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Yuan T, Gao Z, Wang F, Ren JL, Wang T, Zhong H, Gao G, Quan G. Relative T2-FLAIR signal intensity surrounding residual cavity is associated with survival prognosis in patients with lower-grade gliomas. Front Oncol 2022; 12:960917. [PMID: 36185187 PMCID: PMC9520477 DOI: 10.3389/fonc.2022.960917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
Aims To investigate whether the relative signal intensity surrounding the residual cavity on T2-fluid-attenuated inversion recovery (rFLAIR) can improve the survival prediction of lower-grade glioma (LGG) patients. Methods Clinical and pathological data and the follow-up MR imaging of 144 patients with LGG were analyzed. We calculated rFLAIR with Image J software. Logistic analysis was used to explore the significant impact factors on progression-free survival (PFS) and overall survival (OS). Several models were set up to predict the survival prognosis of LGG. Results A higher rFLAIR [1.81 (0.83)] [median (IQR)] of non-enhancing regions surrounding the residual cavity was detected in the progressed group (n=77) than that [1.55 (0.33)] [median (IQR)] of the not-progressed group (n = 67) (P<0.001). Multivariate analysis showed that lower KPS (≤75), and higher rFLAIR (>1.622) were independent predictors for poor PFS (P<0.05), whereas lower KPS (≤75) and thick-linear and nodular enhancement were the independent predictors for poor OS (P<0.05). The cutoff rFLAIR value of 1.622 could be used to predict poor PFS (HR = 0.31, 95%CI 0.20–0.48) (P<0.001) and OS (HR = 0.27, 95%CI 0.14–0.51) (P=0.002). Both the areas under the ROC curve (AUCs) for predicting poor PFS (AUC, 0.771) and OS (AUC, 0.831) with a combined model that contained rFLAIR were higher than those of any other models. Conclusion Higher rFALIR (>1.622) in non-enhancing regions surrounding the residual cavity can be used as a biomarker of the poor survival of LGG. rFLAIR is helpful to improve the survival prediction of posttreatment LGG patients.
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Affiliation(s)
- Tao Yuan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhen Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Wang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jia-Liang Ren
- Department of Pharmaceuticals Diagnostics, General Electric Healthcare China, Beijing, China
| | - Tianda Wang
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Hongbo Zhong
- Department of Radiology, People’s Hospital of Tangshan City, Tangshan, China
| | - Guodong Gao
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guanmin Quan
- Department of Medical Imaging, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Guanmin Quan,
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Ruiz-Garcia H, Middlebrooks EH, Trifiletti DM, Chaichana KL, Quinones-Hinojosa A, Sheehan JP. The Extent of Resection in Gliomas-Evidence-Based Recommendations on Methodological Aspects of Research Design. World Neurosurg 2022; 161:382-395.e3. [PMID: 35505558 DOI: 10.1016/j.wneu.2021.08.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/30/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Modern neurosurgery has established maximal safe resection as a cornerstone in the management of diffuse gliomas. Evaluation of the extent of resection (EOR), and its association with certain outcomes or interventions, heavily depends on an adequate methodology to draw strong conclusions. We aim to identify weaknesses and limitations that may threaten the internal validity and generalizability of studies involving the EOR in patients with glioma and to suggest methodological recommendations that may help mitigate these threats. METHODS A systematic search was performed by querying PubMed, Web of Science, and Scopus since inception to April 30, 2021 using PICOS/PRISMA guidelines. Articles were then screened to identify high-impact studies evaluating the EOR in patients diagnosed with diffuse gliomas in accordance with predefined criteria. We identify common weakness and limitations during the evaluation of the EOR in the selected studies and then delineate potential methodological recommendations for future endeavors dealing with the EOR. RESULTS We identified 31 high-impact studies and found several research design issues including inconsistencies regarding EOR terminology, measurement, data collection, analysis, and reporting. Although some of these issues were related to now outdated reporting standards, many were still present in recent publications and deserve attention in contemporary and future research. CONCLUSIONS There is a current need to focus more attention to the methodological aspects of glioma research. Methodological inconsistencies may introduce weaknesses into the internal validity of the studies and hamper comparative analysis of cohorts from different institutions. We hope our recommendations will eventually help develop stronger methodological designs in future research endeavors.
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Affiliation(s)
- Henry Ruiz-Garcia
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA
| | - Erik H Middlebrooks
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
| | - Daniel M Trifiletti
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA; Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
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3
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Kavouridis VK, Boaro A, Dorr J, Cho EY, Iorgulescu JB, Reardon DA, Arnaout O, Smith TR. Contemporary assessment of extent of resection in molecularly defined categories of diffuse low-grade glioma: a volumetric analysis. J Neurosurg 2020; 133:1291-1301. [PMID: 31653812 PMCID: PMC7348099 DOI: 10.3171/2019.6.jns19972] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While the effect of increased extent of resection (EOR) on survival in diffuse infiltrating low-grade glioma (LGG) patients is well established, there is still uncertainty about the influence of the new WHO molecular subtypes. The authors designed a retrospective analysis to assess the interplay between EOR and molecular classes. METHODS The authors retrospectively reviewed the records of 326 patients treated surgically for hemispheric WHO grade II LGG at Brigham and Women's Hospital and Massachusetts General Hospital (2000-2017). EOR was calculated volumetrically and Cox proportional hazards models were built to assess for predictive factors of overall survival (OS), progression-free survival (PFS), and malignant progression-free survival (MPFS). RESULTS There were 43 deaths (13.2%; median follow-up 5.4 years) among 326 LGG patients. Median preoperative tumor volume was 31.2 cm3 (IQR 12.9-66.0), and median postoperative residual tumor volume was 5.8 cm3 (IQR 1.1-20.5). On multivariable Cox regression, increasing postoperative volume was associated with worse OS (HR 1.02 per cm3; 95% CI 1.00-1.03; p = 0.016), PFS (HR 1.01 per cm3; 95% CI 1.00-1.02; p = 0.001), and MPFS (HR 1.01 per cm3; 95% CI 1.00-1.02; p = 0.035). This result was more pronounced in the worse prognosis subtypes of IDH-mutant and IDH-wildtype astrocytoma, for which differences in survival manifested in cases with residual tumor volume of only 1 cm3. In oligodendroglioma patients, postoperative residuals impacted survival when exceeding 8 cm3. Other significant predictors of OS were age at diagnosis, IDH-mutant and IDH-wildtype astrocytoma classes, adjuvant radiotherapy, and increasing preoperative volume. CONCLUSIONS The results corroborate the role of EOR in survival and malignant transformation across all molecular subtypes of diffuse LGG. IDH-mutant and IDH-wildtype astrocytomas are affected even by minimal postoperative residuals and patients could potentially benefit from a more aggressive surgical approach.
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Affiliation(s)
- Vasileios K. Kavouridis
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Alessandro Boaro
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Dorr
- Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Elise Y. Cho
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - J. Bryan Iorgulescu
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - David A. Reardon
- Harvard Medical School, Boston, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Omar Arnaout
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Timothy R. Smith
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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4
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Scherer M, Jungk C, Götz M, Kickingereder P, Reuss D, Bendszus M, Maier-Hein K, Unterberg A. Early postoperative delineation of residual tumor after low-grade glioma resection by probabilistic quantification of diffusion-weighted imaging. J Neurosurg 2019; 130:2016-2024. [PMID: 30052158 DOI: 10.3171/2018.2.jns172951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/23/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In WHO grade II low-grade gliomas (LGGs), early postoperative MRI (epMRI) may overestimate residual tumor on FLAIR sequences. Consequently, MRI at 3-6 months follow-up (fuMRI) is used for delineation of residual tumor. This study sought to evaluate if integration of apparent diffusion coefficient (ADC) maps permits an accurate estimation of residual tumor early on epMRI. METHODS From a consecutive cohort, 43 cases with an initial surgery for an LGG, and complete epMRI (< 72 hours after resection) and fuMRI including ADC maps, were retrospectively identified. Residual FLAIR hyperintense tumor was manually segmented on epMRI and corresponding ADC maps were coregistered. Using an expectation maximization algorithm, residual tumor segments were probabilistically clustered into areas of residual tumor, ischemia, or normal white matter (NWM) by fitting a mixture model of superimposed Gaussian curves to the ADC histogram. Tumor volumes from epMRI, clustering, and fuMRI were statistically compared and agreement analysis was performed. RESULTS Mean FLAIR hyperintensity suggesting residual tumor was significantly larger on epMRI compared to fuMRI (19.4 ± 16.5 ml vs 8.4 ± 10.2 ml, p < 0.0001). Probabilistic clustering of corresponding ADC histograms on epMRI identified subsegments that were interpreted as mean residual tumor (7.6 ± 10.2 ml), ischemia (8.1 ± 5.9 ml), and NWM (3.7 ± 4.9 ml). Therefore, mean tumor quantification error between epMRI and fuMRI was significantly reduced (11.0 ± 10.6 ml vs -0.8 ± 3.7 ml, p < 0.0001). Mean clustered tumor volumes on epMRI were no longer significantly different from the fuMRI reference (7.6 ± 10.2 ml vs 8.4 ± 10.2 ml, p = 0.16). Correlation (Pearson r = 0.96, p < 0.0001), concordance correlation coefficient (0.89, 95% confidence interval 0.83), and Bland-Altman analysis suggested strong agreement between both measures after clustering. CONCLUSIONS Probabilistic segmentation of ADC maps facilitates accurate assessment of residual tumor within 72 hours after LGG resection. Multiparametric image analysis detected FLAIR signal alterations attributable to surgical trauma, which led to overestimation of residual LGG on epMRI compared to fuMRI. The prognostic value and clinical impact of this method has to be evaluated in larger case series in the future.
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Affiliation(s)
| | | | - Michael Götz
- 2Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - David Reuss
- 4Neuropathology, Heidelberg University Hospital; and
| | | | - Klaus Maier-Hein
- 2Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
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5
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Abstract
BACKGROUND Emerging evidence suggests survival benefit from resection beyond all MRI abnormalities present on T1-enhanced and T2‒fluid attenuated inversion recovery (FLAIR) modalities in glioma (supratotal resection); however, the quality of evidence is unclear. We addressed this question via systematic review of the literature. METHODS EMBASE, MEDLINE, Scopus, and Web of Science databases were queried. Case studies, reviews or editorials, non-English, abstract-only, brain metastases, and descriptive works were excluded. All others were included. RESULTS Three hundred and nine unique references yielded 41 studies for full-text review, with 7 included in the final analysis. Studies were mostly of Oxford Center for Evidence-Based Medicine Level 4 quality. A total of 88 patients underwent supratotal resection in a combined cohort of 492 patients (214 males and 278 females, age 18 to 82 years). Fifty-one supratotal resections were conducted on high-grade gliomas, and 37 on low-grade gliomas. Karnofsky performance status, overall survival, progression-free survival, neurological deficits postoperatively, and anaplastic transformation were the main measured outcomes. No randomized controlled trials were identified. Preliminary low-quality support was found for supratotal resection in increasing overall survival and progression-free survival for both low-grade and high-grade glioma. CONCLUSION The literature suggests insufficient evidence for carte blanche application of supratotal resection, particularly in lower-grade gliomas where neurological deficits can result in long-term disability. While the preliminary studies discussed here, containing data from only a few centers, have reported increased progression-free and overall survival, these claims require validation in prospective research studies involving larger patient populations with clearly defined appropriate outcome metrics in order to reduce potential bias.
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Affiliation(s)
| | - Michael A Vogelbaum
- Brain Tumor and NeuroOncology Center and Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
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6
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Freyschlag CF, Gruber R, Bauer M, Grams AE, Thomé C. Routine Postoperative Computed Tomography Is Not Helpful After Elective Craniotomy. World Neurosurg 2018; 122:e1426-e1431. [PMID: 30465965 DOI: 10.1016/j.wneu.2018.11.079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Next-day postoperative computed tomography (CT) has been routinely used to obtain radiographic "clearance" for transferring patients after elective craniotomy out of the intensive care unit. The value of this traditional policy, however, has repeatedly been questioned. However, the limited patient numbers might have underestimated the very rare, but catastrophic, events. Therefore, we analyzed the value of routine postoperative CT in a larger cohort of elective tumor, epilepsy, and vascular cases. METHODS All the patients who had undergone elective craniotomy were included in our study. The routine postoperative CT scans were analyzed by a neuroradiologist who was unaware of the clinical data. The medical records were retrospectively reviewed for events of arterial hypertension and clinical deterioration. RESULTS The data from 660 patients with tumors (n = 393; 59.5%), aneurysms (n = 107; 16.2%), and skull base lesions were evaluated. In nearly one half of the patients (n = 264; 45.8%), CT depicted the presence of blood that was not associated with symptoms. Of the 660 patients, 21 (3.6%) showed a mass effect radiographically, 11 of whom underwent revision surgery. Arterial hypertension was documented in only 8 patients (1.3%) and was related to the revision surgery (P = 0.018). The overall revision rate was 2.7% (n = 18). All patients who had undergone revision for postoperative hematoma had presented with a new neurological deficit immediately before CT. CONCLUSION Routine postoperative CT did not reveal 1 patient with a serious hematoma that would not have been identified by clinical examination. Patients could be transferred safely from the intensive care unit, if the weaning process and clinical observation findings were uneventful, without deterioration of neurological symptoms or consciousness.
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Affiliation(s)
| | - Ricarda Gruber
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlies Bauer
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Astrid E Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
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7
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Freyschlag CF, Krieg SM, Kerschbaumer J, Pinggera D, Forster MT, Cordier D, Rossi M, Miceli G, Roux A, Reyes A, Sarubbo S, Smits A, Sierpowska J, Robe PA, Rutten GJ, Santarius T, Matys T, Zanello M, Almairac F, Mondot L, Jakola AS, Zetterling M, Rofes A, von Campe G, Guillevin R, Bagatto D, Lubrano V, Rapp M, Goodden J, De Witt Hamer PC, Pallud J, Bello L, Thomé C, Duffau H, Mandonnet E. Imaging practice in low-grade gliomas among European specialized centers and proposal for a minimum core of imaging. J Neurooncol 2018; 139:699-711. [PMID: 29992433 PMCID: PMC6132968 DOI: 10.1007/s11060-018-2916-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Imaging studies in diffuse low-grade gliomas (DLGG) vary across centers. In order to establish a minimal core of imaging necessary for further investigations and clinical trials in the field of DLGG, we aimed to establish the status quo within specialized European centers. METHODS An online survey composed of 46 items was sent out to members of the European Low-Grade Glioma Network, the European Association of Neurosurgical Societies, the German Society of Neurosurgery and the Austrian Society of Neurosurgery. RESULTS A total of 128 fully completed surveys were received and analyzed. Most centers (n = 96, 75%) were academic and half of the centers (n = 64, 50%) adhered to a dedicated treatment program for DLGG. There were national differences regarding the sequences enclosed in MRI imaging and use of PET, however most included T1 (without and with contrast, 100%), T2 (100%) and TIRM or FLAIR (20, 98%). DWI is performed by 80% of centers and 61% of centers regularly performed PWI. CONCLUSION A minimal core of imaging composed of T1 (w/wo contrast), T2, TIRM/FLAIR, PWI and DWI could be identified. All morphologic images should be obtained in a slice thickness of ≤ 3 mm. No common standard could be obtained regarding advanced MRI protocols and PET. IMPORTANCE OF THE STUDY We believe that our study makes a significant contribution to the literature because we were able to determine similarities in numerous aspects of LGG imaging. Using the proposed "minimal core of imaging" in clinical routine will facilitate future cooperative studies.
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Affiliation(s)
- Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | | | - Dominik Cordier
- Department of Neurosurgery, Universitätsspital Basel, Basel, Switzerland
| | - Marco Rossi
- Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Alexandre Roux
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Andrés Reyes
- European Master's in Clinical Linguistics (EMCL), University of Groningen, Groningen, The Netherlands
- EMCL University of Potsdam, Potsdam, Germany
- Neuroscience Institute, and Laboratory of Experimental Psychology, Faculty of Psychology, El Bosque University, Bogotá, Colombia
| | - Silvio Sarubbo
- Division of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, APSS, Trento, Italy
| | - Anja Smits
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Joanna Sierpowska
- Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
- Department of Cognition, Development and Education Psychology, Barcelona, Spain
| | - Pierre A Robe
- Department of Neurology and Neurosurgery, Rudolf Magnus Brain Institute, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Thomas Santarius
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Tomasz Matys
- Department of Radiology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Marc Zanello
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Fabien Almairac
- Neurosurgery Department, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - Lydiane Mondot
- Radiology Department, Hôpital Pasteur 2, University Hospital of Nice, Nice, France
| | - Asgeir S Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Maria Zetterling
- Department of Neurosurgery, Institution of Neuroscience, Uppsala University Hospital, Uppsala, Sweden
| | - Adrià Rofes
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- Department of Cognitive Science, Johns Hopkins University, Baltimore, USA
| | - Gord von Campe
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Remy Guillevin
- DACTIM, UMR CNRS 7348, Université de Poitiers et CHU de Poitiers, Poitiers, France
| | - Daniele Bagatto
- Neuroradiology Department, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Vincent Lubrano
- Department of Neurosurgery, CHU Toulouse, Toulouse, France
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - John Goodden
- Department of Neurosurgery, The General Infirmary at Leeds, Leeds, West Yorkshire, UK
| | | | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Humanitas Research Hospital, IRCCS, Milan, Italy
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France
- Institute of Neuroscience of Montpellier, INSERM U1051, University of Montpellier, Montpellier, France
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France
- University Paris 7, Paris, France
- IMNC, UMR 8165, Orsay, France
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8
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Di Carlo DT, Duffau H, Cagnazzo F, Benedetto N, Morganti R, Perrini P. IDH wild-type WHO grade II diffuse low-grade gliomas. A heterogeneous family with different outcomes. Systematic review and meta-analysis. Neurosurg Rev 2018; 43:383-395. [PMID: 29943141 DOI: 10.1007/s10143-018-0996-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/22/2018] [Accepted: 06/14/2018] [Indexed: 02/08/2023]
Abstract
WHO grade II diffuse low-grade gliomas (DLGGs) were recently divided into sub-groups on the basis of their molecular profiles. IDH wild-type (IDH-wt) tumors seem to be associated with unfavorable prognoses due to biological similarities to glioblastomas. The authors performed a systematic review and meta-analysis of literature examining epidemiology, clinical characteristics, management, and the outcome of IDH-wt grade II DLGGs. According to PRISMA guidelines, a comprehensive review of studies published from January 2009 to October 2017 was carried out. The authors identified series that examined the prevalence rate, clinical and radiological characteristics, treatment, and outcome of IDH-wt DLGGs. Variables influencing outcomes were analyzed using a random-effects meta-analysis model. Finally, a meta-regression analysis was performed to examine the impact of therapeutic strategies on the effect-size. Twenty-two studies were included in this systematic review. The IDH-wt prevalence rate was 22.9% (95% CI 18.4-27.4%). The hazard ratio for this molecular subgroup in the DLGGs population was 3.46 (95% CI 2.24-5.36; p < 0.001), and the heterogeneity was significant (I2 = 85%, τ2 = 0.88) (HR range 1.28-376). Nonetheless, publication bias did not affect the analysis (p = 0.176). The meta-regression revealed that the extent of resection and post-operative chemotherapy affected the outcome in the IDH-wt subgroup (p < 0.001 and 0.015, respectively), with no significant association of the HR with the rate of RT or RT + CHT. The prevalence of IDH-wt tumors is approximately 23% of DLGGs. The absence of IDH mutation is associated with a heterogeneous outcome, and its therapeutic relevance for postoperative management remains unclear. Maximal surgical resection improves the overall survival in the DLGGs population, beyond molecular status. Further molecular stratification is needed to better understand IDH-wt behavior and therapeutic response.
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Affiliation(s)
- Davide Tiziano Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy.
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, Montpellier University Medical Center, 80, Avenue Augustin Fliche, 34295, Montpellier, France.,Institute for Neuroscience of Montpellier, INSERM U1051, Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors," Saint Eloi Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
| | - Nicola Benedetto
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy
| | - Paolo Perrini
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
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9
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Zhang J, Song Y, He M, Ren Q, Zeng Y, Liu Z, Liu H, Xu J. Diagnostic Performance of Increased Signal Intensity Within the Resection Cavity on Fluid-Attenuated Inversion Recovery Sequences for Detection of Progression in Patients with Glioma. World Neurosurg 2017; 110:434-441. [PMID: 29229341 DOI: 10.1016/j.wneu.2017.11.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To systematically evaluate the diagnostic performance of increased signal intensity within the resection cavity on fluid-attenuated inversion recovery (FLAIR) sequences for detection of progression in patients with glioma through performing a meta-analysis. METHODS PubMed, Web of Science, Embase, Cochrane Library, and China National Knowledge Infrastructure were searched for potentially relevant literature. The study characteristics and relevant data were extracted. We estimated the pooled sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, and diagnostic odds ratio and constructed summary receiver operating characteristics curves to identify the diagnostic value of FLAIR signal increase for detection of glioma progression. RESULTS A total of 4 studies with 438 patients were included. The pooled sensitivity and specificity of increased signal intensity in FLAIR sequences in the resection cavity for detection of glioma progression were 0.36 (95% confidence interval 0.31-0.42) and 0.93 (95% confidence interval 0.86-0.97), respectively. The area under the curve was 0.7505. Subgroup analyses also were performed according to different patient sources, tumor grades, and definitions of progression. No significant publication bias was found in the meta-analysis (P = 0.85). CONCLUSIONS Our results suggested that increased signal intensity within the resection cavity on FLAIR sequences could indicate tumor progression early with high specificity in patients with glioma. This readily accessible sign could implicate closer monitoring and could be crucial for therapeutic decisions and outcome. However, because of the limited number of studies, more well-designed studies are warranted to further verify our results and elucidate the underlining mechanisms.
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Affiliation(s)
- Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yanlin Song
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, PR China
| | - Min He
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qingqing Ren
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yunhui Zeng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Zhiyong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Hao Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China.
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Huber T, Alber G, Bette S, Kaesmacher J, Boeckh-Behrens T, Gempt J, Ringel F, Specht HM, Meyer B, Zimmer C, Wiestler B, Kirschke JS. Progressive disease in glioblastoma: Benefits and limitations of semi-automated volumetry. PLoS One 2017; 12:e0173112. [PMID: 28245291 PMCID: PMC5330491 DOI: 10.1371/journal.pone.0173112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 02/15/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose Unambiguous evaluation of glioblastoma (GB) progression is crucial, both for clinical trials as well as day by day routine management of GB patients. 3D-volumetry in the follow-up of GB provides quantitative data on tumor extent and growth, and therefore has the potential to facilitate objective disease assessment. The present study investigated the utility of absolute changes in volume (delta) or regional, segmentation-based subtractions for detecting disease progression in longitudinal MRI follow-ups. Methods 165 high resolution 3-Tesla MRIs of 30 GB patients (23m, mean age 60.2y) were retrospectively included in this single center study. Contrast enhancement (CV) and tumor-related signal alterations in FLAIR images (FV) were semi-automatically segmented. Delta volume (dCV, dFV) and regional subtractions (sCV, sFV) were calculated. Disease progression was classified for every follow-up according to histopathologic results, decisions of the local multidisciplinary CNS tumor board and a consensus rating of the neuro-radiologic report. Results A generalized logistic mixed model for disease progression (yes / no) with dCV, dFV, sCV and sFV as input variables revealed that only dCV was significantly associated with prediction of disease progression (P = .005). Delta volume had a better accuracy than regional, segmentation-based subtractions (79% versus 72%) and a higher area under the curve by trend in ROC curves (.83 versus .75). Conclusion Absolute volume changes of the contrast enhancing tumor part were the most accurate volumetric determinant to detect progressive disease in assessment of GB and outweighed FLAIR changes as well as regional, segmentation-based image subtractions. This parameter might be useful in upcoming objective response criteria for glioblastoma.
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Affiliation(s)
- Thomas Huber
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
- Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Georgina Alber
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Hanno M. Specht
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Jan S. Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Germany
- * E-mail:
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