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Zeng D, Zeng C, Zeng Z, Li S, Deng Z, Chen S, Bian Z, Ma J. Basis and current state of computed tomography perfusion imaging: a review. Phys Med Biol 2022; 67. [PMID: 35926503 DOI: 10.1088/1361-6560/ac8717] [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: 11/17/2021] [Accepted: 08/04/2022] [Indexed: 12/30/2022]
Abstract
Computed tomography perfusion (CTP) is a functional imaging that allows for providing capillary-level hemodynamics information of the desired tissue in clinics. In this paper, we aim to offer insight into CTP imaging which covers the basics and current state of CTP imaging, then summarize the technical applications in the CTP imaging as well as the future technological potential. At first, we focus on the fundamentals of CTP imaging including systematically summarized CTP image acquisition and hemodynamic parameter map estimation techniques. A short assessment is presented to outline the clinical applications with CTP imaging, and then a review of radiation dose effect of the CTP imaging on the different applications is presented. We present a categorized methodology review on known and potential solvable challenges of radiation dose reduction in CTP imaging. To evaluate the quality of CTP images, we list various standardized performance metrics. Moreover, we present a review on the determination of infarct and penumbra. Finally, we reveal the popularity and future trend of CTP imaging.
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Affiliation(s)
- Dong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Cuidie Zeng
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Zhixiong Zeng
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Sui Li
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Zhen Deng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Sijin Chen
- Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Zhaoying Bian
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
| | - Jianhua Ma
- School of Biomedical Engineering, Southern Medical University, Guangdong 510515, China; and Guangzhou Key Laboratory of Medical Radiation Imaging and Detection Technology, Southern Medical University, Guangdong 510515, People's Republic of China
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Di N, Cheng W, Jiang X, Liu X, Zhou J, Xie Q, Chu Z, Chen H, Wang B. Can dynamic contrast-enhanced MRI evaluate VEGF expression in brain glioma? An MRI-guided stereotactic biopsy study. J Neuroradiol 2018; 46:186-192. [PMID: 29752976 DOI: 10.1016/j.neurad.2018.04.008] [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: 11/01/2017] [Revised: 02/16/2018] [Accepted: 04/21/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate whether pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to evaluate vascular endothelial growth factor (VEGF) expression in brain glioma based on a point-to-point basis. MATERIALS AND METHODS Forty-seven patients with treatment-naïve glioma received preoperative DCE-MRI before stereotactic biopsy. We histologically quantified VEGF from section of stereotactic biopsies, and co-registered biopsy locations with localized measurements of DCE-MRI parameters including volume transfer coefficient (Ktrans), reverse reflux rate constant (Kep), extracellular extravascular volume fraction (Ve) and blood plasma volume (Vp). The correlations between DCE-MRI parameters (Ktrans, Kep, Ve and Vp) and VEGF were determined using Spearman correlation coefficient. P≤.05 was considered statistically significant. RESULTS Seventy-nine biopsy samples were obtained and graded into 45 high-grade gliomas (HGGs) and 34 low-grade gliomas (LGGs). Ktrans showed a significant positive correlation with VEGF expression in HGGs group (ρ=0.505, P<0.001) and in combined group (LGGs+HGGs) (ρ=0.549, P<0.001), but not in LGGs group (P>0.05). Kep, Ve or Vp was not correlated with VEGF even though a positive trend showed (P>0.05). CONCLUSIONS DCE-MRI is a useful, non-invasive imaging technique for quantitative evaluation of VEGF, and its parameter Ktrans other than Kep, Ve or Vp may be used as a surrogate for VEGF expression in brain gliomas.
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Affiliation(s)
- Ningning Di
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China; Department of Radiology, Huashan Hospital Fudan University, 12, Wulumuqi road Middle, 200040 Shanghai, China.
| | - Wenna Cheng
- Department of Pharmacy, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Xingyue Jiang
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Xinjiang Liu
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Jinliang Zhou
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Qian Xie
- Department of Radiology, Huashan Hospital Fudan University, 12, Wulumuqi road Middle, 200040 Shanghai, China.
| | - Zhihui Chu
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Huacheng Chen
- Department of Radiology, Weifang Traditional Chinese Hospital, 1055, Weizhou road, 256600 Weifang, China.
| | - Bin Wang
- Department of Medical Imaging and Nuclear, Binzhou Medical University, 346, Guanhai road, 264000 Yantai, China.
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Keil VC, Pintea B, Gielen GH, Hittatiya K, Datsi A, Simon M, Fimmers R, Schild HH, Hadizadeh DR. Meningioma assessment: Kinetic parameters in dynamic contrast-enhanced MRI appear independent from microvascular anatomy and VEGF expression. J Neuroradiol 2018; 45:242-248. [PMID: 29410063 DOI: 10.1016/j.neurad.2018.01.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 12/17/2017] [Accepted: 01/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Kinetic parameters of T1-weighted dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) are considered to be influenced by microvessel environment. This study was performed to explore the extent of this association for meningiomas. MATERIALS AND METHODS DCE-MRI kinetic parameters (contrast agent transfer constants Ktrans and kep, volume fractions vp and ve) were determined in pre-operative 3T MRI of meningioma patients for later biopsy sites (19 patients; 15 WHO Io, no previous radiation, and 4 WHO IIIo pre-radiated recurrent tumors). Sixty-three navigated biopsies were consecutively retrieved. Biopsies were immunohistochemically investigated with endothelial marker CD34 and VEGF antibodies, stratified in a total of 4383 analysis units and computationally assessed for VEGF expression and vascular parameters (vessel density, vessel quantity, vascular fraction within tissue [vascular area ratio], vessel wall thickness). Derivability of kinetic parameters from VEGF expression or microvascularization was determined by mixed linear regression analysis. Tissue kinetic and microvascular parameters were tested for their capacity to identify the radiation status in a subanalysis. RESULTS Kinetic parameters were neither significantly related to the corresponding microvascular parameters nor to tissue VEGF expression. There was no significant association between microvessel density and its presumed correlate vp (P=0.07). The subgroup analysis of high-grade radiated meningiomas showed a significantly reduced microvascular density (AUC 0.91; P<0.0001) and smaller total vascular fraction (AUC 0.73; P=0.01). CONCLUSIONS In meningioma, DCE-MRI kinetic parameters neither allow for a reliable prediction of tumor microvascularization, nor for a prediction of VEGF expression. Kinetic parameters seem to be determined from different independent factors.
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Affiliation(s)
- Vera C Keil
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany.
| | - Bogdan Pintea
- Department of Neurosurgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Gerrit H Gielen
- Department of Neuropathology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Kanishka Hittatiya
- Center for Pathology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Angeliki Datsi
- Department of Neurosurgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Matthias Simon
- Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Kantensiek 11, 33617 Bielefeld, Germany
| | - Rolf Fimmers
- IMBIE (Statistics), University of Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Hans H Schild
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
| | - Dariusch R Hadizadeh
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
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Zhao M, Guo LL, Huang N, Wu Q, Zhou L, Zhao H, Zhang J, Fu K. Quantitative analysis of permeability for glioma grading using dynamic contrast-enhanced magnetic resonance imaging. Oncol Lett 2017; 14:5418-5426. [PMID: 29113174 PMCID: PMC5656018 DOI: 10.3892/ol.2017.6895] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 07/03/2017] [Indexed: 11/20/2022] Open
Abstract
The objective of the present study was to quantitatively analyze the permeability of tumor entity and peritumor edema in glioma grading, using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). In the present retrospective study, 80 patients underwent T1-weighted DCE-MRI examination at 3.0 T and the pathological results (including astrocytoma and oligodendroglioma) were obtained between January 2012 and June 2015. All cases were surgically validated as grade I–IV gliomas. The original DCE-MRI data were analyzed using dual compartment modified Tofts model. The forward volume transfer constant (Ktrans), backflux rate (kep) and fractional volume (ve) were calculated with the region of interest selected on the highest permeability area of the tumor entity and peritumor edema. Analysis of variance with the Bonferroni correction was used to compare the values of Ktrans, kep, and ve of the tumor entity and peritumor edema in different glioma grades. The results of the present study revealed that the Ktrans, kep, and ve values in each stage were associated with the pathological grading (r=0.951, 0.804 and 0.766, respectively). There were significant differences identified between different tumor grades in Ktrans, kep, with the exception being between grades II and III in kep. In addition, there was a significant difference revealed between grade I/II and grade III/IV in ve. Receiver operator characteristics curve analysis was used to evaluate the diagnosis accuracies of permeability parameters. Ktrans was demonstrated to exhibit the highest sensitivity and specificity for evaluating the tumor grade. With the threshold values of 0.160, 0.420 and 0.935 in Ktrans on tumor, glioma grades I vs. II, II vs III and III vs. IV may be differentiated with sensitivities of 0.900, 0.950 and 0.950, and specificities of 0.950, 0.950 and 0.850, respectively. Furthermore, associations were observed between the Ktrans, kep and ve values of peritumor edema and the pathological grading in glioma (Ktrans r=0.438, P<0.001; Kep r=0.385, P<0.001; Ve r=0.397, P<0.001, respectively). Ktrans values in peritumoral edema revealed significant differences between low-grade and high-grade glioma. The sensitivity and specificity for Ktrans of peritumor edema were 0.975 and 0.950, with a threshold value of 0.007. Therefore, the DCE-MRI parameters of Ktrans of tumor entity and peritumor edema in gliomas may be used to accurately differentiate glioma grades.
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Affiliation(s)
- Ming Zhao
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Li-Li Guo
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Ning Huang
- Life Science, GE Healthcare Life Sciences China, Beijing 100176, P.R. China
| | - Qiong Wu
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Li Zhou
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Hui Zhao
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Jing Zhang
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Kuang Fu
- Department of MR Diagnosis, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
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Keil VC, Pintea B, Gielen GH, Greschus S, Fimmers R, Gieseke J, Simon M, Schild HH, Hadizadeh DR. Biopsy targeting with dynamic contrast-enhanced versus standard neuronavigation MRI in glioma: a prospective double-blinded evaluation of selection benefits. J Neurooncol 2017; 133:155-163. [PMID: 28425048 DOI: 10.1007/s11060-017-2424-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/11/2017] [Indexed: 12/30/2022]
Abstract
Current biopsy planning based on contrast-enhanced T1W (CET1W) or FLAIR sequences frequently delivers biopsy samples that are not in concordance with the gross tumor diagnosis. This study investigates whether the quantitative information of transfer constant Ktrans maps derived from T1W dynamic contrast-enhanced MRI (DCE-MRI) can help enhance the quality of biopsy target selection in glioma. 28 patients with suspected glioma received MRI including DCE-MRI and a standard neuronavigation protocol of 3D FLAIR- and CET1W data sets (0.1 mmol/kg gadobutrol) at 3.0 T. After exclusion of five cases with no Ktrans-elevation, 2-6 biopsy targets were independently selected by a neurosurgeon (samples based on standard imaging) and a neuroradiologist (samples based on kinetic parameter Ktrans) per case and tissue samples corresponding to these targets were collected by a separate independent neurosurgeon. Standard technique and Ktrans-based samples were rated for diagnostic concordance with the gross tumor resection reference diagnosis (67 WHO IV; 24 WHO III and II) by a neuropathologist blinded for selection mode. Ktrans-based sample targets differed from standard technique sample targets in 90/91 cases. More Ktrans-based than standard imaging-based samples could be extracted. Diagnoses from Ktrans-based samples were more frequently concordant with the reference gross tumor diagnoses than those from standard imaging-based samples (WHO IV: 30/39 vs. 11/20; p = 0.08; WHO III/II: 12/13 vs. 6/11; p = 0.06). In 4/5 non-contrast-enhancing gliomas, Ktrans-based selection revealed significantly more accurate samples than standard technique sample-selection (10/12 vs. 2/8 samples; p = 0.02). If Ktrans elevation is present, Ktrans-based biopsy targeting provides significantly more diagnostic tissue samples in non-contrast-enhancing glioma than selection based on CET1W and FLAIR-weighted images alone.
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Affiliation(s)
- Vera C Keil
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Gerrit H Gielen
- Department of Neuropathology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Susanne Greschus
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Rolf Fimmers
- University Hospital Bonn, IMBIE, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Jürgen Gieseke
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.,PHILIPS Healthcare, Lübeckertordamm 1-3, 20099, Hamburg, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.,Department of Neurosurgery, Ev. Krankenhaus Bielefeld, Kantensiek 11, 33617, Bielefeld, Germany
| | - Hans H Schild
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany
| | - Dariusch R Hadizadeh
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105, Bonn, Germany.
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Xu X, Yadav NN, Knutsson L, Hua J, Kalyani R, Hall E, Laterra J, Blakeley J, Strowd R, Pomper M, Barker P, Chan K, Liu G, McMahon MT, Stevens RD, van Zijl PCM. Dynamic Glucose-Enhanced (DGE) MRI: Translation to Human Scanning and First Results in Glioma Patients. ACTA ACUST UNITED AC 2015; 1:105-114. [PMID: 26779568 PMCID: PMC4710854 DOI: 10.18383/j.tom.2015.00175] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent animal studies have shown that d-glucose is a potential biodegradable magnetic resonance imaging (MRI) contrast agent for imaging glucose uptake in tumors. We show herein the first translation of that use of d-glucose to human studies. Chemical exchange saturation transfer (CEST) MRI at a single frequency offset optimized for detecting hydroxyl protons in d-glucose was used to image dynamic signal changes in the human brain at 7 T during and after d-glucose infusion. Dynamic glucose enhanced (DGE) image data from 4 normal volunteers and 3 glioma patients showed a strong signal enhancement in blood vessels, while a spatially varying enhancement was found in tumors. Areas of enhancement differed spatially between DGE and conventional gadolinium-enhanced imaging, suggesting complementary image information content for these 2 types of agents. In addition, different tumor areas enhanced with d-glucose at different times after infusion, suggesting a sensitivity to perfusion-related properties such as substrate delivery and blood-brain barrier (BBB) permeability. These preliminary results suggest that DGE MRI is feasible for studying glucose uptake in humans, providing a time-dependent set of data that contains information regarding arterial input function, tissue perfusion, glucose transport across the BBB and cell membrane, and glucose metabolism.
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Affiliation(s)
- Xiang Xu
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Nirbhay N Yadav
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden
| | - Jun Hua
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Rita Kalyani
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erica Hall
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - John Laterra
- Department of Neurology, Oncology, and Neuroscience, The Johns Hopkins Medicine, and The Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States
| | - Jaishri Blakeley
- Department of Neurology, Oncology, and Neuroscience, The Johns Hopkins Medicine, and The Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States
| | - Roy Strowd
- Department of Neurology, Oncology, and Neuroscience, The Johns Hopkins Medicine, and The Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States
| | - Martin Pomper
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter Barker
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Kannie Chan
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Guanshu Liu
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Michael T McMahon
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Robert D Stevens
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States; Department of Neurology, Oncology, and Neuroscience, The Johns Hopkins Medicine, and The Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, MD, United States; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter C M van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States
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Advanced magnetic resonance imaging methods for planning and monitoring radiation therapy in patients with high-grade glioma. Semin Radiat Oncol 2014; 24:248-58. [PMID: 25219809 DOI: 10.1016/j.semradonc.2014.06.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This review explores how the integration of advanced imaging methods with high-quality anatomical images significantly improves the characterization, target definition, assessment of response to therapy, and overall management of patients with high-grade glioma. Metrics derived from diffusion-, perfusion-, and susceptibility-weighted magnetic resonance imaging in conjunction with magnetic resonance spectroscopic imaging, allows us to characterize regions of edema, hypoxia, increased cellularity, and necrosis within heterogeneous tumor and surrounding brain tissue. Quantification of such measures may provide a more reliable initial representation of tumor delineation and response to therapy than changes in the contrast-enhancing or T2 lesion alone and have a significant effect on targeting resection, planning radiation, and assessing treatment effectiveness. In the long term, implementation of these imaging methodologies can also aid in the identification of recurrent tumor and its differentiation from treatment-related confounds and facilitate the detection of radiationinduced vascular injury in otherwise normal-appearing brain tissue.
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Abstract
OBJECTIVE Noninvasive evaluation of glioma is of great help for clinical practice. In this study, we investigated the utility of 13N-ammonia in the evaluation of untreated gliomas and compared the results with that of 18F-FDG. METHODS Forty-five consecutive patients with final diagnosis of glioma were included in this study. PET/CT imaging was performed for all of them with both 18F-FDG and 13N-ammonia as tracers. Imaging results were analyzed by tumor-to-gray matter (T/G) ratios. Receiver operating characteristic curve analysis was conducted to determine the optimal T/G cutoff values of each tracer between low-grade and high-grade gliomas. RESULTS Forty-eight separate lesions were identified in all (grade II, n = 16; grade III, n = 12; and grade IV, n = 20). Twenty-nine out of 32 high-grade lesions (91%) showed higher uptakes than normal gray matter with N-ammonia in comparison with the result of 21 lesions (66%) with 18F-FDG. The optimal T/G cutoff values for 18F-FDG and 13N-ammonia were 0.64 and 0.86 separately with the area under each curve 0.910 and 0.943. The sensitivity and specificity of predicting high-grade gliomas with optimal cutoff values were 83% and 93% for 18F-FDG and 94% and 94% for 13N-ammonia, respectively. CONCLUSION 13N-Ammonia is superior to 18F-FDG not only in separating low-grade gliomas from high-grade ones but also in the detection of high-grade gliomas for better tumor to normal gray matter contrast.
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Cao L, Chen H, Hong J, Ma M, Zhong Q, Wang S. Magnetic resonance imaging appearance of the medial wall of the cavernous sinus for the assessment of cavernous sinus invasion by pituitary adenomas. J Neuroradiol 2013; 40:245-51. [PMID: 23886874 DOI: 10.1016/j.neurad.2013.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 05/31/2013] [Accepted: 06/18/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE The diagnostic criteria for cavernous sinus invasion (CSI) by pituitary adenomas are still unsatisfactory and controversial. For this reason, the study examined the appearance of the medial wall of the cavernous sinus (MWCS) on proton-density-weighted (PDW) magnetic resonance imaging (MRI) to determine its value for preoperative assessment of CSI. METHODS A 3.0-Tesla MRI scanner was used to obtain preoperative PDW images and conventional MRI sequences of 48 consecutive pituitary adenomas, and the MWCS was examined in PDW images to determine the presence of CSI in comparison to surgical findings and three traditional MRI criteria: Knosp grading system (KGS); percentage of encasement of the internal carotid artery (PEICA); and replacement of cavernous sinus compartments (RCSC) by tumors. The value of the MWCS as seen on MRI was compared with that of the Ki-67 labelling index (Ki-67 LI). RESULTS CSI images showed that continuity of the MWCS was interrupted and that tumor tissue had infiltrated the cavernous sinus (CS) compartments through the defects. In 96 CSs from 48 patients, the sensitivity of MRI visualization of the MWCS for detection of CSI was 93.3% with a specificity of 93.8%, which was significantly higher than with KGS, PEICA and RCSC (P=0.007, P=0.008 and P=0.056, respectively). Histopathological results showed no significant differences between MRI visualization of the MWCS and the Ki-67 LI. CONCLUSION PDW imaging permits adequate visualization of the MWCS and is superior to traditional diagnostic criteria for the detection of CSI, providing accurate preoperative images for intraoperative navigation.
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Affiliation(s)
- Lei Cao
- Department of Neurosurgery, Fuzhou General Hospital, 156, Xihuanbei Road, Fuzhou Fujian 350025, China; Capital Medical University, Beijing Neurosurgical Institute, 6, Tiantanxili, Beijing 100050, China
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