J Magn Reson Imaging 2019; 50:347-364. [PMID: 30663162 DOI: 10.1002/jmri.26645] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 02/06/2023] Open
Abstract
Amide proton transfer-weighted (APTw) imaging is a molecular MRI technique that generates image contrast based predominantly on the amide protons in mobile cellular proteins and peptides that are endogenous in tissue. This technique, the most studied type of chemical exchange saturation transfer imaging, has been used successfully for imaging of protein content and pH, the latter being possible due to the strong dependence of the amide proton exchange rate on pH. In this article we briefly review the basic principles and recent technical advances of APTw imaging, which is showing promise clinically, especially for characterizing brain tumors and distinguishing recurrent tumor from treatment effects. Early applications of this approach to stroke, Alzheimer's disease, Parkinson's disease, multiple sclerosis, and traumatic brain injury are also illustrated. Finally, we outline the technical challenges for clinical APT-based imaging and discuss several controversies regarding the origin of APTw imaging signals in vivo. Level of Evidence: 3 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:347-364.
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Affiliation(s)
- Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Linda Knutsson
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Peter C M van Zijl
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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10
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Pérès EA, Etienne O, Grigis A, Boumezbeur F, Boussin FD, Le Bihan D. Longitudinal Study of Irradiation-Induced Brain Microstructural Alterations With S-Index, a Diffusion MRI Biomarker, and MR Spectroscopy. Int J Radiat Oncol Biol Phys 2018; 102:1244-1254. [DOI: 10.1016/j.ijrobp.2018.01.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 01/19/2023]
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11
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A retrospective dosimetry study of intensity-modulated radiotherapy for nasopharyngeal carcinoma: radiation-induced brainstem injury and dose-volume analysis. Radiat Oncol 2018; 13:194. [PMID: 30285884 PMCID: PMC6171220 DOI: 10.1186/s13014-018-1105-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/20/2018] [Indexed: 01/19/2023] Open
Abstract
Background Radiation therapy is the standard radical treatment for nasopharyngeal carcinoma (NPC) but also causes transient as well as long-term complications. Patients who develop severe radiation-induced brainstem injuries have a poor prognosis due to the lack of effective medical therapies. However, the relationship between brainstem injury and radiation volume dose is unknown. In this study, we found that radiation-induced brainstem injury was significantly associated with brainstem dose per unit volume. Methods A retrospective analysis was performed on a consecutive cohort of 327 patients with NPC receiving IMRT from May 2005 to December 2014. Dose-volume data and long-term outcome were analyzed. Results The median follow-up duration was 56 months (range, 3–141 months), and six with T4 and two with T3 patients had radiation-induced brainstem injuries. The 3-year and 5-year incidences were 2.2% and 2.8%, respectively. The latency period of brainstem injury ranged from 9 to 58 months, with a median period of 21 months. The Cox regression analysis showed that brainstem radiation toxicity was associated with the T4 stage, D2% of gross tumor volume of nasopharyngeal primary lesions and their direct extensions (GTVnx), Dmax (the maximum point dose), D1%, D0.1cc (the top dose delivered to a 0.1-ml volume), and D1cc (the top dose delivered to a 1-ml volume) of the brainstem (p < 0.05). Receiver operating characteristic (ROC) curves showed that GTVnx D2% and the Dmax, D1%, D0.1cc, and D1cc of the brainstem were significant predictors of brainstem injury. The area under the ROC curve for these five parameters was 0.724, 0.813, 0.818, 0.818, and 0.798, respectively (p < 0.001), and the cutoff points 77.26 Gy, 67.85 Gy, 60.13 Gy, 60.75 Gy, and 54.58 Gy, respectively, were deemed as the radiation dose limit. Conclusions Radiotherapy-induced brainstem injury was uncommon in patients with NPC who received definitive IMRT. Multiple dose-volume data may be the dose tolerance of radiation-induced brainstem injury.
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12
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Grosshans DR, Duman JG, Gaber MW, Sawakuchi G. Particle Radiation Induced Neurotoxicity in the Central Nervous System. Int J Part Ther 2018; 5:74-83. [PMID: 31773021 DOI: 10.14338/ijpt-18-00026.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/16/2018] [Indexed: 11/21/2022] Open
Abstract
For patients with primary or metastatic brain tumors, radiation therapy plays a central role in treatment. However, despite its efficacy, cranial radiation is associated with a range of side effects ranging from mild cognitive impairment to overt brain necrosis. Given the negative effects on patient quality of life, radiation-induced neurotoxicities have been the subject of intense study for decades. Photon-based therapy has been and largely remains the standard of care for the treatment of brain tumors. This is particularly true for patients with metastatic tumors who may need treatment to the whole brain or those with very aggressive tumors and a limited life expectancy. Particle therapy is now becoming more widely available for clinical use with the two most common particles used being protons and carbon ions. For patients with favorable prognoses, particularly childhood brain tumors, proton therapy is increasingly used for treatment. This is, in part, driven by the desire to reduce the potential for radiation-induced side effects, including lasting cognitive impairment, which may potentially be achieved by reducing dose to normal tissues using the unique physical properties of particle therapy. There is also interest in using carbon ion therapy for the treatment of aggressive brain tumors, as this form of particle therapy not only spares normal tissues but may also improve tumor control. The biological effects of particle therapy, both proton and carbon, may differ substantially from those of photon radiation. In this review, we briefly describe the unique physical properties of particle therapy that produce differential biological effects. Focusing on the effects of various radiation types on brain parenchyma, we then describe biological effects and potential mechanisms underlying these, comparing to photon studies and highlighting potential clinical implications.
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Affiliation(s)
- David R Grosshans
- Departments of Radiation and Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph G Duman
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - M Waleed Gaber
- Department of Pediatrics, Texas Children's Cancer Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Gabriel Sawakuchi
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Yang J, Xu Z, Gao J, Liao C, Wang P, Liu Y, Ke T, Li Q, Han D. Evaluation of early acute radiation-induced brain injury: Hybrid multifunctional MRI-based study. Magn Reson Imaging 2018; 54:101-108. [PMID: 30165095 DOI: 10.1016/j.mri.2018.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/04/2018] [Accepted: 08/24/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Radiation injury is a serious threat to humans that requires prompt and accurate diagnosis and assessment. Currently, there is no effective imaging method to evaluate acute radiation injury in the early stage. We used hybrid multifunctional MRI to evaluate acute radiation-induced brain injury. MATERIALS AND METHODS Different extents of brain injury were created by exposing SD rats to different radiation doses, namely, 0, 10, 20, 30 and 40 Gy. DCE, IVIM-MRI and MRS were performed on the 5th day after irradiation. Immunohistochemistry, western blotting and electron microscopy were used to determine histopathological changes in neurons and glial cells. RESULTS The Ktrans, Ve, and iAUC values in DCE and the S0, f and D* values in IVIM showed significant positive correlations with injury grade. In particular, Ktrans, iAUC and S0 showed very good correlations with injury grade (r > 0.5, P < 0.05), and the values in the 30 Gy group were significantly higher than those in the other groups (P < 0.05). The NAA/Cr ratio in the 30 Gy group was significantly lower than those in the other groups, whereas the NAA/Cho ratio increased from the 10 Gy to the 20 Gy group and decreased significantly in the 30 Gy group (P < 0.05). VEGF, Caspase-3 and GFAP increased with irradiation dose increasing from 10 Gy to 30 Gy (P < 0.05). ROC analysis demonstrated that multifunctional MRI was more effective for diagnosing the 30 Gy group than it was for the 10 Gy and 20 Gy groups. CONCLUSION Hybrid multifunctional MRI can noninvasively evaluate acute radiation-induced brain injury in the early stage, particularly high-dose radiation exposure.
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Affiliation(s)
- Jun Yang
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China; Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming 650032, Yunnan, PR China
| | - Zeyan Xu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China
| | - Jingyan Gao
- Department of Radiation Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China
| | - Chengde Liao
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China
| | - Pengfei Wang
- Department of Key Laboratory, The 2nd Affiliated Hospital of Kunming Medical University, No. 374 Dianmian Road, Kunming 650101, Yunnan, PR China
| | - Yifan Liu
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China
| | - Tengfei Ke
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China
| | - Qinqing Li
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, No. 519 Kunzhou Road, Xishan District, Kunming 650118, Yunnan, PR China.
| | - Dan Han
- Department of Medical Imaging, The First Affiliated Hospital of Kunming Medical University, No. 295 Xichang Road, Kunming 650032, Yunnan, PR China.
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14
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Klein J, Lam WW, Czarnota GJ, Stanisz GJ. Chemical exchange saturation transfer MRI to assess cell death in breast cancer xenografts at 7T. Oncotarget 2018; 9:31490-31501. [PMID: 30140385 PMCID: PMC6101146 DOI: 10.18632/oncotarget.25844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/12/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose Detecting cell death and predicting tumor response early in a course of chemotherapy could help optimize treatment regimens and improve clinical outcomes. Chemical exchange saturation transfer (CEST) MRI was investigated in vivo to study properties that may be able to detect cancer death. Results Using a magnetization transfer ratio (MTR) cutoff of 0.12 at 1.8 ppm was able to differentiate between viable tumor and cell death regions. Comparison of MTR values at this frequency showed significant differences (p < 0.0001) between viable tumor and cell death regions, matching patterns seen on histology. Using this cutoff, the mean increase in cell death index (± standard error of the mean) after chemotherapy was 4 ± 4%, 10% ± 7%, 10 ± 8%, and 4 ± 9% at 4, 8, 12, and 24 h, respectively. Conclusions CEST MRI can detect cell death in MDA-231 xenografts but further work is needed to characterize the clinical applications of this finding. Maximum response to chemotherapy occurred at 8-12 h after chemotherapy injection in this in vivo tumor model. Materials and Methods Breast cancer xenografts (MDA-MB-231) were scanned using 7 T MRI before and after chemotherapy. As a measure of CEST effect at 0.5 µT saturation amplitude, MTR values at frequency offsets of 1.8 and -3.3 ppm were evaluated. CEST signals after chemotherapy treatment were compared to cell-death histopathology of tumors.
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Affiliation(s)
- Jonathan Klein
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Wilfred W Lam
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Gregory J Czarnota
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Greg J Stanisz
- Physical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Department of Neurosurgery and Pediatric Neurosurgery, Medical University of Lublin, Lublin, Poland
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15
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Garbow JR, Tsien CI, Beeman SC. Preclinical MRI: Studies of the irradiated brain. JOURNAL OF MAGNETIC RESONANCE (SAN DIEGO, CALIF. : 1997) 2018; 292:73-81. [PMID: 29705034 PMCID: PMC6029718 DOI: 10.1016/j.jmr.2018.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/20/2018] [Accepted: 03/28/2018] [Indexed: 06/08/2023]
Abstract
Radiation therapy (RT) plays a central role in the treatment of primary brain tumors. However, despite recent advances in RT treatment, local recurrences following therapy remain common. Radiation necrosis (RN) is a severe, late complication of radiation therapy in the brain. RN is a serious clinical problem often associated with devastating neurologic complications. Therapeutic strategies, including neuroprotectants, have been described, but have not been widely translated in routine clinical use. We have developed a mouse model that recapitulates all of the major pathologic features of late-onset RN for the purposes of characterizing the basic pathogenesis of RN, identifying non-invasive (imaging) biomarkers of RN that might allow for the radiologic discernment of tumor and RN, systematic testing of tumor and RN therapeutics, and exploring the complex interplay between RN pathogenesis and tumor recurrence. Herein, we describe the fundamental clinical challenges associated with RN and the progress made towards addressing these challenges by combining our novel mouse model of late-onset RN and magnetic resonance imaging (MRI). MRI techniques discussed include conventional T1- and T2-weighted imaging, diffusion-weighted imaging, magnetization transfer, and measures of tissue oxygenation. Studies of RN mitigation and neuroprotection are described, including the use of anti-VEGF antibodies, and inhibitors of GSK-3β, HIF-1α, and CXCR4. We conclude with some future perspectives on the irradiated brain and the study and treatment of recurrent tumor growing in an irradiated tumor microenvironment.
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Affiliation(s)
- Joel R Garbow
- Department of Radiology, Washington University, Saint Louis, MO, United States; The Alvin J. Siteman Cancer Center, Washington University, Saint Louis, MO, United States.
| | - Christina I Tsien
- Department of Radiation Oncology, Washington University, Saint Louis, MO, United States
| | - Scott C Beeman
- Department of Radiology, Washington University, Saint Louis, MO, United States
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16
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Xu Y, Rong X, Hu W, Huang X, Li Y, Zheng D, Cai Z, Zuo Z, Tang Y. Bevacizumab Monotherapy Reduces Radiation-induced Brain Necrosis in Nasopharyngeal Carcinoma Patients: A Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2018; 101:1087-1095. [PMID: 29885994 DOI: 10.1016/j.ijrobp.2018.04.068] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/20/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Studies have shown that addition of bevacizumab to corticosteroids improves outcome against radiation-induced brain necrosis (RN). Here, we aimed to evaluate the effectiveness and safety of bevacizumab monotherapy on RN in nasopharyngeal carcinoma (NPC) patients. METHODS AND MATERIALS In this multicenter open-label study, patients with RN were randomly assigned (1:1) into a bevacizumab group (5 mg/kg intravenously every 2 weeks, for 4 cycles) or a corticosteroid group (methylprednisolone 500 mg/day intravenously for 3 consecutive days and then gradually tapered, followed by 10 mg/day oral prednisone, for 2 months in total). Magnetic resonance imaging (MRI) was performed pre- and post-treatment to define the radiographic response. The primary outcome was a 2-month response rate as determined by MRI and clinical symptoms. All of the patients were followed up with for 6 months. The trial was registered at www.clinicaltrials.gov (NCT01621880). RESULTS Of 121 patients screened, 112 patients met the entry criteria. Thirty-eight (65.5%) patients in the bevacizumab group showed response, which was significantly higher than that in the corticosteroid group (65.5% vs 31.5%, P < .001). The mean percentage decrease in RN volume seen on T1 post-gadolinium and T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI was 25.5% and 51.8%, respectively, in the bevacizumab group, versus 5.0% and 19.3%, respectively, in the corticosteroid group. Moreover, 36 patients (62.1%) on bevacizumab and 23 patients (42.6%) on corticosteroids demonstrated clinical improvement (P = .039). During the 6-month follow up, fourteen patients on bevacizumab and 13 patients on corticosteroids showed RN recurrence. The most frequent adverse event in the bevacizumab group was hypertension (20.6%). CONCLUSIONS Our study indicate that compared with corticosteroids, bevacizumab offers improved symptomatic relief and radiographic response.
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Affiliation(s)
- Yongteng Xu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Weihan Hu
- Department of Radiation Oncology, Cancer Center of Sun Yat-sen University, Guangzhou, China
| | - Xiaolong Huang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yi Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong Zheng
- Department of Neurology, Guangzhou Brain Hospital, Guangzhou, China
| | - Zhaoxi Cai
- Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhiyi Zuo
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Yamei Tang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Province Key Laboratary of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, Gaungzhou, China.
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17
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Belliveau JG, Jensen MD, Stewart JMP, Solovey I, Klassen LM, Bauman GS, Menon RS. Prediction of radiation necrosis in a rodent model using magnetic resonance imaging apparent transverse relaxation ([Formula: see text]). Phys Med Biol 2018; 63:035010. [PMID: 29372691 DOI: 10.1088/1361-6560/aaa034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Radiation necrosis remains an irreversible long-term side-effect following radiotherapy to the brain. The ability to predict areas that could ultimately develop into necrosis could lead to prevention and management of radiation necrosis. MATERIALS AND METHODS Fischer 344 rats were irradiated using two platforms (micro-CT irradiator and x-Rad 225 IGRT) with radiation up to 30 Gy for the micro-CT and 40 Gy for the xRAD-224 to half the brain. Animals were subsequently imaged using a 9.4 T MRI scanner every 2-4 weeks for up to 28 weeks using a 7-echo gradient echo sequence. The apparent transverse relaxation constant ([Formula: see text]) was calculated and retrospectively analyzed. RESULTS Animals irradiated with the low-dose rate micro-CT did not exhibit any symptoms or imaging changes associated with RN. Animals irradiated with the xRAD-225 exhibited imaging changes consistent with RN at week 24. Analysis of the [Formula: see text] coefficient within the lesion and hippocampus shows the potential for detection of RN up to 10 weeks prior to morphological changes. CONCLUSIONS The ability to predict areas of RN and increases of [Formula: see text] within the hippocampus provides a method for long-term monitoring and prediction of RN.
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Affiliation(s)
- Jean-Guy Belliveau
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada. Centre for Functional and Metabolic Mapping, University of Western Ontario, London, ON, Canada
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18
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Mehta S, Shah A, Jung H. Diagnosis and treatment options for sequelae following radiation treatment of brain tumors. Clin Neurol Neurosurg 2017; 163:1-8. [DOI: 10.1016/j.clineuro.2017.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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The Applicability of Amide Proton Transfer Imaging in the Nervous System: Focus on Hypoxic-Ischemic Encephalopathy in the Neonate. Cell Mol Neurobiol 2017; 38:797-807. [DOI: 10.1007/s10571-017-0552-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/16/2017] [Indexed: 12/29/2022]
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20
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Lee Y, Lee SS, Cheong H, Lee CK, Kim N, Son WC, Hong SM. Intravoxel incoherent motion MRI for monitoring the therapeutic response of hepatocellular carcinoma to sorafenib treatment in mouse xenograft tumor models. Acta Radiol 2017; 58:1045-1053. [PMID: 28273738 DOI: 10.1177/0284185116683576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background With the introduction of targeted therapies, there has been a growing need for non-invasive imaging methods which accurately evaluate therapeutic effects and overcome the limitations of tumor size-based therapeutic response assessments. Purpose To assess diagnostic values of intra-voxel incoherent motion (IVIM) imaging in evaluating therapeutic effects of sorafenib on hepatocellular carcinoma (HCC) using mouse xenograft model. Material and Methods Twenty-four mice bearing Huh-7 were divided into a control group and two treatment groups received sorafenib doses of 5 mg/kg (5 mg-Tx) or 30 mg/kg (30 mg-Tx). IVIM imaging was performed using 10 b-values (0-900 s/mm2). The apparent diffusion coefficient (ADC), diffusion coefficient ( D), and perfusion fraction ( f) were measured for whole tumors and tumor periphery. Changes between baseline and post-treatment parameters ( Δ ADC, Δ D, and Δ f) were calculated, and these parameters were compared with microvessel density (MVD) and area of tumor cell death. Results The post-treatment f and Δ f for tumor periphery were significantly higher in control group, followed by 5 mg-Tx and 30 mg-Tx ( P < 0.001). MVD showed significant positive correlation with post-treatment f ( r = 0.584, P = 0.003) and negative correlation with D ( r = -0.495, P = 0.014) for tumor periphery, while no parameter showed significant correlation with area of tumor cell death. Conclusion The f is significantly correlated with MVD of HCC, and could potentially be used to evaluate the anti-angiogenic effects of sorafenib.
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Affiliation(s)
- Yedaun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
- Current address: Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hyunhee Cheong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chang Kyung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Woo-Chan Son
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Mo Hong
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Galante JR, Rodriguez F, Grossman SA, Strowd RE. Late post-treatment radiographic changes 3 years following chemoradiation for glioma: the importance of histopathology. CNS Oncol 2017; 6:195-201. [PMID: 28718307 PMCID: PMC6009212 DOI: 10.2217/cns-2016-0040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 01/18/2017] [Indexed: 11/21/2022] Open
Abstract
Treatment-related changes can mimic brain tumor progression both clinically and radiographically. Distinguishing these two entities represents a major challenge in neuro-oncology. No single imaging modality is capable of reliably achieving such distinction. While histopathology remains the gold standard, definitive pathological criteria are also lacking which can further complicate such cases. We report a patient with high-grade glioma who, after initially presenting with histopathologically confirmed pseudoprogression 10 months following treatment, re-presented 3 years following concurrent chemoradiation with clinical and radiographic changes that were most consistent with progressive disease but for which histopathology revealed treatment effects without active glioma. This case highlights the potential late onset of treatment-related changes and underscores the importance of histopathologic assessment even years following initial therapy.
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Affiliation(s)
- Joao R Galante
- Poznan University of Medical Sciences, 41 Jackowskiego Street, 60-512 Poznan, Poland
- Department of Oncology, Johns Hopkins University School of Medicine, 733 North Broadway Street, Baltimore, MD 21205, USA
| | - Fausto Rodriguez
- Department of Pathology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, David H. Koch Cancer Research Bldg II, 1550 Orleans Street, Room 1M16, Baltimore, MD 21287, USA
| | - Stuart A Grossman
- Medical Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, David H. Koch Cancer Research Bldg II, 1550 Orleans Street, Room 1M16, Baltimore, MD 21287, USA
| | - Roy E Strowd
- Department of Neurology and Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston Salem, NC 27157, USA
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22
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Jiang S, Eberhart CG, Zhang Y, Heo HY, Wen Z, Blair L, Qin H, Lim M, Quinones-Hinojosa A, Weingart JD, Barker PB, Pomper MG, Laterra J, van Zijl PCM, Blakeley JO, Zhou J. Amide proton transfer-weighted magnetic resonance image-guided stereotactic biopsy in patients with newly diagnosed gliomas. Eur J Cancer 2017; 83:9-18. [PMID: 28704644 DOI: 10.1016/j.ejca.2017.06.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 05/31/2017] [Accepted: 06/11/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE Pathological assessment using World Health Organization (WHO) criteria is the gold standard for diagnosis of gliomas. However, the accuracy of diagnosis is limited by tissue sampling, particularly for infiltrating, heterogeneous tumours. We assessed the accuracy of amide proton transfer-weighted (APTw) magnetic resonance imaging (MRI)-guided tissue sampling to identify regions of high-grade glioma via radiographic-histopathologic correlation in patients with newly suspected glioma. PATIENTS AND METHODS Twenty-four patients with previously undiagnosed gliomas underwent a volumetric APTw MRI prior to their first neurosurgical procedure. A total of 70 specimens were collected via APTw image-directed stereotactic biopsy. Cellularity, necrosis, proliferation and glioma WHO grade were analysed for all specimens and correlated with corresponding APTw signal intensities. RESULTS Thirty-three specimens displayed grade-II pathology, 14 grade-III, 15 grade-IV, and eight specimens revealed only peritumoural oedema. Multiple glioma grades were found within a single lesion in six patients. APTw signal intensities of the biopsied sites and the maximum APTw values across all biopsied sites in each patient were significantly higher for high-grade versus low-grade specimens. APTw signal intensities were significantly positively correlated with cellularity (R = 0.757) and proliferation (R = 0.538). Multiple linear regression analysis showed that tumour cellularity and proliferation index were the best predictors of APTw signal intensities. CONCLUSION APTw imaging identified tumour areas of higher cellularity and proliferation, allowing identification of high-grade regions within heterogeneous gliomas. APTw imaging can be readily translated for more widespread use and can assist diagnostic neurosurgical procedures by increasing the accuracy of tumour sampling in patients with infiltrating gliomas.
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Affiliation(s)
- Shanshan Jiang
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | | | - Yi Zhang
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Hye-Young Heo
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lindsay Blair
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Huamin Qin
- Department of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jon D Weingart
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Peter B Barker
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Martin G Pomper
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - John Laterra
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Peter C M van Zijl
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | | | - Jinyuan Zhou
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA.
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23
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Hartl BA, Ma HSW, Hansen KS, Perks J, Kent MS, Fragoso RC, Marcu L. The effect of radiation dose on the onset and progression of radiation-induced brain necrosis in the rat model. Int J Radiat Biol 2017; 93:676-682. [PMID: 28306402 DOI: 10.1080/09553002.2017.1297902] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To provide a comprehensive understanding of how the selection of radiation dose affects the temporal and spatial progression of radiation-induced necrosis in the rat model. MATERIALS AND METHODS Necrosis was induced with a single fraction of radiation exposure, at doses ranging between 20 and 60 Gy, to the right hemisphere of 8-week-old Fischer rats from a linear accelerator. The development and progression of necrosis in the rats was monitored and quantified every other week with T1- and T2-weighted gadolinium contrast-enhanced MRI studies. RESULTS The time to onset of necrosis was found to be dose-dependent, but after the initial onset, the necrosis progression rate and total volume generated was constant across different doses ranging between 30 and 60 Gy. Radiation doses less than 30 Gy did not develop necrosis within 33 weeks after treatment, indicating a dose threshold existing between 20 and 30 Gy. CONCLUSION The highest dose used in this study led to the shortest time to onset of radiation-induced necrosis, while producing comparable disease progression dynamics after the onset. Therefore, for the radiation-induced necrosis rat model using a linear accelerator, the most optimum results were generated from a dose of 60 Gy.
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Affiliation(s)
- Brad A Hartl
- a Department of Biomedical Engineering , University of California Davis , Davis , CA , USA
| | - Htet S W Ma
- a Department of Biomedical Engineering , University of California Davis , Davis , CA , USA
| | - Katherine S Hansen
- b Department of Surgical and Radiological Sciences , University of California Davis School of Veterinary Medicine , Davis , CA , USA
| | - Julian Perks
- c Department of Radiation Oncology , University of California Davis School of Medicine , Davis , CA , USA
| | - Michael S Kent
- b Department of Surgical and Radiological Sciences , University of California Davis School of Veterinary Medicine , Davis , CA , USA
| | - Ruben C Fragoso
- c Department of Radiation Oncology , University of California Davis School of Medicine , Davis , CA , USA
| | - Laura Marcu
- a Department of Biomedical Engineering , University of California Davis , Davis , CA , USA
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Ford E, Emery R, Huff D, Narayanan M, Schwartz J, Cao N, Meyer J, Rengan R, Zeng J, Sandison G, Laramore G, Mayr N. An image-guided precision proton radiation platform for preclinicalin vivoresearch. Phys Med Biol 2016; 62:43-58. [DOI: 10.1088/1361-6560/62/1/43] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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25
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Cho IK, Wang S, Mao H, Chan AWS. Genetic engineered molecular imaging probes for applications in cell therapy: emphasis on MRI approach. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2016; 6:234-261. [PMID: 27766183 PMCID: PMC5069277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/31/2016] [Indexed: 06/06/2023]
Abstract
Recent advances in stem cell-based regenerative medicine, cell replacement therapy, and genome editing technologies (i.e. CRISPR-Cas 9) have sparked great interest in in vivo cell monitoring. Molecular imaging promises a unique approach to noninvasively monitor cellular and molecular phenomena, including cell survival, migration, proliferation, and even differentiation at the whole organismal level. Several imaging modalities and strategies have been explored for monitoring cell grafts in vivo. We begin this review with an introduction describing the progress in stem cell technology, with a perspective toward cell replacement therapy. The importance of molecular imaging in reporting and assessing the status of cell grafts and their relation to the local microenvironment is highlighted since the current knowledge gap is one of the major obstacles in clinical translation of stem cell therapy. Based on currently available imaging techniques, we provide a brief discussion on the pros and cons of each imaging modality used for monitoring cell grafts with particular emphasis on magnetic resonance imaging (MRI) and the reporter gene approach. Finally, we conclude with a comprehensive discussion of future directions of applying molecular imaging in regenerative medicine to emphasize further the importance of correlating cell graft conditions and clinical outcomes to advance regenerative medicine.
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Affiliation(s)
- In K Cho
- Department of Human Genetics, Emory University School of MedicineAtlanta, GA, USA
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research CenterAtlanta, GA, USA
| | - Silun Wang
- Department of Radiology and Imaging Sciences, Emory University School of MedicineAtlanta, GA, USA
| | - Hui Mao
- Department of Radiology and Imaging Sciences, Emory University School of MedicineAtlanta, GA, USA
| | - Anthony WS Chan
- Department of Human Genetics, Emory University School of MedicineAtlanta, GA, USA
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research CenterAtlanta, GA, USA
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Heo HY, Lee DH, Zhang Y, Zhao X, Jiang S, Chen M, Zhou J. Insight into the quantitative metrics of chemical exchange saturation transfer (CEST) imaging. Magn Reson Med 2016; 77:1853-1865. [PMID: 27170222 DOI: 10.1002/mrm.26264] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 04/01/2016] [Accepted: 04/14/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the reliability of four CEST imaging metrics for brain tumors, at varied saturation power levels and magnetic field strengths (3-9.4 Tesla (T)). METHODS A five-pool proton exchange model (free water, semisolid, amide, amine, and NOE-related protons) was used for the simulations. For the in vivo study, eight glioma-bearing rats were scanned at 4.7 T. The CEST ratio (CESTR), CESTR normalized with the reference value (CESTRnr ), inverse Z-spectrum-based (MTRRex ), and apparent exchange-related relaxation (AREX) were compared. RESULTS The simulated CEST signal intensities using MTRRex and AREX were substantially increased at relatively high radiofrequency (RF) saturation powers at 3 T and 4.7 T, whereas CESTR and CESTRnr metrics remained relatively stable. There were tremendously high MTRRex and AREX signals around the water frequency at all field strengths because of the small denominators. In the rat tumor study at 4.7 T, both CESTR and CESTRnr showed clear contrasts in the tumor with respect to the normal tissue across all saturation power levels (0.5-3 μT), whereas the AREX showed negligible to negative insignificant contrasts. CONCLUSIONS CEST metrics must be carefully selected based on the different experimental settings. CESTR and CESTRnr are more reliable at 3 T (a clinical field strength) and 4.7 T. Magn Reson Med 77:1853-1865, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Hye-Young Heo
- Divison of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Dong-Hoon Lee
- Divison of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yi Zhang
- Divison of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xuna Zhao
- Divison of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Divison of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Min Chen
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Jinyuan Zhou
- Divison of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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Yu Y, Lee DH, Peng SL, Zhang K, Zhang Y, Jiang S, Zhao X, Heo HY, Wang X, Chen M, Lu H, Li H, Zhou J. Assessment of Glioma Response to Radiotherapy Using Multiple MRI Biomarkers with Manual and Semiautomated Segmentation Algorithms. J Neuroimaging 2016; 26:626-634. [PMID: 27128445 DOI: 10.1111/jon.12354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/23/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Multimodality magnetic resonance imaging (MRI) can provide complementary information in the assessment of brain tumors. We aimed to segment tumor in amide proton transfer-weighted (APTw) images and to investigate multiparametric MRI biomarkers for the assessment of glioma response to radiotherapy. For tumor extraction, we evaluated a semiautomated segmentation method based on region of interest (ROI) results by comparing it with the manual segmentation method. METHODS Thirteen nude rats injected with U87 tumor cells were irradiated by an 8-Gy radiation dose. All MRI scans were performed on a 4.7-T animal scanner preradiation, and at day 1, day 4, and day 8 postradiation. Two experts performed manual and semiautomated methods to extract tumor ROIs on APTw images. Multimodality MRI signals of the tumors, including structural (T2 and T1 ), functional (apparent diffusion coefficient and blood flow), and molecular (APTw and magnetization transfer ratio or MTR), were calculated and compared quantitatively. RESULTS The semiautomated method provided more reliable tumor extraction results on APTw images than the manual segmentation, in less time. A considerable increase in the ADC intensities of the tumor was observed during the postradiation. A steady decrease in the blood flow values and in the APTw signal intensities were found after radiotherapy. CONCLUSIONS The semiautomated method of tumor extraction showed greater efficiency and stability than the manual method. Apparent diffusion coefficient, blood flow, and APTw are all useful biomarkers in assessing glioma response to radiotherapy.
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Affiliation(s)
- Yang Yu
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, China
| | - Dong-Hoon Lee
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Shin-Lei Peng
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Kai Zhang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Yi Zhang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Xuna Zhao
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Xiangyang Wang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China.,Department of Radiology, Beijing Hospital, Beijing, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, Beijing, China
| | - Hanzhang Lu
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Haiyun Li
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, China.
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Ngen EJ, Wang L, Gandhi N, Kato Y, Armour M, Zhu W, Wong J, Gabrielson KL, Artemov D. A preclinical murine model for the early detection of radiation-induced brain injury using magnetic resonance imaging and behavioral tests for learning and memory: with applications for the evaluation of possible stem cell imaging agents and therapies. J Neurooncol 2016; 128:225-33. [PMID: 27021492 DOI: 10.1007/s11060-016-2111-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 03/22/2016] [Indexed: 01/15/2023]
Abstract
Stem cell therapies are being developed for radiotherapy-induced brain injuries (RIBI). Magnetic resonance imaging (MRI) offers advantages for imaging transplanted stem cells. However, most MRI cell-tracking techniques employ superparamagnetic iron oxide particles (SPIOs), which are difficult to distinguish from hemorrhage. In current preclinical RIBI models, hemorrhage occurs concurrently with other injury markers. This makes the evaluation of the recruitment of transplanted SPIO-labeled stem cells to injury sites difficult. Here, we developed a RIBI model, with early injury markers reflective of hippocampal dysfunction, which can be detected noninvasively with MRI and behavioral tests. Lesions were generated by sub-hemispheric irradiation of mouse hippocampi with single X-ray beams of 80 Gy. Lesion formation was monitored with anatomical and contrast-enhanced MRI and changes in memory and learning were assessed with fear-conditioning tests. Early injury markers were detected 2 weeks after irradiation. These included an increase in the permeability of the blood-brain barrier, demonstrated by a 92 ± 20 % contrast enhancement of the irradiated versus the non-irradiated brain hemispheres, within 15 min of the administration of an MRI contrast agent. A change in short-term memory was also detected, as demonstrated by a 40.88 ± 5.03 % decrease in the freezing time measured during the short-term memory context test at this time point, compared to that before irradiation. SPIO-labeled stem cells transplanted contralateral to the lesion migrated toward the lesion at this time point. No hemorrhage was detected up to 10 weeks after irradiation. This model can be used to evaluate SPIO-based stem cell-tracking agents, short-term.
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Affiliation(s)
- Ethel J Ngen
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Traylor Building 217, Baltimore, MD, 21205, USA
| | - Lee Wang
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Traylor Building 217, Baltimore, MD, 21205, USA
| | - Nishant Gandhi
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yoshinori Kato
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Traylor Building 217, Baltimore, MD, 21205, USA
| | - Michael Armour
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wenlian Zhu
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Traylor Building 217, Baltimore, MD, 21205, USA
| | - John Wong
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kathleen L Gabrielson
- Department of Molecular and Comparative Pathobiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dmitri Artemov
- Division of Cancer Imaging Research, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 720 Rutland Avenue, Traylor Building 217, Baltimore, MD, 21205, USA.
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Ma B, Blakeley JO, Hong X, Zhang H, Jiang S, Blair L, Zhang Y, Heo HY, Zhang M, van Zijl PCM, Zhou J. Applying amide proton transfer-weighted MRI to distinguish pseudoprogression from true progression in malignant gliomas. J Magn Reson Imaging 2016; 44:456-62. [PMID: 26788865 DOI: 10.1002/jmri.25159] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/04/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To assess amide proton transfer-weighted (APTW) imaging features in patients with malignant gliomas after chemoradiation and the diagnostic performance of APT imaging for distinguishing true progression from pseudoprogression. MATERIALS AND METHODS After approval by the Institutional Review Board, 32 patients with clinically suspected tumor progression in the first 3 months after chemoradiation were enrolled and scanned at 3T. Longitudinal routine magnetic resonance imaging (MRI) changes and medical records were assessed to confirm true progression versus pseudoprogression. True progression was defined as lesions progressing on serial imaging over 6 months, and pseudoprogression was defined as lesions stabilizing or regressing without intervention. The APTWmean and APTWmax signals were obtained from three to five regions of interests for each patient and compared between the true progression and pseudoprogression groups. The diagnostic performance was assessed with receiver operating characteristic curve analysis. RESULTS The true progression was associated with APTW hyperintensity (APTWmean = 2.75% ± 0.42%), while pseudoprogression was associated with APTW isointensity to mild hyperintensity (APTWmean = 1.56% ± 0.42%). The APTW signal intensities were significantly higher in the true progression group (n = 20) than in the pseudoprogression group (P < 0.001; n = 12). The cutoff APTWmean and APTWmax intensity values to distinguish between true progression and pseudoprogression were 2.42% (with a sensitivity of 85.0% and a specificity of 100%) and 2.54% (with a sensitivity of 95.0% and a specificity of 91.7%), respectively. CONCLUSION The APTW-MRI signal is a valuable imaging biomarker for distinguishing pseudoprogression from true progression in glioma patients. J. Magn. Reson. Imaging 2016;44:456-462.
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Affiliation(s)
- Bo Ma
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, Henan, PR China
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiaohua Hong
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hongyan Zhang
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Lindsay Blair
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yi Zhang
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hye-Young Heo
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mingzhi Zhang
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Peter C M van Zijl
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Jinyuan Zhou
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland, USA
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Temporal Cerebral Microbleeds Are Associated With Radiation Necrosis and Cognitive Dysfunction in Patients Treated for Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2015; 94:1113-20. [PMID: 27026315 DOI: 10.1016/j.ijrobp.2015.11.037] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 11/15/2015] [Accepted: 11/29/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE Radiation therapy for patients with nasopharyngeal carcinoma (NPC) may be complicated with radiation-induced brain necrosis (RN), resulting in deteriorated cognitive function. However, the underlying mechanism of this phenomenon remains unclear. This study attempts to elucidate the association between cerebral microbleeds (CMBs) and radiation necrosis and cognitive dysfunction in NPC patients treated with radiation therapy. METHODS AND MATERIALS This cross-sectional study included 106 NPC patients who were exposed to radiation therapy (78 patients with RN and 28 without RN). Sixty-six patients without discernable intracranial pathology were included as the control group. CMBs were confirmed using susceptibility-weighted magnetic resonance imaging. Cognitive function was accessed using Montreal Cognitive Assessment. Patients with a total score below 26 were defined as cognitively dysfunction. RESULTS Seventy-seven patients (98.7%) in the RN group and 12 patients (42.9%) in the non-RN group had at least 1 CMB. In contrast, only 14 patients (21.2%) in the control group had CMBs. In patients with a history of radiation therapy, CMBs most commonly presented in temporal lobes (76.4%) followed by cerebellum (23.7%). Patients with RN had more temporal CMBs than those in the non-RN group (37.7 ± 51.9 vs 3.8 ± 12.6, respectively; P<.001). The number of temporal lobe CMBs was predictive for larger volume of brain necrosis (P<.001) in multivariate linear regression analysis. Although cognitive impairment was diagnosed in 55.1% of RN patients, only 7.1% of non-RN patients sustained cognitive impairment (P<.001). After adjusting for age, sex, education, period after radiation therapy, CMBs in other lobes, and RN volume, the number of temporal CMBs remained an independent risk factor for cognitive dysfunction (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.04; P=.003). CONCLUSIONS CMBs is a common radiological manifestation in NPC patients with RN. The number of temporal CMBs is independently associated with increased likelihood of cognitive dysfunction in patients with RN.
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Pérez-Carro R, Cauli O, López-Larrubia P. Multiparametric magnetic resonance in the assessment of the gender differences in a high-grade glioma rat model. EJNMMI Res 2014; 4:44. [PMID: 26116110 PMCID: PMC4452640 DOI: 10.1186/s13550-014-0044-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 07/22/2014] [Indexed: 01/05/2023] Open
Abstract
Background Glioblastoma, the most frequent and aggressive of all astrocytomas, presents a clear predominance in male humans, but the assessment of sexual differences in its tumourigenesis and growth has received little attention so far. In this study, we aim to identify gender-dependent surrogate markers in an animal model of this cancer by means of magnetic resonance (MR) imaging and biochemical and behavioural studies. Methods A high-grade glioma model developed in male and female rats was used. Multiparametric magnetic resonance images and localized spectra were acquired. The MR parameters linked to tumoural features were quantified. Motor and metabolic activity was also assessed. Postmortem analyses were carried out to measure indicators of malignancy, tumoural metabolism and viability of the blood-brain barrier (BBB). Results Statistically significant differences dependent on the animal sex were found in the study of pathological indicators like oedema, inflammation, cellularity and microvasculature. Results suggest higher cell proliferative rate, inflammation and vasogenic oedema and or necrosis in glioma-bearing male rats. Haemodynamic parameters measured indicated a major disruption of the BBB, postmortem confirmed, in this sex. Metabolomic and energetic metabolism activity data are in agreement with a major malignancy and aggressiveness of this cancer model on males. Conclusions Gender differences should be taken into account in preclinical studies of glioblastoma models, in the characterization of the tumoural behaviour and consequently in the development and validation of new therapeutic approaches. MR imaging and spectroscopy allow to non-invasively monitor this sexual dimorphism in the diagnosis and prognosis of brain cancer.
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Affiliation(s)
- Rocío Pérez-Carro
- Laboratory of Magnetic Resonance in the Study of the Central Nervous System, Instituto de Investigaciones Biomédicas 'Alberto Sols', CSIC-UAM, Arturo Duperier 4, 28029, Madrid, Spain,
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Bolcaen J, Descamps B, Deblaere K, Boterberg T, De Vos Pharm F, Kalala JP, Van den Broecke C, Decrock E, Leybaert L, Vanhove C, Goethals I. (18)F-fluoromethylcholine (FCho), (18)F-fluoroethyltyrosine (FET), and (18)F-fluorodeoxyglucose (FDG) for the discrimination between high-grade glioma and radiation necrosis in rats: a PET study. Nucl Med Biol 2014; 42:38-45. [PMID: 25218024 DOI: 10.1016/j.nucmedbio.2014.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 07/04/2014] [Accepted: 07/21/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Discrimination between (high-grade) brain tumor recurrence and radiation necrosis (RN) remains a diagnostic challenge because both entities have similar imaging characteristics on conventional magnetic resonance imaging (MRI). Metabolic imaging, such as positron emission tomography (PET) could overcome this diagnostic dilemma. In this study, we investigated the potential of 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG), O-(2-[(18)F]-fluoroethyl)-L-tyrosine ((18)F-FET), and [(18)F]-Fluoromethyl-dimethyl-2-hydroxyethylammonium ((18)F-fluoromethylcholine, (18)F-FCho) PET in discriminating high-grade tumor from RN. METHODS We developed a glioblastoma (GB) rat model by inoculating F98 GB cells into the right frontal region. Induction of RN was achieved by irradiating the right frontal region with 60 Gy using three arcs with a beam aperture of 3×3 mm (n=3). Dynamic PET imaging with (18)F-FDG, (18)F-FET, and (18)F-FCho, as well as (18)F-FDG PET at a delayed time interval (240 min postinjection), was acquired. RESULTS MRI revealed contrast-enhancing tumors at 15 days after inoculation (n=4) and contrast-enhancing RN lesions 5-6 months postirradiation (n=3). On (18)F-FDG PET, the mean lesion-to-normal ratio (LNRmean) was significantly higher in GB than in RN (p=0.034). The difference in the LNRmean between tumors and RN was higher on the late (18)F-FDG PET images than on the PET images reconstructed from the last time frame of the dynamic acquisition (this is at a conventional time interval). LNRs obtained from (18)F-FCho PET were not significantly different between GB and RN (p=1.000). On (18)F-FET PET, the LNRmean was significantly higher in GB compared to RN (p=0.034). CONCLUSIONS Unlike (18)F-FCho, (18)F-FDG and (18)F-FET PET were effective in discriminating GB from RN. Interestingly, in the case of (18)F-FDG, delayed PET seems particularly useful. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE Our results suggest that (delayed) (18)F-FDG and (18)F-FET PET can be used to discriminate GB (recurrence) from RN. Confirmation of these results in clinical studies is needed.
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Affiliation(s)
- Julie Bolcaen
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
| | - Benedicte Descamps
- iMinds Medical IT - MEDISIP - Infinity lab, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Karel Deblaere
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Elke Decrock
- Department of Basic Medical Sciences-Physiology group, Ghent University, Ghent, Belgium
| | - Luc Leybaert
- Department of Basic Medical Sciences-Physiology group, Ghent University, Ghent, Belgium
| | - Christian Vanhove
- iMinds Medical IT - MEDISIP - Infinity lab, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Ingeborg Goethals
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
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Perez-Torres CJ, Engelbach JA, Cates J, Thotala D, Yuan L, Schmidt RE, Rich KM, Drzymala RE, Ackerman JJH, Garbow JR. Toward distinguishing recurrent tumor from radiation necrosis: DWI and MTC in a Gamma Knife--irradiated mouse glioma model. Int J Radiat Oncol Biol Phys 2014; 90:446-53. [PMID: 25104071 DOI: 10.1016/j.ijrobp.2014.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/05/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Accurate noninvasive diagnosis is vital for effective treatment planning. Presently, standard anatomical magnetic resonance imaging (MRI) is incapable of differentiating recurring tumor from delayed radiation injury, as both lesions are hyperintense in both postcontrast T1- and T2-weighted images. Further studies are therefore necessary to identify an MRI paradigm that can differentially diagnose these pathologies. Mouse glioma and radiation injury models provide a powerful platform for this purpose. METHODS AND MATERIALS Two MRI contrasts that are widely used in the clinic were chosen for application to a glioma/radiation-injury model: diffusion weighted imaging, from which the apparent diffusion coefficient (ADC) is obtained, and magnetization transfer contrast, from which the magnetization transfer ratio (MTR) is obtained. These metrics were evaluated longitudinally, first in each lesion type alone-glioma versus irradiation - and then in a combined irradiated glioma model. RESULTS MTR was found to be consistently decreased in all lesions compared to nonlesion brain tissue (contralateral hemisphere), with limited specificity between lesion types. In contrast, ADC, though less sensitive to the presence of pathology, was increased in radiation injury and decreased in tumors. In the irradiated glioma model, ADC also increased immediately after irradiation, but decreased as the tumor regrew. CONCLUSIONS ADC is a better metric than MTR for differentiating glioma from radiation injury. However, MTR was more sensitive to both tumor and radiation injury than ADC, suggesting a possible role in detecting lesions that do not enhance strongly on T1-weighted images.
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Affiliation(s)
| | - John A Engelbach
- Department of Radiology, Washington University, St. Louis, Missouri
| | - Jeremy Cates
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Dinesh Thotala
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Liya Yuan
- Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Robert E Schmidt
- Department of Neuropathology, Washington University, St. Louis, Missouri
| | - Keith M Rich
- Department of Radiation Oncology, Washington University, St. Louis, Missouri; Department of Neurosurgery, Washington University, St. Louis, Missouri
| | - Robert E Drzymala
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Joseph J H Ackerman
- Department of Chemistry, Washington University, St. Louis, Missouri; Department of Radiology, Washington University, St. Louis, Missouri; Department of Internal Medicine, Washington University, St. Louis, Missouri
| | - Joel R Garbow
- Department of Radiology, Washington University, St. Louis, Missouri.
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Scheidegger R, Wong ET, Alsop DC. Contributors to contrast between glioma and brain tissue in chemical exchange saturation transfer sensitive imaging at 3 Tesla. Neuroimage 2014; 99:256-68. [PMID: 24857712 DOI: 10.1016/j.neuroimage.2014.05.036] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/30/2014] [Accepted: 05/14/2014] [Indexed: 11/26/2022] Open
Abstract
Off-resonance saturation transfer images have shown intriguing differences in intensity in glioma compared to normal brain tissues. Interpretation of these differences is complicated, however, by the presence of multiple sources of exchanging magnetization including amide, amine, and hydroxyl protons, asymmetric magnetization transfer contrast (MTC) from macromolecules, and various protons with resonances in the aliphatic spectral region. We report a study targeted at separating these components and identifying their relative contributions to contrast in glioma. Off-resonance z-spectra at several saturation powers and durations were obtained from 6 healthy controls and 8 patients with high grade glioma. Results indicate that broad macromolecular MTC in normal brain tissue is responsible for the majority of contrast with glioma. Amide exchange could be detected with lower saturation power than has previously been reported in glioma, but it was a weak signal source with no detectable contrast from normal brain tissue. At higher saturation powers, amine proton exchange was a major contributor to the observed signal but showed no significant difference from normal brain. Robust acquisition strategies that effectively isolate the contributions of broad macromolecular MTC asymmetry from amine exchange were demonstrated that may provide improved contrast between glioma and normal tissue.
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Affiliation(s)
- Rachel Scheidegger
- Harvard-MIT Division of Health Sciences and Technology, 77 Massachusetts Ave E25, Cambridge, MA 02139, USA; Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA.
| | - Eric T Wong
- Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA; Neurology, Harvard Medical School, Boston, MA 02115, USA.
| | - David C Alsop
- Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215, USA; Radiology, Harvard Medical School, Boston, MA 02115, USA.
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Xu J, Li K, Zu Z, Xia L, Gochberg DF, Gore JC. Quantitative magnetization transfer imaging of rodent glioma using selective inversion recovery. NMR IN BIOMEDICINE 2014; 27:253-60. [PMID: 24338993 PMCID: PMC3947425 DOI: 10.1002/nbm.3058] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 11/07/2013] [Accepted: 11/08/2013] [Indexed: 05/08/2023]
Abstract
Magnetization transfer (MT) provides an indirect means to detect noninvasively variations in macromolecular contents in biological tissues, but, so far, there have been only a few quantitative MT (qMT) studies reported in cancer, all of which used off-resonance pulsed saturation methods. This article describes the first implementation of a different qMT approach, selective inversion recovery (SIR), for the characterization of tumor in vivo using a rodent glioma model. The SIR method is an on-resonance method capable of fitting qMT parameters and T1 relaxation time simultaneously without mapping B0 and B1 , which is very suitable for high-field qMT measurements because of the lower saturation absorption rate. The results show that the average pool size ratio (PSR, the macromolecular pool versus the free water pool) in rat 9 L glioma (5.7%) is significantly lower than that in normal rat gray matter (9.2%) and white matter (17.4%), which suggests that PSR is potentially a sensitive imaging biomarker for the assessment of brain tumor. Despite being less robust, the estimated MT exchange rates also show clear differences from normal tissues (19.7 Hz for tumors versus 14.8 and 10.2 Hz for gray and white mater, respectively). In addition, the influence of confounding effects, e.g. B1 inhomogeneity, on qMT parameter estimates is investigated with numerical simulations. These findings not only help to better understand the changes in the macromolecular contents of tumors, but are also important for the interpretation of other imaging contrasts, such as chemical exchange saturation transfer of tumors.
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Affiliation(s)
- Junzhong Xu
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA
- Corresponding author: Address: Vanderbilt University, Institute of Imaging Science, 1161 21 Avenue South, AA 1105 MCN, Nashville, TN 37232-2310, United States. Fax: +1 615 322 0734. (Junzhong Xu)
| | - Ke Li
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA
| | - Zhongliang Zu
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA
| | - Li Xia
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA
| | - Daniel F. Gochberg
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN 37232, USA
| | - John C. Gore
- Institute of Imaging Science, Vanderbilt University, Nashville, TN 37232, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN 37232, USA
- Department of Physics and Astronomy, Vanderbilt University, Nashville, TN 37232, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37232, USA
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN 37232, USA
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Hong X, Liu L, Wang M, Ding K, Fan Y, Ma B, Lal B, Tyler B, Mangraviti A, Wang S, Wong J, Laterra J, Zhou J. Quantitative multiparametric MRI assessment of glioma response to radiotherapy in a rat model. Neuro Oncol 2013; 16:856-67. [PMID: 24366911 DOI: 10.1093/neuonc/not245] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The inability of structural MRI to accurately measure tumor response to therapy complicates care management for patients with gliomas. The purpose of this study was to assess the potential of several noninvasive functional and molecular MRI biomarkers for the assessment of glioma response to radiotherapy. METHODS Fourteen U87 tumor-bearing rats were irradiated using a small-animal radiation research platform (40 or 20 Gy), and 6 rats were used as controls. MRI was performed on a 4.7 T animal scanner, preradiation treatment, as well as at 3, 6, 9, and 14 days postradiation. Image features of the tumors, as well as tumor volumes and animal survival, were quantitatively compared. RESULTS Structural MRI showed that all irradiated tumors still grew in size during the initial days postradiation. The apparent diffusion coefficient (ADC) values of tumors increased significantly postradiation (40 and 20 Gy), except at day 3 postradiation, compared with preradiation. The tumor blood flow decreased significantly postradiation (40 and 20 Gy), but the relative blood flow (tumor vs contralateral) did not show a significant change at most time points postradiation. The amide proton transfer weighted (APTw) signals of the tumor decreased significantly at all time points postradiation (40 Gy), and also at day 9 postradiation (20 Gy). The blood flow and APTw maps demonstrated tumor features that were similar to those seen on gadolinium-enhanced T1-weighted images. CONCLUSIONS Tumor ADC, blood flow, and APTw were all useful imaging biomarkers by which to predict glioma response to radiotherapy. The APTw signal was most promising for early response assessment in this model.
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Affiliation(s)
- Xiaohua Hong
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Li Liu
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Meiyun Wang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Kai Ding
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Ying Fan
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Bo Ma
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Bachchu Lal
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Betty Tyler
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Antonella Mangraviti
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Silun Wang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - John Wong
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - John Laterra
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
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Results of a questionnaire regarding practice patterns for the diagnosis and treatment of intracranial radiation necrosis after SRS. J Neurooncol 2013; 115:469-75. [DOI: 10.1007/s11060-013-1248-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 09/07/2013] [Indexed: 10/26/2022]
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Zhou J, Hong X, Zhao X, Gao JH, Yuan J. APT-weighted and NOE-weighted image contrasts in glioma with different RF saturation powers based on magnetization transfer ratio asymmetry analyses. Magn Reson Med 2013; 70:320-7. [PMID: 23661598 DOI: 10.1002/mrm.24784] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Revised: 03/11/2013] [Accepted: 04/03/2013] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the saturation-power dependence of amide proton transfer (APT)-weighted and nuclear Overhauser enhancement-weighted image contrasts in a rat glioma model at 4.7 T. METHODS The 9L tumor-bearing rats (n = 8) and fresh chicken eggs (n = 4) were scanned on a 4.7-T animal magnetic resonance imaging scanner. Z-spectra over an offset range of ±6 ppm were acquired with different saturation powers, followed by the magnetization transfer-ratio asymmetry analyses around the water resonance. RESULTS The nuclear Overhauser enhancement signal upfield from the water resonance (-2.5 to -5 ppm) was clearly visible at lower saturation powers (e.g., 0.6 µT) and was larger in the contralateral normal brain tissue than in the tumor. Conversely, the APT effect downfield from the water resonance was maximized at relatively higher saturation powers (e.g., 2.1 µT) and was larger in the tumor than in the contralateral normal brain tissue. The nuclear Overhauser enhancement decreased the APT-weighted image signal, based on the magnetization transfer-ratio asymmetry analysis, but increased the APT-weighted image contrast between the tumor and contralateral normal brain tissue. CONCLUSION The APT and nuclear Overhauser enhancement image signals in tumor are maximized at different saturation powers. The saturation power of roughly 2 μT is ideal for APT-weighted imaging at clinical B0 field strengths.
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Affiliation(s)
- Jinyuan Zhou
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.
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Diffusion tensor magnetic resonance imaging of rat glioma models: a correlation study of MR imaging and histology. J Comput Assist Tomogr 2013. [PMID: 23192213 DOI: 10.1097/rct.0b013e3182685436] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Diffusion tensor magnetic resonance (MR) imaging (DTI) can be used to characterize the microstructures of ordered biological tissues. This study was designed to assess histological features of gliomas and surrounding brain tissues in rats using DTI. METHODS Three types of tumors, a 9L gliosarcoma (n = 8), a F98 glioma (n = 5), and a human glioblastoma xenograft (GBM22; n = 8) were incubated in rat brains and underwent conventional MRI and DTI scanning using a 4.7-T animal MRI system. Fractional anisotropy (FA), isotropic apparent diffusion coefficient, parallel diffusivity (λ//), and perpendicular diffusivity (λ⊥), as well as histological features within several regions of interest were analyzed. RESULTS All tumor masses consisted of low-FA central zones (tumor center) and high-FA peripheral regions (tumor rim). Histological examination revealed the existence of highly coherent tumor organizations (circular for 9L and F98 or radial for GBM22) in the tumor rims. There were higher apparent diffusion coefficient, λ⊥, and λ// in the peritumoral edema compared to the contralateral gray matter. There were significantly lower FA and higher λ⊥ in the ipsilateral white matter than in the contralateral white matter for the GBM22 tumor, whereas there were no differences for the 9L and F98 tumors. Histologic examination showed GBM22 tumor infiltration into the ipsilateral damaged white matter. CONCLUSIONS Quantitative analysis of DTI indices provides useful information for assessing tumor microstructure and tumor cell invasion into the adjacent gray matter and white matter.
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Radiation induced brain injury: assessment of white matter tracts in a pre-clinical animal model using diffusion tensor MR imaging. J Neurooncol 2013; 112:9-15. [PMID: 23334608 DOI: 10.1007/s11060-012-1031-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 12/26/2012] [Indexed: 01/16/2023]
Abstract
We aim to study radiation induced white matter injury in a pre-clinical model using Diffusion tensor MR imaging (DTI). Nineteen 12-week old Sprague-Dawley rats were irradiated to the right hemisphere using a linear accelerator. The dose distribution map was coregistered to the DTI map to generate the actual radiation dose to each white matter tract. Rats underwent longitudinal DTI scans at five time points from 4 to 48 weeks post-radiation with histological evaluations. Fractional anisotropy (FA) of the external capsule, fornix, cerebral peduncle, anterior commissure, optic tract and optic nerve was evaluated. Radiation dose was highest at the ipsilateral external capsule and fornix (29.4 ± 1.3 and 29.8 ± 1.1 Gy, respectively). Optic nerve received 50 % dose to the external capsule and other white matter tracts received 80 % dose. Significantly lower FA was firstly found in the ipsilateral external capsule at 4 weeks post-radiation and in the ipsilateral fornix at 40 weeks post-radiation compared to the contralateral side. Significantly lower FA was found in contralateral optic nerve compared to ipsilateral optic nerve at 48 weeks post-radiation despite ipsilateral optic nerves receiving higher radiation dose than contralateral optic nerve (p = 0.021). No differences were found in other white matter regions until 48 weeks. Histology indicated demyelination, axonal degeneration and coagulative necrosis in all injured white matter. DTI can serve as a promising tool for assessment of radiation induced white matter injury and regional radiosensitivity of white matter tracts.
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