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Curcio C, Mucciolo G, Roux C, Brugiapaglia S, Scagliotti A, Guadagnin G, Conti L, Longo D, Grosso D, Papotti MG, Hirsch E, Cappello P, Varner JA, Novelli F. PI3Kγ inhibition combined with DNA vaccination unleashes a B-cell-dependent antitumor immunity that hampers pancreatic cancer. J Exp Clin Cancer Res 2024; 43:157. [PMID: 38824552 PMCID: PMC11143614 DOI: 10.1186/s13046-024-03080-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024] Open
Abstract
Phosphoinositide-3-kinase γ (PI3Kγ) plays a critical role in pancreatic ductal adenocarcinoma (PDA) by driving the recruitment of myeloid-derived suppressor cells (MDSC) into tumor tissues, leading to tumor growth and metastasis. MDSC also impair the efficacy of immunotherapy. In this study we verify the hypothesis that MDSC targeting, via PI3Kγ inhibition, synergizes with α-enolase (ENO1) DNA vaccination in counteracting tumor growth.Mice that received ENO1 vaccination followed by PI3Kγ inhibition had significantly smaller tumors compared to those treated with ENO1 alone or the control group, and correlated with i) increased circulating anti-ENO1 specific IgG and IFNγ secretion by T cells, ii) increased tumor infiltration of CD8+ T cells and M1-like macrophages, as well as up-modulation of T cell activation and M1-like related transcripts, iii) decreased infiltration of Treg FoxP3+ T cells, endothelial cells and pericytes, and down-modulation of the stromal compartment and T cell exhaustion gene transcription, iv) reduction of mature and neo-formed vessels, v) increased follicular helper T cell activation and vi) increased "antigen spreading", as many other tumor-associated antigens were recognized by IgG2c "cytotoxic" antibodies. PDA mouse models genetically devoid of PI3Kγ showed an increased survival and a pattern of transcripts in the tumor area similar to that of pharmacologically-inhibited PI3Kγ-proficient mice. Notably, tumor reduction was abrogated in ENO1 + PI3Kγ inhibition-treated mice in which B cells were depleted.These data highlight a novel role of PI3Kγ in B cell-dependent immunity, suggesting that PI3Kγ depletion strengthens the anti-tumor response elicited by the ENO1 DNA vaccine.
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Affiliation(s)
- Claudia Curcio
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Gianluca Mucciolo
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Cecilia Roux
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Silvia Brugiapaglia
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Alessandro Scagliotti
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Giorgia Guadagnin
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Laura Conti
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
- Molecular Biotechnology Center, University of Torino, Turin, Italy
| | - Dario Longo
- Institute of Biostructures and Bioimaging (IBB), National Research Council of Italy (CNR), Turin, Italy
| | - Demis Grosso
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
| | - Mauro Giulio Papotti
- Pathology Unit, Department of Medical Sciences, University of Torino, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
- Molecular Biotechnology Center, University of Torino, Turin, Italy
| | - Paola Cappello
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy
- Molecular Biotechnology Center, University of Torino, Turin, Italy
| | - Judith A Varner
- Moores Cancer Center, Department of Pathology, University of California, San Diego, CA, USA
| | - Francesco Novelli
- Department of Molecular Biotechnology and Health Sciences, University of Torino, Piazza Nizza 44Bis, 10126, Turin, Italy.
- Molecular Biotechnology Center, University of Torino, Turin, Italy.
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Wang J, Geng W, Wu J, Kang T, Wu Z, Lin J, Yang Y, Cai C, Cai S. Intravoxel incoherent motion magnetic resonance imaging reconstruction from highly under-sampled diffusion-weighted PROPELLER acquisition data via physics-informed residual feedback unrolled network. Phys Med Biol 2023; 68:175022. [PMID: 37541226 DOI: 10.1088/1361-6560/aced77] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/04/2023] [Indexed: 08/06/2023]
Abstract
Objective. The acquisition of diffusion-weighted images for intravoxel incoherent motion (IVIM) imaging is time consuming. This work aims to accelerate the scan through a highly under-sampling diffusion-weighted turbo spin echo PROPELLER (DW-TSE-PROPELLER) scheme and to develop a reconstruction method for accurate IVIM parameter mapping from the under-sampled data.Approach.The proposed under-sampling DW-TSE-PROPELLER scheme for IVIM imaging is that a few blades perb-value are acquired and rotated along theb-value dimension to cover high-frequency information. A physics-informed residual feedback unrolled network (PIRFU-Net) is proposed to directly estimate distortion-free and artifact-free IVIM parametric maps (i.e., the perfusion-free diffusion coefficientDand the perfusion fractionf) from highly under-sampled DW-TSE-PROPELLER data. PIRFU-Net used an unrolled convolution network to explore data redundancy in the k-q space to remove under-sampling artifacts. An empirical IVIM physical constraint was incorporated into the network to ensure that the signal evolution curves along theb-value follow a bi-exponential decay. The residual between the realistic and estimated measurements was fed into the network to refine the parametric maps. Meanwhile, the use of synthetic training data eliminated the need for genuine DW-TSE-PROPELLER data.Main results.The experimental results show that the DW-TSE-PROPELLER acquisition was six times faster than full k-space coverage PROPELLER acquisition and within a clinically acceptable time. Compared with the state-of-the-art methods, the distortion-freeDandfmaps estimated by PIRFU-Net were more accurate and had better-preserved tissue boundaries on a simulated human brain and realistic phantom/rat brain/human brain data.Significance.Our proposed method greatly accelerates IVIM imaging. It is capable of directly and simultaneously reconstructing distortion-free, artifact-free, and accurateDandfmaps from six-fold under-sampled DW-TSE-PROPELLER data.
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Affiliation(s)
- Jiechao Wang
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Wenhua Geng
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Jian Wu
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Taishan Kang
- Department of Radiology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361004, People's Republic of China
| | - Zhigang Wu
- Clinical & Technical Solutions, Philips Healthcare, Shenzhen, 518000, People's Republic of China
| | - Jianzhong Lin
- Department of Radiology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361004, People's Republic of China
| | - Yu Yang
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Congbo Cai
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005, People's Republic of China
| | - Shuhui Cai
- Department of Electronic Science, Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance, Xiamen University, Xiamen, 361005, People's Republic of China
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Azmitia L, Taylor G, Massimi L, Visocchi M. Pediatric Meningiomas: Current Insights on Pathogenesis and Management. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:69-74. [PMID: 38153451 DOI: 10.1007/978-3-031-36084-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Meningiomas are rare tumors in children, ranging from 0.4 to 4% of intracranial tumors. Differently from their adult counterpart, pediatric meningiomas (PMs) often show peculiar aspects such as the development of tumoral cysts, the involvement of the intraventricular space, and missing attachment to the dura mater. The most important difference with adults is represented by the high incidence of WHO grade II and III variants, which can account for more than 70% of cases. The prognosis of PMs mainly depends on the initial surgical resection because radiotherapy, which is the main treatment option in the case of tumor recurrence or progression, does not seem to increase the relapse free survival and the overall survival, and chemotherapy still misses specific and effective protocols.On these grounds, the need to better understand these tumors, to favor an appropriate multidisciplinary management, is particularly felt. The present review is focused on the advances on the pathogenesis, the molecular aspects, and the managements of PMs, with the goal to improve the knowledge of these challenging neoplasms.
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Affiliation(s)
- Luis Azmitia
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
- Department of Neurosurgery, Military Hospital, Hamburg, Germany
| | - Gerardo Taylor
- Department of Neurosurgery, Hospital de Chimaltenango, Chimaltenango, Guatemala
| | - Luca Massimi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
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Abstract
Protons and carbon ions (hadrons) have useful properties for the treatments of patients affected by oncological pathologies. They are more precise than conventional X-rays and possess radiobiological characteristics suited for treating radio-resistant or inoperable tumours. This paper gives an overview of the status of hadron therapy around the world. It focusses on the Italian National Centre for Oncological Hadron therapy (CNAO), introducing operation procedures, system performance, expansion projects, methodologies and modelling to build individualized treatments. There is growing evidence that supports safety and effectiveness of hadron therapy for a variety of clinical situations. However, there is still a lack of high-level evidence directly comparing hadron therapy with modern conventional radiotherapy techniques. The results give an overview of pre-clinical and clinical research studies and of the treatments of 3700 patients performed at CNAO. The success and development of hadron therapy is strongly associated with the creation of networks among hadron therapy facilities, clinics, universities and research institutions. These networks guarantee the growth of cultural knowledge on hadron therapy, favour the efficient recruitment of patients and present available competences for R&D (Research and Development) programmes.
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Chen F, Dai Z, Yao L, Dong C, Shi H, Dou W, Xing W. Association of cerebral microvascular perfusion and diffusion dynamics detected by intravoxel incoherent motion-diffusion weighted imaging with initial neurological function and clinical outcome in acute ischemic stroke. PeerJ 2021; 9:e12196. [PMID: 34616631 PMCID: PMC8450009 DOI: 10.7717/peerj.12196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background This work aimed to explore the association of cerebral microvascular perfusion and diffusion dynamics measured by intravoxel incoherent motion (IVIM) imaging with initial neurological function and clinical outcome in acute stroke. Methods In total, 39 patients were assessed with admission National Institutes of Health Stroke Scale (NIHSS) and day-90 modified Rankin Scale (mRS). The parametrical maps of IVIM were obtained, including apparent diffusion coefficient (ADC), pseudo-diffusion coefficient (D*), true diffusion coefficient (D) and perfusion fraction (f). The fD* was the product of f and D*. Moreover, the ratios of lesioned/contralateral parameters (rADC, rD, rD*, rf and rfD*) were also obtained. The differences of these parameters between the poor outcome group and good outcome group were evaluated. Partial correlation analysis was used to evaluate the correlations between the admission NIHSS/day-90 mRS and each parameter ratio, with lesion volumes controlled. Results The ADC, D, D*, f and fD* values of lesions were significantly reduced than those of the contralateral regions. The rADC and rD were significantly decreased in the poor outcome group than good outcome group (all p < 0.01). With lesion volume controlled, rADC showed a weak negative correlation (r = −0.340, p = 0.037) and a notable negative correlation (r = −0.688, p < 0.001) with admission NIHSS score and day-90 mRS score, respectively. In addition, rD showed a strong negative correlation (r = −0.731, p < 0.001) with day-90 mRS score. Conclusion Significant negative correlations were revealed between IVIM derived diffusion dynamics parameters and initial neurological function as well as clinical outcome for patients with acute ischemic stroke. IVIM can be therefore suggested as an effective non-invasive method for evaluating the acute ischemic stroke.
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Affiliation(s)
- Fei Chen
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China.,Department of Radiology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Zhenyu Dai
- Department of Radiology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Lizheng Yao
- Department of Radiology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Congsong Dong
- Department of Radiology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | - Haicun Shi
- Department of Neurology, Yancheng Third People's Hospital, Yancheng, Jiangsu, China
| | | | - Wei Xing
- Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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6
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Abstract
The signal acquired in vivo using a diffusion-weighted MR imaging (DWI) sequence is influenced by blood motion in the tissue. This means that perfusion information from a DWI sequence can be obtained in addition to thermal diffusion, if the appropriate sequence parameters and postprocessing methods are applied. This is commonly regrouped under the denomination intravoxel incoherent motion (IVIM) perfusion MR imaging. Of relevance, the perfusion information acquired with IVIM is essentially local, quantitative and acquired without intravenous injection of contrast media. The aim of this work is to review the IVIM method and its clinical applications.
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Affiliation(s)
- Christian Federau
- University and ETH Zürich, Institute for Biomedical Engineering, Gloriastrasse 35, Zürich 8092, Switzerland; Ai Medical AG, Goldhaldenstr 22a, Zollikon 8702, Switzerland.
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7
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Buizza G, Zampini MA, Riva G, Molinelli S, Fontana G, Imparato S, Ciocca M, Iannalfi A, Orlandi E, Baroni G, Paganelli C. Investigating DWI changes in white matter of meningioma patients treated with proton therapy. Phys Med 2021; 84:72-79. [PMID: 33872972 DOI: 10.1016/j.ejmp.2021.03.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To evaluate changes in diffusion and perfusion-related properties of white matter (WM) induced by proton therapy, which is capable of a greater dose sparing to organs at risk with respect to conventional X-ray radiotherapy, and to eventually expose early manifestations of delayed neuro-toxicities. METHODS Apparent diffusion coefficient (ADC) and IVIM parameters (D, D* and f) were estimated from diffusion-weighted MRI (DWI) in 46 patients affected by meningioma and treated with proton therapy. The impact on changes in diffusion and perfusion-related WM properties of dose and time, as well as the influence of demographic and pre-treatment clinical information, were investigated through linear mixed-effects models. RESULTS Decreasing trends in ADC and D were found for WM regions hit by medium-high (30-40 Gy(RBE)) and high (>40 Gy(RBE)) doses, which are compatible with diffusion restriction due to radiation-induced cellular injury. Significant influence of dose and time on median ADC changes were observed. Also, D* showed a significant dependency on dose, whereas f consistently showed no dependency on dose and time. Age, gender and surgery extent were also found to affect changes in ADC. CONCLUSIONS These results overall agree with those from studies conducted on cohorts of mixed proton and X-ray radiotherapy patients. Future work should focus on relating our findings with clinical information of co-morbidities and thus exploiting such or more advanced imaging data to build normal tissue complication probability models to better integrate clinical and dose information.
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Affiliation(s)
- Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy.
| | - Marco Andrea Zampini
- MR Solutions Ltd., Ashbourne House, Old Portsmouth Rd., Guildford, United Kingdom.
| | - Giulia Riva
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Silvia Molinelli
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Giulia Fontana
- Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Sara Imparato
- Radiology Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Mario Ciocca
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Alberto Iannalfi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Ester Orlandi
- Clinical Department, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; Clinical Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi 53, 27100 Pavia, Italy.
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy.
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Jabehdar Maralani P, Myrehaug S, Mehrabian H, Chan AKM, Wintermark M, Heyn C, Conklin J, Ellingson BM, Rahimi S, Lau AZ, Tseng CL, Soliman H, Detsky J, Daghighi S, Keith J, Munoz DG, Das S, Atenafu EG, Lipsman N, Perry J, Stanisz G, Sahgal A. Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma. Radiother Oncol 2021; 156:258-265. [PMID: 33418005 PMCID: PMC8186561 DOI: 10.1016/j.radonc.2020.12.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion: ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada.
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Hatef Mehrabian
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Aimee K M Chan
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Max Wintermark
- Department of Radiology, Stanford University, United States
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, United States
| | - Benjamin M Ellingson
- Department of Radiological Sciences and Psychiatry, University of California Los Angeles, United States
| | - Saba Rahimi
- Department of Biomedical Engineering, University of Toronto, Canada
| | - Angus Z Lau
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Shadi Daghighi
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - David G Munoz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - Sunit Das
- Department of Surgery, Division of Neurosurgery, University of Toronto, Canada
| | | | - Nir Lipsman
- Department of Surgery, Division of Neurosurgery, University of Toronto, Canada
| | - James Perry
- Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Greg Stanisz
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
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Intravoxel incoherent motion as a tool to detect early microstructural changes in meningiomas treated with proton therapy. Neuroradiology 2021; 63:1053-1060. [PMID: 33392736 DOI: 10.1007/s00234-020-02630-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess early microstructural changes of meningiomas treated with proton therapy through quantitative analysis of intravoxel incoherent motion (IVIM) and diffusion-weighted imaging (DWI) parameters. METHODS Seventeen subjects with meningiomas that were eligible for proton therapy treatment were retrospectively enrolled. Each subject underwent a magnetic resonance imaging (MRI) including DWI sequences and IVIM assessments at baseline, immediately before the 1st (t0), 10th (t10), 20th (t20), and 30th (t30) treatment fraction and at follow-up. Manual tumor contours were drawn on T2-weighted images by two expert neuroradiologists and then rigidly registered to DWI images. Median values of the apparent diffusion coefficient (ADC), true diffusion (D), pseudo-diffusion (D*), and perfusion fraction (f) were extracted at all timepoints. Statistical analysis was performed using the pairwise Wilcoxon test. RESULTS Statistically significant differences from baseline to follow-up were found for ADC, D, and D* values, with a progressive increase in ADC and D in conjunction with a progressive decrease in D*. MRI during treatment showed statistically significant differences in D values between t0 and t20 (p = 0.03) and t0 and t30 (p = 0.02), and for ADC values between t0 and t20 (p = 0.04), t10 and t20 (p = 0.02), and t10 and t30 (p = 0.035). Subjects that showed a volume reduction greater than 15% of the baseline tumor size at follow-up showed early D changes, whereas ADC changes were not statistically significant. CONCLUSION IVIM appears to be a useful tool for detecting early microstructural changes within meningiomas treated with proton therapy and may potentially be able to predict tumor response.
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Sacco S, Ballati F, Gaetani C, Lomoro P, Farina LM, Bacila A, Imparato S, Paganelli C, Buizza G, Iannalfi A, Baroni G, Valvo F, Bastianello S, Preda L. Multi-parametric qualitative and quantitative MRI assessment as predictor of histological grading in previously treated meningiomas. Neuroradiology 2020; 62:1441-1449. [PMID: 32583368 DOI: 10.1007/s00234-020-02476-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Meningiomas are mainly benign tumors, though a considerable proportion shows aggressive behaviors histologically consistent with atypia/anaplasia. Histopathological grading is usually assessed through invasive procedures, which is not always feasible due to the inaccessibility of the lesion or to treatment contraindications. Therefore, we propose a multi-parametric MRI assessment as a predictor of meningioma histopathological grading. METHODS Seventy-three patients with 74 histologically proven and previously treated meningiomas were retrospectively enrolled (42 WHO I, 24 WHO II, 8 WHO III) and studied with MRI including T2 TSE, FLAIR, Gradient Echo, DWI, and pre- and post-contrast T1 sequences. Lesion masks were segmented on post-contrast T1 sequences and rigidly registered to ADC maps to extract quantitative parameters from conventional DWI and intravoxel incoherent motion model assessing tumor perfusion. Two expert neuroradiologists assessed morphological features of meningiomas with semi-quantitative scores. RESULTS Univariate analysis showed different distributions (p < 0.05) of quantitative diffusion parameters (Wilcoxon rank-sum test) and morphological features (Pearson's chi-square; Fisher's exact test) among meningiomas grouped in low-grade (WHO I) and higher grade forms (WHO II/III); the only exception consisted of the tumor-brain interface. A multivariate logistic regression, combining all parameters showing statistical significance in the univariate analysis, allowed discrimination between the groups of meningiomas with high sensitivity (0.968) and specificity (0.925). Heterogeneous contrast enhancement and low ADC were the best independent predictors of atypia and anaplasia. CONCLUSION Our multi-parametric MRI assessment showed high sensitivity and specificity in predicting histological grading of meningiomas. Such an assessment may be clinically useful in characterizing lesions without histological diagnosis. Key points • When surgery and biopsy are not feasible, parameters obtained from both conventional and diffusion-weighted MRI can predict atypia and anaplasia in meningiomas with high sensitivity and specificity. • Low ADC values and heterogeneous contrast enhancement are the best predictors of higher grade meningioma.
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Affiliation(s)
- Simone Sacco
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francesco Ballati
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Clara Gaetani
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Pascal Lomoro
- Department of Radiology, Valduce Hospital, Como, Italy
| | | | - Ana Bacila
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Sara Imparato
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alberto Iannalfi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Francesca Valvo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Stefano Bastianello
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Diagnostic Imaging Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100, Pavia, PV, Italy.
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