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Pons-Escoda A, Garcia-Ruiz A, Naval-Baudin P, Martinez-Zalacain I, Castell J, Camins A, Vidal N, Bruna J, Cos M, Perez-Lopez R, Oleaga L, Warnert E, Smits M, Majos C. Differentiating IDH-mutant astrocytomas and 1p19q-codeleted oligodendrogliomas using DSC-PWI: high performance through cerebral blood volume and percentage of signal recovery percentiles. Eur Radiol 2024; 34:5320-5330. [PMID: 38282078 PMCID: PMC11255054 DOI: 10.1007/s00330-024-10611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/13/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE Presurgical differentiation between astrocytomas and oligodendrogliomas remains an unresolved challenge in neuro-oncology. This research aims to provide a comprehensive understanding of each tumor's DSC-PWI signatures, evaluate the discriminative capacity of cerebral blood volume (CBV) and percentage of signal recovery (PSR) percentile values, and explore the synergy of CBV and PSR combination for pre-surgical differentiation. METHODS Patients diagnosed with grade 2 and 3 IDH-mutant astrocytomas and IDH-mutant 1p19q-codeleted oligodendrogliomas were retrospectively retrieved (2010-2022). 3D segmentations of each tumor were conducted, and voxel-level CBV and PSR were extracted to compute mean, minimum, maximum, and percentile values. Statistical comparisons were performed using the Mann-Whitney U test and the area under the receiver operating characteristic curve (AUC-ROC). Lastly, the five most discriminative variables were combined for classification with internal cross-validation. RESULTS The study enrolled 52 patients (mean age 45-year-old, 28 men): 28 astrocytomas and 24 oligodendrogliomas. Oligodendrogliomas exhibited higher CBV and lower PSR than astrocytomas across all metrics (e.g., mean CBV = 2.05 and 1.55, PSR = 0.68 and 0.81 respectively). The highest AUC-ROCs and the smallest p values originated from CBV and PSR percentiles (e.g., PSRp70 AUC-ROC = 0.84 and p value = 0.0005, CBVp75 AUC-ROC = 0.8 and p value = 0.0006). The mean, minimum, and maximum values yielded lower results. Combining the best five variables (PSRp65, CBVp70, PSRp60, CBVp75, and PSRp40) achieved a mean AUC-ROC of 0.87 for differentiation. CONCLUSIONS Oligodendrogliomas exhibit higher CBV and lower PSR than astrocytomas, traits that are emphasized when considering percentiles rather than mean or extreme values. The combination of CBV and PSR percentiles results in promising classification outcomes. CLINICAL RELEVANCE STATEMENT The combination of histogram-derived percentile values of cerebral blood volume and percentage of signal recovery from DSC-PWI enhances the presurgical differentiation between astrocytomas and oligodendrogliomas, suggesting that incorporating these metrics into clinical practice could be beneficial. KEY POINTS • The unsupervised selection of percentile values for cerebral blood volume and percentage of signal recovery enhances presurgical differentiation of astrocytomas and oligodendrogliomas. • Oligodendrogliomas exhibit higher cerebral blood volume and lower percentage of signal recovery than astrocytomas. • Cerebral blood volume and percentage of signal recovery combined provide a broader perspective on tumor vasculature and yield promising results for this preoperative classification.
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Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain.
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain.
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), Carrer de Casanova 143, 08036, Barcelona, Spain.
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain.
| | - Alonso Garcia-Ruiz
- Radiomics Group, Vall d'Hebron Institut d'Oncologia- VHIO, Carrer de Natzaret, 115-117, 08035, Barcelona, Spain
| | - Pablo Naval-Baudin
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Ignacio Martinez-Zalacain
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain
| | - Josep Castell
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Angels Camins
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Noemi Vidal
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain
- Pathology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Jordi Bruna
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain
| | - Monica Cos
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
| | - Raquel Perez-Lopez
- Radiomics Group, Vall d'Hebron Institut d'Oncologia- VHIO, Carrer de Natzaret, 115-117, 08035, Barcelona, Spain
| | - Laura Oleaga
- Radiology Department, Hospital Clinic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Esther Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Carles Majos
- Radiology Department, Feixa Llarga SN, Hospital Universitari de Bellvitge, 08907, Barcelona, Spain
- Neuro-oncology Unit, Feixa Llarga SN, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, 08907, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Feixa Llarga SN, 08907, Barcelona, Spain
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Pons-Escoda A, Naval-Baudin P, Viveros M, Flores-Casaperalta S, Martinez-Zalacaín I, Plans G, Vidal N, Cos M, Majos C. DSC-PWI presurgical differentiation of grade 4 astrocytoma and glioblastoma in young adults: rCBV percentile analysis across enhancing and non-enhancing regions. Neuroradiology 2024; 66:1267-1277. [PMID: 38834877 PMCID: PMC11246293 DOI: 10.1007/s00234-024-03385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/29/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE The presurgical discrimination of IDH-mutant astrocytoma grade 4 from IDH-wildtype glioblastoma is crucial for patient management, especially in younger adults, aiding in prognostic assessment, guiding molecular diagnostics and surgical planning, and identifying candidates for IDH-targeted trials. Despite its potential, the full capabilities of DSC-PWI remain underexplored. This research evaluates the differentiation ability of relative-cerebral-blood-volume (rCBV) percentile values for the enhancing and non-enhancing tumor regions compared to the more commonly used mean or maximum preselected rCBV values. METHODS This retrospective study, spanning 2016-2023, included patients under 55 years (age threshold based on World Health Organization recommendations) with grade 4 astrocytic tumors and known IDH status, who underwent presurgical MR with DSC-PWI. Enhancing and non-enhancing regions were 3D-segmented to calculate voxel-level rCBV, deriving mean, maximum, and percentile values. Statistical analyses were conducted using the Mann-Whitney U test and AUC-ROC. RESULTS The cohort consisted of 59 patients (mean age 46; 34 male): 11 astrocytoma-4 and 48 glioblastoma. While glioblastoma showed higher rCBV in enhancing regions, the differences were not significant. However, non-enhancing astrocytoma-4 regions displayed notably higher rCBV, particularly in lower percentiles. The 30th rCBV percentile for non-enhancing regions was 0.705 in astrocytoma-4, compared to 0.458 in glioblastoma (p = 0.001, AUC-ROC = 0.811), outperforming standard mean and maximum values. CONCLUSION Employing an automated percentile-based approach for rCBV selection enhances differentiation capabilities, with non-enhancing regions providing more insightful data. Elevated rCBV in lower percentiles of non-enhancing astrocytoma-4 is the most distinguishable characteristic and may indicate lowly vascularized infiltrated edema, contrasting with glioblastoma's pure edema.
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Affiliation(s)
- Albert Pons-Escoda
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain.
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain.
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), Barcelona, Spain.
| | - Pablo Naval-Baudin
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Facultat de Medicina i Ciències de La Salut, Universitat de Barcelona (UB), Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
| | - Mildred Viveros
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Ignacio Martinez-Zalacaín
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Diagnostic Imaging and Nuclear Medicine Research Group, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
| | - Gerard Plans
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
- Neurosurgery Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Noemi Vidal
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
- Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Monica Cos
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Carles Majos
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Neuro-oncology Unit, Institut d'Investigació Biomèdica de Bellvitge- IDIBELL, Barcelona, Spain
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Jaimovich SG, Takeuchi K, Testa VT, Okumura E, Jaimovich R, Cinalli G. Cylinder tumor surgery in pediatric low-grade gliomas. Childs Nerv Syst 2024:10.1007/s00381-024-06417-5. [PMID: 38644385 DOI: 10.1007/s00381-024-06417-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Periventricular pediatric low-grade gliomas (pLGG) present a surgical challenge due to their deep-seated location, accessibility, and relationship with the subcortical network connections. Minimally invasive parafascicular approaches with tubular brain retractors (port brain surgery) have emerged, in recent years, as an alternative to conventional microsurgical and endoscopic approaches for removal of periventricular tumors. OBJECTIVES To describe the minimally invasive approach with tubular brain retractors for periventricular pLGG, its technique, applications, safety, and efficacy. METHODS In this article, we describe the port brain surgery techniques for periventricular pLGG as performed in different centers, with different commercialized tubular retractor systems. Illustrative cases followed by a literature review are analyzed, with a detailed description of different approaches or techniques, comparing their advantages and disadvantages with contemporary microsurgical and endoscopic approaches. CONCLUSIONS The port brain surgery with micro-exoscopic vision and endoscopic assistance, for the treatment of deep-seated lesions such as periventricular pLGG, is an alternative for achieving a functionally safe-gross total or subtotal-tumor resection, obtaining adequate tissue for pathological examination. This technique could offer a new dimension for a less-invasive, safe, and effective access to deep-seated tumors, offering the possibility to lower morbidity in experienced hands.
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Affiliation(s)
- Sebastian Gaston Jaimovich
- Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina
- Department of Neurosurgery, FLENI, Buenos Aires, Argentina
| | - Kazuhito Takeuchi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | | | - Eriko Okumura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Roberto Jaimovich
- Department of Neurosurgery, "Prof. Dr. Juan P. Garrahan" Pediatric Hospital, Buenos Aires, Argentina
- Department of Neurosurgery, FLENI, Buenos Aires, Argentina
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital (AORN), Naples, Italy.
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González-López P, Kuptsov A, Gómez-Revuelta C, Fernández-Villa J, Abarca-Olivas J, Daniel RT, Meling TR, Nieto-Navarro J. The Integration of 3D Virtual Reality and 3D Printing Technology as Innovative Approaches to Preoperative Planning in Neuro-Oncology. J Pers Med 2024; 14:187. [PMID: 38392620 PMCID: PMC10890029 DOI: 10.3390/jpm14020187] [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: 12/16/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Our study explores the integration of three-dimensional (3D) virtual reality (VR) and 3D printing in neurosurgical preoperative planning. Traditionally, surgeons relied on two-dimensional (2D) imaging for complex neuroanatomy analyses, requiring significant mental visualization. Fortunately, nowadays advanced technology enables the creation of detailed 3D models from patient scans, utilizing different software. Afterwards, these models can be experienced through VR systems, offering comprehensive preoperative rehearsal opportunities. Additionally, 3D models can be 3D printed for hands-on training, therefore enhancing surgical preparedness. This technological integration transforms the paradigm of neurosurgical planning, ensuring safer procedures.
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Affiliation(s)
- Pablo González-López
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
| | - Artem Kuptsov
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
| | | | | | - Javier Abarca-Olivas
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
| | - Roy T Daniel
- Centre Hospitalier Universitaire Vaudois, 1005 Lausanne, Switzerland
| | - Torstein R Meling
- Department of Neurosurgery, Rigshospitalet, 92100 Copenhagen, Denmark
| | - Juan Nieto-Navarro
- Department of Neurosurgery, Hospital General Universitario, 03010 Alicante, Spain
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Salihoğlu AK, Booth TC. Editorial for "Apparent Diffusion Coefficient as Imaging Biomarker for Identifying IDH Mutation, 1p19q Codeletion, and MGMT Promoter Methylation Status in Patients With Glioma". J Magn Reson Imaging 2023; 58:739-740. [PMID: 36594487 DOI: 10.1002/jmri.28587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Arif K Salihoğlu
- Faculty of Medicine, Department of Physiology, Karadeniz Technical University, Trabzon, Turkey
| | - Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, St. Thomas' Hospital, London, UK
- Department of Neuroradiology, King's College Hospital National Health Service Foundation Trust, London, UK
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Yuan YS, Jin X, Chen L, Liao JM, Zhang Y, Yu KW, Li WK, Cao SW, Huang XZ, Kang CM. A novel model based on necroptosis-related genes for predicting immune status and prognosis in glioma. Front Immunol 2022; 13:1027794. [DOI: 10.3389/fimmu.2022.1027794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundGlioma is a highly aggressive brain cancer with a poor prognosis. Necroptosis is a form of programmed cell death occurring during tumor development and in immune microenvironments. The prognostic value of necroptosis in glioma is unclear. This study aimed to develop a prognostic glioma model based on necroptosis.MethodsA necroptosis-related risk model was constructed by Cox regression analysis based on The Cancer Genome Atlas (TCGA) training set, validated in two Chinese Glioma Genome Atlas (CGGA) validation sets. We explored the differences in immune infiltration and immune checkpoint genes between low and high risk groups and constructed a nomogram. Moreover, we compiled a third validation cohort including 43 glioma patients. The expression of necroptosis-related genes was verified in matched tissues using immunochemical staining in the third cohort, and we analyzed their relationship to clinicopathological features.ResultsThree necroptosis-related differentially expressed genes (EZH2, LEF1, and CASP1) were selected to construct the prognostic model. Glioma patients with a high risk score in the TCGA and CGGA cohorts had significantly shorter overall survival. The necroptosis-related risk model and nomogram exhibited good predictive performance in the TCGA training set and the CGGA validation sets. Furthermore, patients in the high risk group had higher immune infiltration status and higher expression of immune checkpoint genes, which was positively correlated with poorer outcomes. In the third validation cohort, the expression levels of the three proteins encoded by EZH2, LEF1, and CASP1 in glioma tissues were significantly higher than those from paracancerous tissues. They were also closely associated with disease severity and prognosis.ConclusionsOur necroptosis-related risk model can be used to predict the prognosis of glioma patients and improve prognostic accuracy, which may provide potential therapeutic targets and a theoretical basis for treatment.
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Ren P, Wang JY, Zeng ZR, Li NX, Chen HL, Peng XG, Bhawal UK, Guo WZ. A novel hypoxia-driven gene signature that can predict the prognosis and drug resistance of gliomas. Front Genet 2022; 13:976356. [PMID: 36118887 PMCID: PMC9478203 DOI: 10.3389/fgene.2022.976356] [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: 06/23/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Hypoxia spontaneously forms in the interior of glioma tissues and regulates the expression of various genes. However, the status of hypoxia-driven genes in glioma tissues is not completely known. In the current study, RNA-seq data of 695 glioma tissues in The Cancer Genome Atlas (TCGA) were set as a discovery cohort and were used to identify hypoxia-driven genes and construct a novel gene signature. The prognostic values of that signature were verified in data from the TCGA and the Chinese Glioma Genome Atlas (CGGA). The expression and diagnostic values of hypoxia-driven genes were analyzed using immunohistochemistry and receiver operator characteristic curves. Finally, the effects of hypoxia-driven genes on temozolomide (TMZ) resistance were analyzed by western blot, CCK-8 and colony formation assay. A total of 169 hypoxia-driven genes were identified, which were associated with a poor outcome in glioma patients. Among them, 22 genes had a degree score ≥10 and 6 genes (WT1, HOXA2, HOXC6, MMP9, SHOX2 and MYOD1) were selected to construct a signature to classify glioma patients into low- or high-risk groups. That signature had a remarkable prognostic value for glioma patients in TCGA and CGGA. The expression of HOXC6, MMP9, SHOX2 and MYOD1 was associated with hypoxia degree in glioma tissues and in recurrent cases, had a remarkable diagnostic value and a significant relationship with disease free survival in glioma patients. Moreover, SHOX2 was highly expressed in glioma tissues with O-6-methylguanine-DNA methyltransferase (MGMT)-unmethylation and temozolomide (TMZ) resistant glioma cell lines, and associated with MGMT expression. Knockdown the expression of SHOX2 significantly reduced the TMZ-resistance induced by hypoxia in glioma cells. Ultimately, we identified six novel hypoxia-driven genes for reliable prognostic prediction in gliomas and found that SHOX2 might be a potential target to overcome the TMZ resistance induced by hypoxia.
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Affiliation(s)
- Peng Ren
- Department of Anesthesiology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jing-Ya Wang
- Department of Anesthesiology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhi-Rui Zeng
- Guizhou Provincial Key Laboratory of Pathogenesis and Drug Research on Common Chronic Diseases, Department of Physiology, School of Basic Medical Sciences, Guizhou Medical University, Guizhou, China
| | - Nan-Xi Li
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, China
| | - Hong-Lei Chen
- Hengyang Medical College, University of South China, Hengyang, China
| | - Xin-Ge Peng
- Guizhou Provincial Key Laboratory of Pathogenesis and Drug Research on Common Chronic Diseases, Department of Physiology, School of Basic Medical Sciences, Guizhou Medical University, Guizhou, China
| | - Ujjal K. Bhawal
- Department of Biochemistry and Molecular Biology, Nihon University School of Dentistry at Matsudo, Chiba, Japan
- Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Chennai, India
- *Correspondence: Ujjal K. Bhawal, ; Wen-Zhi Guo,
| | - Wen-Zhi Guo
- Department of Anesthesiology, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
- *Correspondence: Ujjal K. Bhawal, ; Wen-Zhi Guo,
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