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Ghaderi S, Mohammadi S, Fatehi F. Diffusion Tensor Imaging (DTI) Biomarker Alterations in Brain Metastases and Comparable Tumors: A Systematic Review of DTI and Tractography Findings. World Neurosurg 2024; 190:113-129. [PMID: 38986953 DOI: 10.1016/j.wneu.2024.07.037] [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: 03/05/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Brain metastases (BMs) are the most frequent tumors of the central nervous system. Diffusion tensor imaging (DTI) is a magnetic resonance imaging technique that provides insights into brain microstructural alterations and tensor metrics and generates tractography to visualize white matter fiber tracts based on diffusion directionality. This systematic review assessed evidence from DTI biomarker alterations in BMs and comparable tumors such as glioblastoma. METHODS PubMed, Scopus, and Web of Science were searched, and published between January 2000 and August 2023. The key inclusion criteria were studies reporting DTI metrics in BMs and comparisons with other tumors. Data on study characteristics, tumor types, sample details, and main DTI findings were extracted. RESULTS Fifty-seven studies with 1592 BM patients and 1578 comparable brain tumors were included. Peritumoral fractional anisotropy (FA) consistently differentiates BMs from primary brain tumors, whereas intratumoral FA shows limited discriminatory power. Mean diffusivity increased in BMs versus comparators. Intratumoral metrics were less consistent but revealed differences in BM origin. Axial and radial diffusivity have provided insights into the effects of radiation, tumor origin, and infiltration. Axial diffusivity/radial diffusivity differentiated tumor infiltration from vasogenic edema. Tractography revealed anatomical relationships between white matter tracts and BMs. In addition, tractography-guided BM surgery and radiotherapy planning are required. Machine learning models incorporating DTI biomarkers/metrics accurately classified BMs versus comparators and improved diagnostic classification. CONCLUSIONS DTI metrics provide noninvasive biomarkers for distinguishing BMs from other tumors and predicting outcomes. Key metrics included peritumoral FA and mean diffusivity.
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Affiliation(s)
- Sadegh Ghaderi
- Department of Neurology, Neuromuscular Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sana Mohammadi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran; Neurology Department, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
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El-Morsy A, Elmokadem AH, Abdel Razek A, Ezzat Mousa A, Sakrana AA, Abdel-Wahab RM. Utility of diffusion tensor imaging in differentiating benign from malignant thyroid nodules. Neuroradiol J 2024:19714009241260807. [PMID: 38864496 DOI: 10.1177/19714009241260807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Purpose: To assess diffusion tensor imaging (DTI) in differentiating benign from malignant thyroid nodules. Methods: A retrospective analysis was done on 55 patients with thyroid nodules who had undergone DTI. The fraction anisotropy (FA) and mean diffusivity (MD) of the thyroid nodules were measured using region of interest (ROI) by two observers. The final diagnosis was malignant and benign, as proved by pathological examination. Results: The mean MD of benign thyroid nodules (1.84 ± 0.42 and 1.90 ± 0.37 × 10-3mm2/s) was significantly higher (p < .001) than malignant nodules (0.95 ± 0.46 and 0.97 ± 0.41 × 10-3mm2/s) as scored by both observers. The cut-off values of 1.45 and 1.50 × 10-3mm2/s were used to differentiate malignant from benign thyroid nodules with the areas under the curve (AUC) of 0.926 and 0.937, respectively. The mean FA of benign thyroid nodules (0.23 ± 0.07 and 0.24 ± 0.08) was significantly lower (p < .001) than malignant nodules (0.48 ± 0.21 and 0.49 ± 0.18). The FA cut-off value of ≤0.32 and 0.33 was used for differentiating malignant from benign thyroid nodules with an AUC of 0.877 and 0.881, respectively. A combination of MD and FA values was used to differentiate benign from malignant thyroid nodules with an AUC of 0.932 and an accuracy of 87%. There was an excellent agreement between both observers for FA and MD (K = 0.939, 0.929). Conclusion: The DTI is a non-invasive, non-contrast imaging tool that can differentiate benign from malignant thyroid nodules.
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Affiliation(s)
- Ahmed El-Morsy
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Radiology, Mansoura University, Mansoura, Egypt
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Teng M, Wang M, He F, Liang W, Zhang G. Arterial Spin Labeling and Amide Proton Transfer Imaging can Differentiate Glioblastoma from Brain Metastasis: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 182:e702-e711. [PMID: 38072160 DOI: 10.1016/j.wneu.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Currently, arterial spin labeling (ASL) and amide proton transfer (APT) imaging have shown potential for distinguishing glioblastoma from brain metastases. Thus, a meta-analysis was conducted to investigate this further. METHODS An extensive and comprehensive search was conducted in 6 English and Chinese databases according to predefined inclusion and exclusion criteria, encompassing data up to July 2023. Data from eligible literature were extracted, and bivariate models were employed to calculate pooled sensitivities, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and area under the curve (AUC) of the summary receiver operating characteristic curve. RESULTS The meta-analysis included 11 articles. For ASL, the pooled sensitivity was 0.77 (95% confidence interval [CI], 0.63-0.87), and the pooled specificity was 0.87 (95% CI, 0.77-0.93). The pooled PLR was 5.89 (95% CI, 2.97-11.69), the pooled NLR was 0.26 (95% CI, 0.15-0.47), the pooled DOR was 22.33 (95% CI, 6.89-72.34), and AUC was 0.90 (95% CI, 0.87-0.92). For APT imaging, the pooled sensitivity was 0.78 (95% CI, 0.70-0.85), and the pooled specificity was 0.86 (95% CI, 0.77-0.92). The pooled PLR was 5.51 (95% CI, 3.24-9.37), the pooled NLR was 0.25 (95% CI, 0.17-0.37), the pooled DOR was 21.99 (95% CI, 10.28-47.03), and the AUC was 0.90 (95% CI, 0.87-0.92). CONCLUSIONS This meta-analysis suggest that both ASL and APT imaging exhibit high accuracy in distinguishing between glioblastoma and brain metastasis.
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Affiliation(s)
- Minghao Teng
- Department of Neurosurgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases, Enshi, Hubei, China; Hubei Provincial Clinical Medical Research Center for Nephropathy, Enshi, Hubei, China
| | - Minshu Wang
- Department of Neurosurgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases, Enshi, Hubei, China; Hubei Provincial Clinical Medical Research Center for Nephropathy, Enshi, Hubei, China
| | - Feng He
- Department of Neurosurgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases, Enshi, Hubei, China; Hubei Provincial Clinical Medical Research Center for Nephropathy, Enshi, Hubei, China
| | - Wu Liang
- Department of Neurosurgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases, Enshi, Hubei, China; Hubei Provincial Clinical Medical Research Center for Nephropathy, Enshi, Hubei, China
| | - Guisheng Zhang
- Department of Neurosurgery, Minda Hospital of Hubei Minzu University, Enshi, Hubei, China; Hubei Provincial Key Laboratory of Occurrence and Intervention of Rheumatic Diseases, Enshi, Hubei, China; Hubei Provincial Clinical Medical Research Center for Nephropathy, Enshi, Hubei, China.
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Dong W, Wang N, Qi Z. Advances in the application of neuroinflammatory molecular imaging in brain malignancies. Front Immunol 2023; 14:1211900. [PMID: 37533851 PMCID: PMC10390727 DOI: 10.3389/fimmu.2023.1211900] [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: 04/25/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
The prevalence of brain cancer has been increasing in recent decades, posing significant healthcare challenges. The introduction of immunotherapies has brought forth notable diagnostic imaging challenges for brain tumors. The tumor microenvironment undergoes substantial changes in induced immunosuppression and immune responses following the development of primary brain tumor and brain metastasis, affecting the progression and metastasis of brain tumors. Consequently, effective and accurate neuroimaging techniques are necessary for clinical practice and monitoring. However, patients with brain tumors might experience radiation-induced necrosis or other neuroinflammation. Currently, positron emission tomography and various magnetic resonance imaging techniques play a crucial role in diagnosing and evaluating brain tumors. Nevertheless, differentiating between brain tumors and necrotic lesions or inflamed tissues remains a significant challenge in the clinical diagnosis of the advancements in immunotherapeutics and precision oncology have underscored the importance of clinically applicable imaging measures for diagnosing and monitoring neuroinflammation. This review summarizes recent advances in neuroimaging methods aimed at enhancing the specificity of brain tumor diagnosis and evaluating inflamed lesions.
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Affiliation(s)
- Wenxia Dong
- Department of Radiology, The First People’s Hospital of Linping District, Hangzhou, China
| | - Ning Wang
- Department of Medical Imaging, Jining Third People’s Hospital, Jining, Shandong, China
| | - Zhe Qi
- Department of Radiology, Zibo Central Hospital, Zibo, Shandong, China
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Chen L, Li T, Li Y, Zhang J, Li S, Zhu L, Qin J, Tang L, Zeng Z. Combining amide proton transfer-weighted and arterial spin labeling imaging to differentiate solitary brain metastases from glioblastomas. Magn Reson Imaging 2023; 102:96-102. [PMID: 37172748 DOI: 10.1016/j.mri.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/03/2023] [Accepted: 05/09/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate the clinical utility of amide proton transfer-weighted imaging (APTw) and arterial spin labeling (ASL) in differentiating solitary brain metastases (SBMs) from glioblastomas (GBMs). METHODS Forty-eight patients diagnosed with brain tumors were enrolled. All patients underwent conventional MRI, APTw, and ASL scans on a 3.0 T MRI system. The mean APTw value and mean cerebral blood flow (CBF) value were measured. The differences in various parameters between GBMs and SBMs were assessed using the independent-samples t-test. The quantitative performance of these MRI parameters in distinguishing between GBMs and SBMs was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS GBMs exhibited significantly higher APTw and CBF values in peritumoral regions compared with SBMs (P < 0.05). There was no significant difference between SBMs and GBMs in tumor cores. APTw MRI had a higher diagnostic efficiency in differentiating SBMs from GBMs (area under the curve [AUC]: 0.864; 75.0% sensitivity and 81.8% specificity). Combined use of APTw and CBF value increased the AUC to 0.927. CONCLUSION APTw may be superior to ASL for distinguishing between SBMs and GBMs. Combination of APTw and ASL showed better discrimination and a superior diagnostic performance.
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Affiliation(s)
- Ling Chen
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, Guangxi 530021, China; Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Tao Li
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Yao Li
- Department of Neurosurgery, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Jinhuan Zhang
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Shuanghong Li
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Li Zhu
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Jianli Qin
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Lifang Tang
- Department of Medical Imaging Center, The Fourth Affiliated Hospital, Guangxi Medical University, Heping Road No.156, Liunan District, Liuzhou, Guangxi 545007, China
| | - Zisan Zeng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6, Shuangyong Road, Nanning, Guangxi 530021, China.
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Khedr D, Razek AAKA, Talaat M. Multi-parametric arterial spin labeling and diffusion-weighted imaging of paranasal sinuses masses. Oral Radiol 2023; 39:321-328. [PMID: 35900660 DOI: 10.1007/s11282-022-00640-z] [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: 03/27/2021] [Accepted: 07/07/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate arterial spin labeling (ASL) and diffusion-weighted imaging (DWI) in discrimination of benign from malignant paranasal sinus (PNS) tumors. MATERIAL AND METHODS A prospective study was done upon 42 cases of PNS masses that underwent magnetic resonance ASL and DWI of the head. Tumor blood flow (TBF) and apparent diffusion coefficient (ADC) of the masses were calculated by two observers. The pathological diagnosis was malignant (n = 28) and benign (n = 14) cases. RESULTS For both observers, the malignant PNS masses had significantly higher TBF (P < 0.001, 0.001) and lower ADC (P < 0.001, 0.001) than in benign masses. The ROC curve analysis of TBF, The threshed TBF was (121.45, 122.68 mL/100 g/min) used for differentiation between benign and malignant PNS masses, revealed sensitivity (92.9%, 89.3%), specificity (85.7%, 85.7%), accuracy (90.5%, 88.1%) and the AUC was 0.87 and 0.86 by both observers. the ROC curve analysis of ADC, The threshold ADC (1.215, 1.205 X10-3mm2/s) was used for differentiation between benign and malignant PNS masses, revealed sensitivity (96.4%, 89.3%), specificity (78.6%, 78.6%), accuracy of (90.5%, 85.7%) and the AUC was 0.93 and 0.92 by both observers. Combined analysis of TBF and ADC used for differentiation between benign and malignant PNS masses had revealed sensitivity (96.4%, 89.3%), specificity (92.9%, 85.7%) accuracy of (95.2%, 88.1%) and AUC. (0.995, 0.985) for both observers. CONCLUSION Combined using of TBF and ADC have a role in differentiation malignant from benign PNS masses.
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Affiliation(s)
- Doaa Khedr
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Elgomheryia street, Mansoura, 35511, Egypt.
| | | | - Mona Talaat
- Department of Diagnostic Radiology, Kafr Elsheak Faculty of Medicine, Kafrelsheikh, Egypt
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Fioni F, Chen SJ, Lister INE, Ghalwash AA, Long MZ. Differentiation of high grade glioma and solitary brain metastases by measuring relative cerebral blood volume and fractional anisotropy: a systematic review and meta-analysis of MRI diagnostic test accuracy studies. Br J Radiol 2023; 96:20220052. [PMID: 36278795 PMCID: PMC10997014 DOI: 10.1259/bjr.20220052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE This study aims to research the efficacy of MRI (I) for differentiating high-grade glioma (HGG) (P) with solitary brain metastasis (SBM) (C) by creating a combination of relative cerebral blood volume (rCBV) (O) and fractional anisotropy (FA) (O) in patients with intracerebral tumors. METHODS Searches were conducted on September 2021 with no publication date restriction, using an electronic search for related articles published in English, from PubMed (1994 to September 2021), Scopus (1977 to September 2021), Web of Science (1985 to September 2021), and Cochrane (1997 to September 2021). A total of 1056 studies were found, with 23 used for qualitative and quantitative data synthesis. Inclusion criteria were: patients diagnosed with HGG and SBM without age, sex, or race restriction; MRI examination of rCBV and FA; reliable histopathological diagnostic method as the gold-standard for all conditions of interest; observational and clinical studies. Newcastle-Ottawa quality assessment Scale (NOS) and Cochrane risk of bias tool (ROB) for observational and clinical trial studies were managed to appraise the quality of individual studies included. Data extraction results were managed using Mendeley and Excel, pooling data synthesis was completed using the Review Manager 5.4 software with random effect model to discriminate HGG and SBM, and divided into four subgroups. RESULTS There were 23 studies included with a total sample size of 597 HGG patients and 373 control groups/SBM. The analysis was categorized into four subgroups: (1) the subgroup with rCBV values in the central area of the tumor/intratumoral (399 HGG and 232 SBM) shows that HGG patients are not significantly different from SBM/controls group (SMD [95% CI] = -0.27 [-0.66, 0.13]), 2) the subgroup with rCBV values in the peritumoral area (452 HGG and 274 SBM) shows that HGG patients are significantly higher than SBM (SMD [95% CI] = -1.23 [-1.45 to -1.01]), (3) the subgroup with FA values in the central area of the tumor (249 HGG and 156 SBM) shows that HGG patients are significantly higher than SBM (SMD [95% CI] = - 0.44 [-0.84,-0.04]), furthermore (4) the subgroup with FA values in the peritumoral area (261 HGG and 168 SBM) shows that the HGG patients are significantly higher than the SBM (SMD [95% CI] = -0.59 [-1.02,-0.16]). CONCLUSION Combining rCBV and FA measurements in the peritumoral region and FA in the intratumoral region increase the accuracy of MRI examination to differentiate between HGG and SBM patients effectively. Confidence in the accuracy of our results may be influenced by major interstudy heterogeneity. Whereas the I2 for the rCBV in the intratumoral subgroup was 80%, I2 for the rCBV in the peritumoral subgroup was 39%, and I2 for the FA in the intratumoral subgroup was 69%, and I2 for the FA in the peritumoral subgroup was 74%. The predefined accurate search criteria, and precise selection and evaluation of methodological quality for included studies, strengthen this studyOur study has no funder, no conflict of interest, and followed an established PROSPERO protocol (ID: CRD42021279106). ADVANCES IN KNOWLEDGE The combination of rCBV and FA measurements' results is promising in differentiating HGG and SBM.
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Affiliation(s)
- Fioni Fioni
- Department of Radiology, Nanjing Medical University, first
affiliated hospital (Jiangsu Provincial People’s
Hospital), Jiangsu, China
| | - Song Jia Chen
- Department of Radiology, Nanjing Medical University, first
affiliated hospital (Jiangsu Provincial People’s
Hospital), Jiangsu, China
| | - I Nyoman Ehrich Lister
- Medicine, Universitas Prima Indonesia and Royal Prima
Hospital, Medan, North Sumatera, Indoneisa
| | | | - Ma Zhan Long
- Department of Radiology, Nanjing Medical University, first
affiliated hospital (Jiangsu Provincial People’s
Hospital), Jiangsu, China
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Elmongui A, AbdelRazek A, Abou-Elsaad T, Belal T, Ibrahim N, Alnaghy E. Diffusion tensor imaging of dorsal stream language areas in patients with post-stroke aphasia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-021-00690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Aphasia complicating stroke occurs due to language deficits that decrease communication abilities and functional independence. Our study aims to assess fractional anisotropy (FA) and mean diffusivity (MD) parameters of diffusion tensor imaging (DTI) of the dorsal stream language areas in patients with post-stroke aphasia. It was conducted on 27 patients with post-stroke aphasia and 27 age- and sex-matched controls who underwent DTI of the brain. FA and MD values of Broca's area (BA), Wernick's area (WA), superior longitudinal fasciculus (SLF), and arcuate fasciculus (AF), and number of tract fibers (TF) of AF and SLF were calculated. Results were correlated with National Institutes of Health Stroke Scale (NIHSS), Arabic version of Comprehensive Aphasia Test (Arabic CAT), and Mansoura Arabic Screening Aphasia Test (MASAT).
Results
FA of AF and SLF in patients was significantly lower (P = 0.001) than controls. MD of AF and SLF in patients was significantly higher (P = 0.001) than controls. The mean volume TF of AF and SLF in patients was significantly (P = 0.001) lower than the mean volume in controls for AF and SLF. FA cutoff for AF was 0.34 and for SLF, it was 0.35 with sensitivity, specificity, and accuracy (85.2%, 62.1%, 73.2%) for AF, (74.1%, 69%, 71.4%) for SLF, respectively. MD cutoff value for AF was 0.87, and 0.84 for SLF with sensitivity, specificity, and accuracy (63%, 72.4%, 67.8%) for AF, (81.5%, 79.3%, 80.4%) for SLF, respectively. Cutoff TF of AF was 1728 and for SLF it was 601 with sensitivity, specificity, and accuracy (88.9%, 72.4%, 80.4%) for AF and (85.2%, 85.2%, 78.6%) for SLF, respectively.
Conclusions
DTI is a non-invasive promising method that can be used to assess language areas in patients with post-stroke aphasia.
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Solozhentseva K, Batalov A, Zakharova N, Goryaynov S, Pogosbekyan E, Pronin I. The Role of 3D-pCASL MRI in the Differential Diagnosis of Glioblastoma and Brain Metastases. Front Oncol 2022; 12:874924. [PMID: 35558515 PMCID: PMC9086561 DOI: 10.3389/fonc.2022.874924] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/21/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose The first aim of this study was to compare the intratumoral and peritumoral blood flow parameters in glioblastomas and brain metastases measured by pseudocontinuous arterial spin labeling MRI (3D pCASL). The second aim of this study was to determine whether pCASL could aid in identifying the source of brain metastases. Materials and Methods This study included 173 patients aged 12 to 83 years (median age—61 years), who were observed at the National Medical Research Center for Neurosurgery. All patients underwent preoperative MRI with pCASL perfusion. Thereafter patients were operated on and received histological diagnosis. No patients received preoperative chemo or radiotherapy. Results The values of maximum and normalized intratumoral blood flow were significantly higher in the group with gliblastoma than in the group with brain metastases: 168.98 + −91.96 versus 152.1 + −173.32 and 7.6 + −8.4 versus 9.3 + −5.33 respectively (p <0.01). However, ROC analysis showed low AUC specificity and sensitivity (0.64, 70%, 60% for mTBF and 0.66, 77%, 62% for nTBF). Peritumoral blood flow parameters were also higher in the glioblastoma group (29.61 + −22.89 versus 16.58 + −6.46 for mTBF and 1.63 + −1.14 versus 0.88 + −0.38 for nTBF, respectively; p <0.01). ROC analysis showed the following measurements of AUC, specificity, and sensitivity (0.75, 68%, 73% for mTBF and 0.77, 58%, 91% for nTBF). Regarding pCASL and various histological subsets of brain metastases, the study found statistically significant differences between the lung and melanoma metastases and the lung and kidney metastases. ROC analysis gave the following values for lung and melanoma metastases: AUC—0.76, specificity—75%, and sensitivity—73% for mTBF; 0.83, 67%, and 93% respectively, for nTBF. For lung and kidney metastases: AUC—0.74, specificity—70%, and sensitivity—93% for mTBF; 0.75, 70%, and 93% respectively, for nTBF. Conclusions pCASL could aid in differential diagnosis between glioblastoma and brain metastases. Measurement of peritumoral blood flow demonstrates higher specificity and sensitivity than with intratumoral blood flow. Moreover, pCASL provides the ability to distinguish lung metastases from kidney and melanoma metastases.
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Affiliation(s)
- Kristina Solozhentseva
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Artem Batalov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Natalia Zakharova
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Sergey Goryaynov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Eduard Pogosbekyan
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Igor Pronin
- N.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of the Russian Federation, Moscow, Russia
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Zhang Y, Lin Y, Xing Z, Yao S, Cao D, Miao WB. Non-invasive assessment of heterogeneity of gliomas using diffusion and perfusion MRI: correlation with spatially co-registered PET. Acta Radiol 2022; 63:664-671. [PMID: 33858207 DOI: 10.1177/02841851211006913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Heterogeneity of gliomas challenges the neuronavigated biopsy and oncological therapy. Diffusion and perfusion magnetic resonance imaging (MRI) can reveal the cellular and hemodynamic heterogeneity of tumors. Integrated positron emission tomography (PET)/MRI is expected to be a non-invasive imaging approach to characterizing glioma. PURPOSE To evaluate the value of apparent diffusion coefficient (ADC), cerebral blood volume (CBV), and spatially co-registered maximal standard uptake value (SUVmax) for tissue characterization and glioma grading. MATERIAL AND METHODS Thirty-seven consecutive patients with pathologically confirmed gliomas were retrospectively investigated. The relative minimum ADC (rADCmin), relative maximal ADC (rADCmax), relative maximal rCBV (rCBVmax), the relative minimum rCBV (rCBVmin), and the corresponding relative SUVmax (rSUVmax) were measured. The paired t-test was used to compare the quantitative parameters between different regions to clarify tumor heterogeneity. Imaging parameters between WHO grade IV and grade II/III gliomas were compared by t-test. The diagnostic efficiency of multiparametric PET/MRI was analyzed by receiver operating characteristic (ROC) curve. RESULTS The values of rSUVmax were significantly different between maximal diffusion/perfusion area and minimum diffusion/perfusion area (P < 0.001/P < 0.001) within tumor. The values of rADCmin (P < 0.001), rCBVmax (P = 0.002), and corresponding rSUVmax (P = 0.001/P < 0.001) could be used for grading gliomas. The areas under the ROC curves of rSUVmax defined by rADCmin and rCBVmax were 0.89 and 0.91, respectively. CONCLUSION Diffusion and perfusion MRI can detect glioma heterogeneity with excellent molecular imaging correlations. Regions with rCBVmax suggest tissues with the highest metabolism and malignancy for guiding glioma grading and tissue sampling.
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Affiliation(s)
- Ying Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Yu Lin
- Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian, PR China
| | - Zhen Xing
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Shaobo Yao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
| | - Wei-bing Miao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, PR China
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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Hu WZ, Guo F, Xu YQ, Xi YB, He B, Yin H, Kang XW. Differentiation of Neoplastic and Non-neoplastic Intracranial Enhancement Lesions Using Three-Dimensional Pseudo-Continuous Arterial Spin Labeling. Front Neurosci 2022; 16:812997. [PMID: 35299623 PMCID: PMC8923048 DOI: 10.3389/fnins.2022.812997] [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: 11/11/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose It is sometimes difficult to effectively distinguish non-neoplastic from neoplastic intracranial enhancement lesions using conventional magnetic resonance imaging (MRI). This study aimed to evaluate the diagnostic performance of three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL) to differentiate non-neoplastic from neoplastic enhancement lesions intracranially. Materials and Methods This prospective study included thirty-five patients with high-grade gliomas (HGG), twelve patients with brain metastasis, and fifteen non-neoplastic patients who underwent conventional, contrast enhancement and 3D-pCASL imaging at 3.0-T MR; all lesions were significantly enhanced. Quantitative parameters including cerebral blood flow (CBF) and relative cerebral blood flow (rCBF) were compared between neoplastic and non-neoplastic using Student’s t-test. In addition, the area under the receiver operating characteristic (ROC) curve (AUC) was measured to assess the differentiation diagnostic performance of each parameter. Results The non-neoplastic group demonstrated significantly lower rCBF values of lesions and perilesional edema compared with the neoplastic group. For the ROC analysis, both relative cerebral blood flow of lesion (rCBF-L) and relative cerebral blood flow of perilesional edema (rCBF-PE) had good diagnostic performance for discriminating non-neoplastic from neoplastic lesions, with an AUC of 0.994 and 0.846, respectively. Conclusion 3D-pCASL may contribute to differentiation of non-neoplastic from neoplastic lesions.
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Affiliation(s)
- Wen-zhong Hu
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yong-qiang Xu
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
| | - Yi-bin Xi
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
| | - Bei He
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
| | - Hong Yin
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, China
- *Correspondence: Hong Yin,
| | - Xiao-wei Kang
- Department of Radiology, Xi’an People’s Hospital, Xi’an Fourth Hospital, Xi’an, China
- *Correspondence: Hong Yin,
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Rui L, Jing L, Zhenchang W. Diffusion Tensor Imaging Technology to Quantitatively Assess Abnormal Changes in Patients With Thyroid-Associated Ophthalmopathy. Front Hum Neurosci 2022; 15:805945. [PMID: 35185495 PMCID: PMC8855114 DOI: 10.3389/fnhum.2021.805945] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective We aim to investigate the feasibility of using diffusion tensor imaging (DTI) to evaluate changes in extraocular muscles (EOMs) and lacrimal gland (LG) in patients with thyroid-associated ophthalmopathy (TAO) and to evaluate disease severity. Materials and Methods A total of 74 participants, including 17 healthy controls (HCs), 22 patients with mild TAO, and 35 patients with moderate-severe TAO, underwent 3-Tesla DTI to measure fractional anisotropy (FA) and mean diffusivity (MD) of the EOMs and LG. Ophthalmological examinations, including visual acuity, exophthalmos, intraocular pressure, and fundoscopy, were performed. FA and MD values were compared among patients with different disease severity. Multiple linear regression was adopted to predict the impact of clinical variables on DTI parameters of orbital soft tissue. Results TAO patients’ EOMs and LG showed significantly lower FA values and higher MD compared to HCs’ (P < 0.05). Moderate-severe TAO patients’ EOMs and LG had dramatically lower FA and higher MD compared with HCs (P < 0.05). In addition, only the DTI parameters of the medial rectus were considerably different between mild and moderate-severe TAO patients (P = 0.017, P = 0.021). Multiple linear regression showed that disease severity had a significant impact on the DTI parameters of orbital soft tissue. Conclusion DTI is a useful tool for detecting microstructural changes in TAO patients’ orbital soft tissue. DTI findings, especially medial rectus DTI parameters, can help to indicate the disease severity in TAO patients.
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Shady MMS, Gibreel AFES, Rashed DRM, Tharwat N. Arterial spin labeling assessment of myometrial perfusion changes in patients with uterine fibroid and its impact on fertility. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Fibroids are the most common uterine tumor in the reproductive age group. These tumors although benign, their relation to infertility is still controversial. The purpose of this study is to assess the fibroid impact on fertility using arterial spin labeling (ASL) technique.
Results
This prospective study included 40 cases (30 female patients having uterine fibroid and 10 age- and sex-matched control cases). The 30 patients were divided according to their fertility into 2 subgroups: fertile (n = 15) and infertile (n = 15). All cases underwent pelvic magnetic resonance imaging (MRI) examination with ASL technique. The perfusion values were measured in the uterine walls, fibroids, and in the gluteus maximus muscle as control. ASL demonstrated non-significant difference in the perfusion between anterior and posterior uterine walls in the control cases and revealed significant difference in the perfusion between fibroid positive and fibroid negative uterine walls in patients with uterine fibroid (p value < 0.04). Perfusion values of the fertile and infertile subgroups showed no statistically significant difference.
Conclusion
Arterial spin labeling is an evolving technique that can be used to evaluate the myometrial perfusion changes in patients with uterine fibroid without using contrast media. Uterine fibroids were associated with decreased perfusion but with no statistically significant impact on fertility.
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Wu J, Liang F, Wei R, Lai S, Lv X, Luo S, Wu Z, Chen H, Zhang W, Zeng X, Ye X, Wu Y, Wei X, Jiang X, Zhen X, Yang R. A Multiparametric MR-Based RadioFusionOmics Model with Robust Capabilities of Differentiating Glioblastoma Multiforme from Solitary Brain Metastasis. Cancers (Basel) 2021; 13:cancers13225793. [PMID: 34830943 PMCID: PMC8616314 DOI: 10.3390/cancers13225793] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/13/2021] [Accepted: 11/13/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Glioblastoma multiforme (GBM) and solitary brain metastasis (SBM) are common brain tumors in adults. The two tumors often pose a diagnostic dilemma owing to their similar features on conventional magnetic resonance imaging (MRI). Ability to discriminate the two tumors is critical as it informs clinical treatment strategies. This pilot study attempts to employ the machine learning technique to identify GBM and SBM by fusing radiomics features of multiple MRI sequences and multiple models. A multiparametric MR-based RadioFusionOmics (RFO) model was developed and has demonstrated promising prediction accuracy for the identifications of GBM and SBM. Abstract This study aimed to evaluate the diagnostic potential of a novel RFO model in differentiating GBM and SBM with multiparametric MR sequences collected from 244 (131 GBM and 113 SBM) patients. Three basic volume of interests (VOIs) were delineated on the conventional axial MR images (T1WI, T2WI, T2_FLAIR, and CE_T1WI), including volumetric non-enhanced tumor (nET), enhanced tumor (ET), and peritumoral edema (pTE). Using the RFO model, radiomics features extracted from different multiparametric MRI sequence(s) and VOI(s) were fused and the best sequence and VOI, or possible combinations, were determined. A multi-disciplinary team (MDT)-like fusion was performed to integrate predictions from the high-performing models for the final discrimination of GBM vs. SBM. Image features extracted from the volumetric ET (VOIET) had dominant predictive performances over features from other VOI combinations. Fusion of VOIET features from the T1WI and T2_FLAIR sequences via the RFO model achieved a discrimination accuracy of AUC = 0.925, accuracy = 0.855, sensitivity = 0.856, and specificity = 0.853, on the independent testing cohort 1, and AUC = 0.859, accuracy = 0.836, sensitivity = 0.708, and specificity = 0.919 on the independent testing cohort 2, which significantly outperformed three experienced radiologists (p = 0.03, 0.01, 0.02, and 0.01, and p = 0.02, 0.01, 0.45, and 0.02, respectively) and the MDT-decision result of three experienced experts (p = 0.03, 0.02, 0.03, and 0.02, and p = 0.03, 0.02, 0.44, and 0.03, respectively).
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Affiliation(s)
- Jialiang Wu
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
- Department of Radiology, The University of Hong Kong Shenzhen Hospital, Shenzhen 518000, China
| | - Fangrong Liang
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China;
| | - Ruili Wei
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Shengsheng Lai
- School of Medical Equipment, Guangdong Food and Drug Vocational College, Guangzhou 510520, China;
| | - Xiaofei Lv
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China;
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Shiwei Luo
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Zhe Wu
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Huixian Chen
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Wanli Zhang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Xiangling Zeng
- Department of Radiology, Huizhou Municipal Central Hospital, Huizhou 516001, China;
| | - Xianghua Ye
- Department of Radiation Oncology, 1st Affiliated Hospital, Zhejiang University, Hangzhou 310009, China;
| | - Yong Wu
- Department of Oncology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China;
| | - Xinhua Wei
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Xinqing Jiang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
| | - Xin Zhen
- School of Biomedical Engineering, Southern Medical University, Guangzhou 510515, China;
- Correspondence: (X.Z.); (R.Y.); Tel.: +86-20-62789323 (X.Z.); +86-20-81048873 (R.Y.)
| | - Ruimeng Yang
- Department of Radiology, the Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou 510180, China; (J.W.); (R.W.); (S.L.); (Z.W.); (H.C.); (W.Z.); (X.W.); (X.J.)
- Correspondence: (X.Z.); (R.Y.); Tel.: +86-20-62789323 (X.Z.); +86-20-81048873 (R.Y.)
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Wang DJJ, Le Bihan D, Krishnamurthy R, Smith M, Ho ML. Noncontrast Pediatric Brain Perfusion: Arterial Spin Labeling and Intravoxel Incoherent Motion. Magn Reson Imaging Clin N Am 2021; 29:493-513. [PMID: 34717841 DOI: 10.1016/j.mric.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Noncontrast magnetic resonance imaging techniques for measuring brain perfusion include arterial spin labeling (ASL) and intravoxel incoherent motion (IVIM). These techniques provide noninvasive and repeatable assessment of cerebral blood flow or cerebral blood volume without the need for intravenous contrast. This article discusses the technical aspects of ASL and IVIM with a focus on normal physiologic variations, technical parameters, and artifacts. Multiple pediatric clinical applications are presented, including tumors, stroke, vasculopathy, vascular malformations, epilepsy, migraine, trauma, and inflammation.
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Affiliation(s)
- Danny J J Wang
- USC Institute for Neuroimaging and Informatics, SHN, 2025 Zonal Avenue, Health Sciences Campus, Los Angeles, CA 90033, USA
| | - Denis Le Bihan
- NeuroSpin, Centre d'études de Saclay, Bâtiment 145, Gif-sur-Yvette 91191, France
| | - Ram Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive - ED4, Columbus, OH 43205, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive - ED4, Columbus, OH 43205, USA
| | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, 700 Children's Drive - ED4, Columbus, OH 43205, USA.
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Abdel Razek AAK, Alksas A, Shehata M, AbdelKhalek A, Abdel Baky K, El-Baz A, Helmy E. Clinical applications of artificial intelligence and radiomics in neuro-oncology imaging. Insights Imaging 2021; 12:152. [PMID: 34676470 PMCID: PMC8531173 DOI: 10.1186/s13244-021-01102-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/26/2021] [Indexed: 12/15/2022] Open
Abstract
This article is a comprehensive review of the basic background, technique, and clinical applications of artificial intelligence (AI) and radiomics in the field of neuro-oncology. A variety of AI and radiomics utilized conventional and advanced techniques to differentiate brain tumors from non-neoplastic lesions such as inflammatory and demyelinating brain lesions. It is used in the diagnosis of gliomas and discrimination of gliomas from lymphomas and metastasis. Also, semiautomated and automated tumor segmentation has been developed for radiotherapy planning and follow-up. It has a role in the grading, prediction of treatment response, and prognosis of gliomas. Radiogenomics allowed the connection of the imaging phenotype of the tumor to its molecular environment. In addition, AI is applied for the assessment of extra-axial brain tumors and pediatric tumors with high performance in tumor detection, classification, and stratification of patient's prognoses.
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Affiliation(s)
| | - Ahmed Alksas
- Biomaging Lab, Department of Bioengineering, University of Louisville, Louisville, KY, 40292, USA
| | - Mohamed Shehata
- Biomaging Lab, Department of Bioengineering, University of Louisville, Louisville, KY, 40292, USA
| | - Amr AbdelKhalek
- Internship at Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Khaled Abdel Baky
- Department of Diagnostic Radiology, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Ayman El-Baz
- Biomaging Lab, Department of Bioengineering, University of Louisville, Louisville, KY, 40292, USA
| | - Eman Helmy
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Elgomheryia Street, Mansoura, 3512, Egypt.
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Roesler R, Dini SA, Isolan GR. Neuroinflammation and immunoregulation in glioblastoma and brain metastases: Recent developments in imaging approaches. Clin Exp Immunol 2021; 206:314-324. [PMID: 34591980 DOI: 10.1111/cei.13668] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 01/12/2023] Open
Abstract
Brain tumors and brain metastases induce changes in brain tissue remodeling that lead to immunosuppression and trigger an inflammatory response within the tumor microenvironment. These immune and inflammatory changes can influence invasion and metastasis. Other neuroinflammatory and necrotic lesions may occur in patients with brain cancer or brain metastases as sequelae from treatment with radiotherapy. Glioblastoma (GBM) is the most aggressive primary malignant brain cancer in adults. Imaging methods such as positron emission tomography (PET) and different magnetic resonance imaging (MRI) techniques are highly valuable for the diagnosis and therapeutic evaluation of GBM and other malignant brain tumors. However, differentiating between tumor tissue and inflamed brain tissue with imaging protocols remains a challenge. Here, we review recent advances in imaging methods that have helped to improve the specificity of primary tumor diagnosis versus evaluation of inflamed and necrotic brain lesions. We also comment on advances in differentiating metastasis from neuroinflammation processes. Recent advances include the radiosynthesis of 18 F-FIMP, an L-type amino acid transporter 1 (LAT1)-specific PET probe that allows clearer differentiation between tumor tissue and inflammation compared to previous probes, and the combination of different advanced imaging protocols with the inclusion of radiomics and machine learning algorithms.
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Affiliation(s)
- Rafael Roesler
- Department of Pharmacology, Institute for Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.,Cancer and Neurobiology Laboratory, Experimental Research Center, Clinical Hospital (CPE-HCPA), Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Simone Afonso Dini
- The Center for Advanced Neurology and Neurosurgery (CEANNE)-Brazil, Porto Alegre, RS, Brazil
| | - Gustavo R Isolan
- The Center for Advanced Neurology and Neurosurgery (CEANNE)-Brazil, Porto Alegre, RS, Brazil.,Mackenzie Evangelical University of Paraná (FEMPAR), Curitiba, PR, Brazil
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The role of diffusion tensor imaging of the liver in children with autoimmune hepatitis. Pol J Radiol 2021; 86:e461-e467. [PMID: 34567291 PMCID: PMC8449556 DOI: 10.5114/pjr.2021.108171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/15/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose To evaluate the role of diffusion tensor imaging (DTI) of the liver in children with autoimmune hepatitis (AIH). Material and methods A prospective study was done on 42 children with AIH (30 girls and 12 boys, with a mean age of 13 years) and 20 age- and sex-matched healthy control children. They underwent DTI of the liver and laboratory tests. Liver biopsy was done for the patients. The mean diffusivity (MD) and fractional anisotropy (FA) of the liver were calculated and correlated with the pathological results. Results The mean MD and FA of the liver in children with AIH were 1.42 ± 0.06 × 10-3 mm2/s and 0.37 ± 0.11; and in the control children they were 1.55 ± 0.07 × 10-3 mm2/s and 0.25 ± 0.03, respectively. The MD and FA were significantly different in the children with AIH compared to the control children (p = 0.001). The cutoff MD and FA used to differentiate patients from controls were 1.50 × 10-3 mm2/s, 0.31 with AUC of 0.919 and 0.813, sensitivity of 97.6% and 66.7%, a specificity of 80% and 70%, an accuracy of 94.2% and 67.3%, PPV of 95.3 and 90.3, and NPV of 88.9 and 33.3, respectively. There was significantly lower MD and higher FA of the liver in children with AIH type I (n = 31) than type II (n = 11) (p = 0.001), and patients with (n = 9) and without (n = 33) overlap syndrome (p = 0.005). Conclusions We concluded that DTI parameters can help to diagnose AIH, detect its phenotyping, and give clues as to the presence of associated overlap syndrome.
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Differentiating Glioblastomas from Solitary Brain Metastases: An Update on the Current Literature of Advanced Imaging Modalities. Cancers (Basel) 2021; 13:cancers13122960. [PMID: 34199151 PMCID: PMC8231515 DOI: 10.3390/cancers13122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
Differentiating between glioblastomas and solitary brain metastases proves to be a challenging diagnosis for neuroradiologists, as both present with imaging patterns consisting of peritumoral hyperintensities with similar intratumoral texture on traditional magnetic resonance imaging sequences. Early diagnosis is paramount, as each pathology has completely different methods of clinical assessment. In the past decade, recent developments in advanced imaging modalities enabled providers to acquire a more accurate diagnosis earlier in the patient's clinical assessment, thus optimizing clinical outcome. Dynamic susceptibility contrast has been optimized for detecting relative cerebral blood flow and relative cerebral blood volume. Diffusion tensor imaging can be used to detect changes in mean diffusivity. Neurite orientation dispersion and density imaging is an innovative modality detecting changes in intracellular volume fraction, isotropic volume fraction, and extracellular volume fraction. Magnetic resonance spectroscopy is able to assist by providing a metabolic descriptor while detecting variable ratios of choline/N-acetylaspartate, choline/creatine, and N-acetylaspartate/creatine. Finally, radiomics and machine learning algorithms have been devised to assist in improving diagnostic accuracy while often utilizing more than one advanced imaging protocol per patient. In this review, we provide an update on all the current evidence regarding the identification and differentiation of glioblastomas from solitary brain metastases.
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Beig Zali S, Alinezhad F, Ranjkesh M, Daghighi MH, Poureisa M. Accuracy of apparent diffusion coefficient in differentiation of glioblastoma from metastasis. Neuroradiol J 2021; 34:205-212. [PMID: 33417503 PMCID: PMC8165902 DOI: 10.1177/1971400920983678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Brain metastasis and glioblastoma multiforme are two of the most common malignant brain neoplasms. There are many difficulties in distinguishing these diseases from each other. PURPOSE The purpose of this study was to determine whether the mean apparent diffusion coefficient and absolute standard deviation derived from apparent diffusion coefficient measurements can be used to differentiate glioblastoma multiforme from brain metastasis based on cellularity levels. MATERIAL AND METHODS Magnetic resonance images of 34 patients with histologically verified brain tumors were evaluated retrospectively. Apparent diffusion coefficient and standard deviation values were measured in the enhancing tumor, peritumoral region, and contralateral healthy white matter. Then, to determine whether there was a statistical difference between brain metastasis and glioblastoma multiforme, we analyzed different variables between the two groups. RESULTS Neither mean apparent diffusion coefficient values and ratios nor standard deviation values and ratios were significantly different between glioblastoma multiforme and brain metastasis. Receiver operating characteristic curve analysis of the logistic model with backward stepwise feature selection yielded an area under the curve of 0.77, a specificity of 84%, a sensitivity of 67%, a positive predictive value of 83.33%, and a negative predictive value of 78.26% for distinguishing between glioblastoma multiforme and brain metastasis. The absolute standard deviation and standard deviation ratios were significantly higher in the peritumoral edema compared to the tumor region in each case. CONCLUSION Apparent diffusion coefficient values and ratios, as well as standard deviation values and ratios in peritumoral edema, cannot be used to differentiate edema with infiltration of tumor cells from vasogenic edema. However, standard deviation values could successfully characterize areas of peritumoral edema from the tumoral region in each case.
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Affiliation(s)
- Sanaz Beig Zali
- Neuroscience Research Center, Tabriz University of Medical Sciences, Iran
| | - Farbod Alinezhad
- Student Research Committee, Tabriz University of Medical Sciences, Iran
| | - Mahnaz Ranjkesh
- Department of Radiology, Tabriz University of Medical Sciences, Iran
| | | | - Masoud Poureisa
- Department of Radiology, Tabriz University of Medical Sciences, Iran
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Momeni F, Abedi-Firouzjah R, Farshidfar Z, Taleinezhad N, Ansari L, Razmkon A, Banaei A, Mehdizadeh A. Differentiating Between Low- and High-grade Glioma Tumors Measuring Apparent Diffusion Coefficient Values in Various Regions of the Brain. Oman Med J 2021; 36:e251. [PMID: 33936779 PMCID: PMC8077446 DOI: 10.5001/omj.2021.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/31/2020] [Indexed: 11/03/2022] Open
Abstract
Objectives Our study aimed to apply the apparent diffusion coefficient (ADC) values to quantify the differences between low- and high-grade glioma tumors. Methods We conducted a multicenter, retrospective study between September to December 2019. Magnetic resonance imaging (MRI) diffusion-weighted images (DWIs), and the pathologic findings of 56 patients with glioma tumors (low grade = 28 and high grade = 28) were assessed to measure the ADC values in the tumor center, tumor edema, boundary area between tumor with normal tissue, and inside the healthy hemisphere. These values were compared between the two groups, and cut-off values were calculated using the receiver operating characteristic curve. Results We saw significant differences between the mean ADC values measured in the tumor center and edema between high- and low-grade tumors (p< 0.005). The ADC values in the boundary area between tumors with normal tissue and inside healthy hemisphere did not significantly differ in the groups. The ADC values at tumor center and edema were higher than 1.12 × 10-3 mm2/s (sensitivity = 100% and specificity = 96.0%) and 1.15 × 10-3 mm2/s (sensitivity = 75.0% and specificity = 64.0%), respectively, could be classified as low-grade tumors. Conclusions The ADC values from the MRI DWIs in the tumor center and edema could be used as an appropriate method for investigating the differences between low- and high-grade glioma tumors. The ADC values in the boundary area and healthy tissues had no diagnostic values in grading the glioma tumors.
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Affiliation(s)
- Farideh Momeni
- Medical Physics and Biomedical Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razzagh Abedi-Firouzjah
- Department of Medical Physics, Radiobiology and Radiation Protection, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Farshidfar
- Radiology Technology Department, School of Paramedicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nastaran Taleinezhad
- Medical Physics and Biomedical Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Ansari
- Medical Physics and Biomedical Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Razmkon
- Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amin Banaei
- Department of Medical Physics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.,Department of Radiology, Faculty of Paramedical Sciences, AJA University of Medical Sciences, Tehran, Iran
| | - Alireza Mehdizadeh
- Medical Physics and Biomedical Engineering Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Research Center for Neuromodulation and Pain, Shiraz University of Medical Sciences, Shiraz, Iran
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Dikaios N. Deep learning magnetic resonance spectroscopy fingerprints of brain tumours using quantum mechanically synthesised data. NMR IN BIOMEDICINE 2021; 34:e4479. [PMID: 33448078 DOI: 10.1002/nbm.4479] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/24/2020] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Metabolic fingerprints are valuable biomarkers for diseases that are associated with metabolic disorders. 1H magnetic resonance spectroscopy (MRS) is a unique noninvasive diagnostic tool that can depict the metabolic fingerprint based solely on the proton signal of different molecules present in the tissue. However, its performance is severely hindered by low SNR, field inhomogeneities and overlapping spectra of metabolites, which affect the quantification of metabolites. Consequently, MRS is rarely included in routine clinical protocols and has not been proven in multi-institutional trials. This work proposes an alternative approach, where instead of quantifying metabolites' concentration, deep learning (DL) is used to model the complex nonlinear relationship between diseases and their spectroscopic metabolic fingerprint (pattern). DL requires large training datasets, acquired (ideally) with the same protocol/scanner, which are very rarely available. To overcome this limitation, a novel method is proposed that can quantum mechanically synthesise MRS data for any scanner/acquisition protocol. The proposed methodology is applied to the challenging clinical problem of differentiating metastasis from glioblastoma brain tumours on data acquired across multiple institutions. DL algorithms were trained on the augmented synthetic spectra and tested on two independent datasets acquired by different scanners, achieving a receiver operating characteristic area under the curve of up to 0.96 and 0.97, respectively.
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Affiliation(s)
- Nikolaos Dikaios
- Mathematics Research Center, Academy of Athens, Athens, Greece
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK
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Zeng T, Xu Z, Yan J. The value of asphericity derived from T1-weighted MR in differentiating intraparenchymal ring-enhancing lesions-comparison of glioblastomas and brain abscesses. Neurol Sci 2021; 42:5171-5175. [PMID: 33796946 DOI: 10.1007/s10072-021-05226-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Both brain abscess(BA)and glioblastoma (GBM) are common causative pathologies of intraparenchymal ring-enhancing lesions. Advanced MR sequences such as diffusion weighted image (DWI) were often used to increase distinguishability of both entities. PURPOSE To evaluate the value of asphericity (ASP) from conventional T1-weighted MR images in differentiating BA from morphologically similar ring-enhancing GBM. MATERIAL AND METHODS Twenty-one BA and twenty-nine GBM were retrospectively included in this study. Each region of interest (ROI) was delineated twice with the software of ITK-SNAP on the contrast-enhanced T1 images by two observers. ASP was calculated to define the relative deviation of the ROI's shape from a sphere. Intraclass correlation coefficients (ICC) for inter-observer and intra-observer were calculated. The diagnostic capabilities of ASP and conventional volume (VOL) of ROI were evaluated with receiver operating characteristic (ROC) curve analysis. In addition, areas under the ROC curves of ASP and VOL were compared. RESULTS ICC of intra-observer and inter-observer were 0.99 (95% confidence interval, [CI] 0.97-0.99) and 0.98 (0.95-0.99), respectively. Both ASP and VOL showed significant difference between BA and GBM. The mean ASP values for BA and GBM were 66.3±7.8 and 14.7±1.8, respectively. The mean VOL value of BA was also larger than that of GBM (47.2±7.4 vs. 20.7±1.5 mm3). The mean AUC of ASP and VOL were 0.977 (95% CI 0.944-1) and 0.86 (95% CI 0.746-0.974), respectively. The AUC of ASP was significantly higher than that of VOL (p=0.04). The optimal cut point values of ASP and VOL were 24.39 and 24.86 mm3, respectively. CONCLUSIONS ASP derived from routine MRI is useful in differentiating BA from GBM.
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Affiliation(s)
- Tao Zeng
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Zijun Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Middle Yanchang Road, Shanghai, 200072, China
| | - Jianhua Yan
- Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China. .,Molecular Imaging Precision Medicine Collaborative Innovation Center, Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
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Zou Y, Zhang J, Zhang T, Feng Y, Xiong Z, Xu C, Gong P, Si J, Chen J. Characteristics and operation outcomes of neuro-oncology patients after COVID-19 pandemic - A case series. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021; 25:101172. [PMID: 33754122 PMCID: PMC7955585 DOI: 10.1016/j.inat.2021.101172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 12/24/2022]
Abstract
Background COVID-19 has been spreading worldwide at hitherto unknown speed, and the treatment of neuro-oncology patients without COVID-19 has been greatly affected. Methods To compare the medical records and surgical results of surgical patients before and after the pandemic. We collected a total of 80 patients form April 2020 to May 2020 after pandemic and from April 2019 to May 2019 before pandemic. The patient's demographics, past medical history, comorbidities, imaging, pathology, laboratory teat, and Karnofsky Performance Score (KPS) were analyzed. Results The most common presenting symptom was intracranial hypertension and neurological deficit. Hypertension and diabetes were the most common comorbid diseases. The pre-operation KPS were 83.21 ± 15.60, 80 ± 14.77, 78.57 ± 12.83 and 74.14 ± 12.72, respectively. The post-operation KPS were 94.64 ± 8.65, 95.45 ± 6.56, 91.43 ± 10.82 and 84.21 ± 22.55, respectively. The tumor volume was larger and the midline shift distance was greater after the pandemic than before. For pathological grade, meningiomas were mostly grade I, while gliomas were mainly grade III and IV. Conclusion Although affected by the COVID-19 pandemic, patients with glioma should be operated as soon as possible to obtain better surgical results, however, for patients with meningiomas, their operation can be postponed slightly when the patients are tolerable.
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Affiliation(s)
- Yichun Zou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jiangjiang Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yu Feng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhongwei Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Chengshi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Pian Gong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Jichun Si
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Cepeda S, García-García S, Arrese I, Fernández-Pérez G, Velasco-Casares M, Fajardo-Puentes M, Zamora T, Sarabia R. Comparison of Intraoperative Ultrasound B-Mode and Strain Elastography for the Differentiation of Glioblastomas From Solitary Brain Metastases. An Automated Deep Learning Approach for Image Analysis. Front Oncol 2021; 10:590756. [PMID: 33604286 PMCID: PMC7884775 DOI: 10.3389/fonc.2020.590756] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/17/2020] [Indexed: 12/29/2022] Open
Abstract
Background The differential diagnosis of glioblastomas (GBM) from solitary brain metastases (SBM) is essential because the surgical strategy varies according to the histopathological diagnosis. Intraoperative ultrasound elastography (IOUS-E) is a relatively novel technique implemented in the surgical management of brain tumors that provides additional information about the elasticity of tissues. This study compares the discriminative capacity of intraoperative ultrasound B-mode and strain elastography to differentiate GBM from SBM. Methods We performed a retrospective analysis of patients who underwent craniotomy between March 2018 to June 2020 with glioblastoma (GBM) and solitary brain metastases (SBM) diagnoses. Cases with an intraoperative ultrasound study were included. Images were acquired before dural opening, first in B-mode, and then using the strain elastography module. After image pre-processing, an analysis based on deep learning was conducted using the open-source software Orange. We have trained an existing neural network to classify tumors into GBM and SBM via the transfer learning method using Inception V3. Then, logistic regression (LR) with LASSO (least absolute shrinkage and selection operator) regularization, support vector machine (SVM), random forest (RF), neural network (NN), and k-nearest neighbor (kNN) were used as classification algorithms. After the models’ training, ten-fold stratified cross-validation was performed. The models were evaluated using the area under the curve (AUC), classification accuracy, and precision. Results A total of 36 patients were included in the analysis, 26 GBM and 10 SBM. Models were built using a total of 812 ultrasound images, 435 of B-mode, 265 (60.92%) corresponded to GBM and 170 (39.8%) to metastases. In addition, 377 elastograms, 232 (61.54%) GBM and 145 (38.46%) metastases were analyzed. For B-mode, AUC and accuracy values of the classification algorithms ranged from 0.790 to 0.943 and from 72 to 89%, respectively. For elastography, AUC and accuracy values ranged from 0.847 to 0.985 and from 79% to 95%, respectively. Conclusion Automated processing of ultrasound images through deep learning can generate high-precision classification algorithms that differentiate glioblastomas from metastases using intraoperative ultrasound. The best performance regarding AUC was achieved by the elastography-based model supporting the additional diagnostic value that this technique provides.
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Affiliation(s)
- Santiago Cepeda
- Neurosurgery Department, University Hospital Río Hortega, Valladolid, Spain
| | | | - Ignacio Arrese
- Neurosurgery Department, University Hospital Río Hortega, Valladolid, Spain
| | | | | | | | - Tomás Zamora
- Pathology Department, University Hospital Río Hortega, Valladolid, Spain
| | - Rosario Sarabia
- Neurosurgery Department, University Hospital Río Hortega, Valladolid, Spain
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Razek AAKA, Elsebaie NA. Imaging of vascular cognitive impairment. Clin Imaging 2021; 74:45-54. [PMID: 33434866 DOI: 10.1016/j.clinimag.2020.12.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Abstract
Vascular cognitive impairment (VCI) is a major health challenge and represents the second most common cause of dementia. We review the updated imaging classification and imaging findings of different subtypes of VCI. We will focus on the magnetic resonance imaging (MRI) markers of each subtype and highlight the role of advanced MR imaging sequences in the evaluation of these patients. Small vessel dementia appears as white matter hyperintensity, lacunae, microinfarcts, and microbleeds. Large vessel dementia includes strategic infarction and multi-infarction dementias. Hypoperfusion dementia can be seen as watershed infarcts and cortical laminar necrosis. Hemorrhagic dementia results from cerebral amyloid angiopathy and cortical superficial siderosis. Hereditary forms of VCI, caused by gene mutations such as CADASIL, should be suspected when dementia presents in young patients. Mixed dementia is seen in patients with Alzheimer's disease and the coexistence of cerebrovascular disease.
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Affiliation(s)
- Ahmed Abdel Khalek Abdel Razek
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
| | - Nermeen A Elsebaie
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt; Department of Radiology, Alexandria Faculty of Medicine, Alexandria, Egypt.
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Aasen SN, Espedal H, Keunen O, Adamsen TCH, Bjerkvig R, Thorsen F. Current landscape and future perspectives in preclinical MR and PET imaging of brain metastasis. Neurooncol Adv 2021; 3:vdab151. [PMID: 34988446 PMCID: PMC8704384 DOI: 10.1093/noajnl/vdab151] [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] [Indexed: 11/13/2022] Open
Abstract
Brain metastasis (BM) is a major cause of cancer patient morbidity. Clinical magnetic resonance imaging (MRI) and positron emission tomography (PET) represent important resources to assess tumor progression and treatment responses. In preclinical research, anatomical MRI and to some extent functional MRI have frequently been used to assess tumor progression. In contrast, PET has only to a limited extent been used in animal BM research. A considerable culprit is that results from most preclinical studies have shown little impact on the implementation of new treatment strategies in the clinic. This emphasizes the need for the development of robust, high-quality preclinical imaging strategies with potential for clinical translation. This review focuses on advanced preclinical MRI and PET imaging methods for BM, describing their applications in the context of what has been done in the clinic. The strengths and shortcomings of each technology are presented, and recommendations for future directions in the development of the individual imaging modalities are suggested. Finally, we highlight recent developments in quantitative MRI and PET, the use of radiomics and multimodal imaging, and the need for a standardization of imaging technologies and protocols between preclinical centers.
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Affiliation(s)
- Synnøve Nymark Aasen
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Heidi Espedal
- The Molecular Imaging Center, Department of Biomedicine, University of Bergen, Bergen, Norway
- Mohn Medical Imaging and Visualization Centre, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Olivier Keunen
- Translational Radiomics, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Tom Christian Holm Adamsen
- Centre for Nuclear Medicine, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- 180 °N – Bergen Tracer Development Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway
- Department of Chemistry, University of Bergen, Bergen, Norway
| | - Rolf Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway
- NorLux Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Frits Thorsen
- Department of Biomedicine, University of Bergen, Bergen, Norway
- The Molecular Imaging Center, Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Qilu Hospital of Shandong University and Brain Science Research Institute, Shandong University, Key Laboratory of Brain Functional Remodeling, Shandong, Jinan, P.R. China
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Eissa L, Abdel Razek AAK, Helmy E. Arterial spin labeling and diffusion-weighted MR imaging: Utility in differentiating idiopathic orbital inflammatory pseudotumor from orbital lymphoma. Clin Imaging 2020; 71:63-68. [PMID: 33171369 DOI: 10.1016/j.clinimag.2020.10.057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/26/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To assess arterial spin-labeling (ASL) and diffusion-weighted imaging (DWI) and in combination for differentiating between idiopathic orbital inflammatory pseudotumor (IOIP) and orbital lymphoma. MATERIAL AND METHODS A retrospective study was done on 37 untreated patients with orbital masses, suspected to be IOIP or orbital lymphoma that underwent ASL and DWI of the orbit. Quantitative measurement of tumor blood flow (TBF) and apparent diffusion coefficient (ADC) of the orbital lesion was done. RESULTS There was a significant difference (P = 0.001) in TBF between patients with IOIP (n = 21) (38.1 ± 6.2, 40.3 ± 7.1 ml/100 g/min) and orbital lymphoma (n = 16) (55.5 ± 7.1, 56.8 ± 7.9 ml/100 g/min) for both observers respectively. Thresholds of TBF used for differentiating IOIP from orbital lymphoma were 48, 46 ml/100 g/min revealed area under the curve (AUC) of (0.958 and 0.921), and accuracy of (86% and 83%) for both observers respectively. There was a significant difference (P = 0.001) in ADC between patients with IOIP (1.04 ± 0.19, 1.12 ± 0.23 × 10-3 mm2/s) and orbital lymphoma (0.69 ± 0.10, 0.72 ± 0.11 × 10-3 mm2/s) for both observers respectively. Thresholds of ADC used for differentiating IOIP from orbital lymphoma were 0.84 and 0.86 × 10-3 mm2/s with AUC of (0.933 and 0.920), and accuracy of 89% and 90% for both observers respectively. The combined TBF and ADC used for differentiating IOIP from orbital lymphoma had AUC of (0.973 and 0.970) and accuracy of (91% and 89%) for both observers respectively. CONCLUSION TBF and ADC alone and in combination are useful for differentiating IOIP from orbital lymphoma.
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Affiliation(s)
- Lamya Eissa
- Department of Radiodiagnosis, Alexandria Faculty of Medicine, Alexandria, Egypt; Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ahmed Abdel Khalek Abdel Razek
- Department of Radiodiagnosis, Alexandria Faculty of Medicine, Alexandria, Egypt; Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt.
| | - Eman Helmy
- Department of Radiodiagnosis, Alexandria Faculty of Medicine, Alexandria, Egypt; Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
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Tzanetakos D, Vakrakou AG, Tzartos JS, Velonakis G, Evangelopoulos ME, Anagnostouli M, Koutsis G, Dardiotis E, Karavasilis E, Toulas P, Stefanis L, Kilidireas C. Heterogeneity of Baló's concentric sclerosis: a study of eight cases with different therapeutic concepts. BMC Neurol 2020; 20:400. [PMID: 33138795 PMCID: PMC7604966 DOI: 10.1186/s12883-020-01971-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022] Open
Abstract
Background Baló’s Concentric Sclerosis (BCS) is a rare heterogeneous demyelinating disease with a variety of phenotypes on Magnetic Resonance Imaging (MRI). Existing literature lacks data especially on the therapeutic approach of the disease which we intended to elucidate by means of suggesting a new possible BCS classification and introducing different therapeutic concepts based on each BCS-subgroup characteristics. Methods We present a retrospective study of eight treated patients with BCS-type lesions, emphasizing on MRI characteristics and differences on therapeutic maneuvers. Results Data analysis showed: at disease onset the BCS-type lesion was tumefactive (size ≥2 cm) in 6 patients, with a mean size of 2.7 cm (± 0.80 SD); a coexistence of MS-like plaques on brain MRI was identified in 7 patients of our cohort. The mean age was 26.3 years (±7.3 SD) at disease onset and the mean follow-up period was 56.8 months (range 9–132 months). According to radiological characteristics and response to therapies, we further categorized them into 3 subgroups: a) Group-1; BCS with or without coexisting nonspecific white matter lesions; poor response to intravenous methylprednisolone (IVMP); treated with high doses of immunosuppressive agents (4 patients), b) Group-2; BCS with typical MS lesions; good response to IVMP; treated with MS-disease modifying therapies (2 patients), c) Group-3; BCS with typical MS lesions; poor response to IVMP; treated with rituximab (2 patients). Conclusions Our study introduces a new insight regarding the categorization of BCS into three subgroups depending on radiological features at onset and during the course of the disease, in combination with the response to different immunotherapies. Immunosuppressive agents such as cyclophosphamide are usually effective in BCS. However, therapeutic alternatives like anti-CD20 monoclonal antibodies or more classical disease-modifying MS therapies can be considered when BCS has also mixed lesions similar to MS. Future studies with a larger sample size are necessary to further establish these findings, thus leading to better treatment algorithms and improved clinical outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-020-01971-2.
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Affiliation(s)
- D Tzanetakos
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - A G Vakrakou
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - J S Tzartos
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Velonakis
- Research Unit of Radiology - 2nd Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - M E Evangelopoulos
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - M Anagnostouli
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Koutsis
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Dardiotis
- Department of Neurology, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - E Karavasilis
- Research Unit of Radiology - 2nd Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - P Toulas
- Research Unit of Radiology - 2nd Department of Radiology, National and Kapodistrian University of Athens, Athens, Greece
| | - L Stefanis
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - C Kilidireas
- Demyelinating Diseases Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Multi-parametric arterial spin labeling and diffusion-weighted imaging in differentiation of metastatic from reactive lymph nodes in head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2020; 278:2529-2535. [DOI: 10.1007/s00405-020-06390-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/20/2020] [Indexed: 12/19/2022]
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Abstract
Neuronal and mixed glioneuronal tumors represent a group of neoplasms with varying degrees of neural and glial elements. Their age of presentation varies, but they are most commonly seen in children and young adults. With the exception of anaplastic ganglioglioma and other atypical variants, most lesions are low grade; however, they can have significant morbidity because of seizures, mass effect, or difficult to treat hydrocephalus. Although many tumors show overlapping clinical and imaging features, some have relatively distinctive imaging characteristics that may aid in narrowing the differential diagnosis. In this review, we discuss relevant clinical and pathologic characteristics of these tumors and provide an overview of conventional and advanced imaging features that provide clues as to the diagnosis.
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Abstract
We aim to review the imaging appearance of fulminant demyelinating disorders of central nervous system that have different pathological features, clinical course, clinical features, and imaging findings different from classic multiple sclerosis. Routine magnetic resonance imaging (MRI) can help in accurate localization of the lesions, detection of associated lesions, and monitoring of these patients. Advanced MRI combined with routine MRI can aid in differentiation fulminant demyelinating lesions from simulating malignancy. Tumefactive demyelination lesions are located in supratentorial white matter mainly frontal and parietal regions with incomplete rim enhancement. Baló concentric sclerosis shows characteristic concentric onion skin appearance. Schilder disease is subacute or acute demyelinating disorders with one or more lesions commonly involving the centrum semiovale. Marburg disease is the most severe demyelinating disorder with diffuse infiltrative lesions and massive edema involving both the cerebral hemisphere and brain stem.
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Liver Imaging Reporting and Data System Version 2018: What Radiologists Need to Know. J Comput Assist Tomogr 2020; 44:168-177. [PMID: 32195795 DOI: 10.1097/rct.0000000000000995] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this article, we aim to review Liver Imaging Reporting and Data System version 18 (LI-RADS v2018). Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy. Liver Imaging Reporting and Data System developed for standardizing interpreting, reporting, and data collection of HCC describes 5 major features for accurate HCC diagnosis and several ancillary features, some favoring HCC in particular or malignancy in general and others favoring benignity. Untreated hepatic lesions LI-RADS affords 8 unique categories based on imaging appearance on computed tomography and magnetic resonance imaging, which indicate the possibility of HCC or malignancy with or without tumor in vein. Furthermore, LI-RADS defines 4 treatment response categories for treated HCCs after different locoregional therapy. These continuous recent updates on LI-RADS improve the communication between the radiologists and the clinicians for better management and patient outcome.
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Panyaping T, Taebunpakul P, Tritanon O. Accuracy of apparent diffusion coefficient values and magnetic resonance imaging in differentiating suprasellar germinomas from chiasmatic/hypothalamic gliomas. Neuroradiol J 2020; 33:201-209. [PMID: 32193980 DOI: 10.1177/1971400920912656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to differentiate suprasellar germinomas from chiasmatic/hypothalamic gliomas (CHGs) using apparent diffusion coefficient (ADC) values and magnetic resonance imaging (MRI) characteristics. MATERIALS AND METHODS A cross-sectional study was conducted on 11 patients with suprasellar germinomas and 11 patients with CHGs who underwent pretreatment MRI. The ADC values (minimum and average ADC values) of the tumors were measured and the MRI characteristics were evaluated. RESULTS The average and minimum ADC values of suprasellar germinomas were significantly lower than those of CHGs (p = 0.016 and 0.004 respectively). The selection of 941.15 × 10-6 mm2/s as a cutoff value of the minimum ADC value was used to differentiate suprasellar germinomas and CHGs; the best results were obtained with area under the curve of 0.889, sensitivity of 87.5%, specificity of 77.8% and accuracy of 82.4%. MRI characteristics suggested the diagnosis of suprasellar germinomas were T2W hypointensity and involvement of pituitary gland and/or stalk. MRI characteristics suggested the diagnosis of CHGs was higher degree of contrast enhancement and presence of macrocysts. CONCLUSION ADC values have a role in differentiating suprasellar germinomas and CHGs, especially when imaging findings on conventional MRI are inconclusive. Furthermore, some MRI features are in favor of differentiation between these tumor entities including tumor location, cyst pattern, T2W hypointensity, degree of contrast enhancement, stalk and pituitary gland involvement.
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Affiliation(s)
- Theeraphol Panyaping
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Piyakarn Taebunpakul
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Oranan Tritanon
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Sallabanda M, García-Berrocal MI, Romero J, García-Jarabo V, Expósito MJ, Rincón DF, Zapata I, Magallón MR. Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival. Clin Transl Oncol 2020; 22:1809-1817. [PMID: 32124243 DOI: 10.1007/s12094-020-02321-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). METHODS/PATIENTS This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. RESULTS Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. CONCLUSIONS SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients.
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Affiliation(s)
- M Sallabanda
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain.
| | - M I García-Berrocal
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - J Romero
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - V García-Jarabo
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - M J Expósito
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - D F Rincón
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - I Zapata
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
| | - M R Magallón
- Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda, Calle Manuel de Falla N.1, Majadahonda, CP. 28222, Madrid, Spain
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Multi-parametric arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of grade II and grade III gliomas. Pol J Radiol 2020; 85:e110-e117. [PMID: 32467745 PMCID: PMC7247019 DOI: 10.5114/pjr.2020.93397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/20/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose To assess arterial spin labelling (ASL) perfusion and diffusion MR imaging (DWI) in the differentiation of grade II from grade III gliomas. Material and methods A prospective cohort study was done on 36 patients (20 male and 16 female) with diffuse gliomas, who underwent ASL and DWI. Diffuse gliomas were classified into grade II and grade III. Calculation of tumoural blood flow (TBF) and apparent diffusion coefficient (ADC) of the tumoral and peritumoural regions was made. The ROC curve was drawn to differentiate grade II from grade III gliomas. Results There was a significant difference in TBF of tumoural and peritumoural regions of grade II and III gliomas (p = 0.02 and p =0.001, respectively). Selection of 26.1 and 14.8 ml/100 g/min as the cut-off for TBF of tumoural and peritumoural regions differentiated between both groups with area under curve (AUC) of 0.69 and 0.957, and accuracy of 77.8% and 88.9%, respectively. There was small but significant difference in the ADC of tumoural and peritumoural regions between grade II and III gliomas (p = 0.02 for both). The selection of 1.06 and 1.36 × 10-3 mm2/s as the cut-off of ADC of tumoural and peritumoural regions was made, to differentiate grade II from III with AUC of 0.701 and 0.748, and accuracy of 80.6% and 80.6%, respectively. Combined TBF and ADC of tumoural regions revealed an AUC of 0.808 and accuracy of 72.7%. Combined TBF and ADC for peritumoural regions revealed an AUC of 0.96 and accuracy of 94.4%. Conclusion TBF and ADC of tumoural and peritumoural regions are accurate non-invasive methods of differentiation of grade II from grade III gliomas.
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Zhang H, Zhou Y, Li J, Zhang P, Li Z, Guo J. The value of DWI in predicting the response to synchronous radiochemotherapy for advanced cervical carcinoma: comparison among three mathematical models. Cancer Imaging 2020; 20:8. [PMID: 31937371 PMCID: PMC6961298 DOI: 10.1186/s40644-019-0285-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background Diffusion weighted imaging(DWI) mode mainly includes intravoxel incoherent motion (IVIM), stretched exponential model (SEM) and Gaussian diffusion model, but it is still unclear which mode is the most valuable in predicting the response to radiochemotherapy for cervical cancer. This study aims to compare the values of three mathematical models in predicting the response to synchronous radiochemotherapy for cervical cancer. Methods Eighty-four patients with cervical cancer were enrolled into this study. They underwent DWI examination by using 12 b-values prior to treatment. The imaging parameters were calculated on the basis of IVIM, SEM and Gaussian diffusion models respectively. The imaging parameters derived from three mathematical modes were compared between responders and non-responders groups. The repeatability of each imaging parameter was assessed. Results The ADC, D or DDC value was lower in responders than in non-responders groups (P = 0.03, 0.02, 0.01). The α value was higher in responders group than in non-responders group (P = 0.03). DDC had the largest area under curves (AUC) (=0.948) in predicting the response to treatment. The imaging parameters derived from SEM had better repeatability (CCC for DDC and α were 0.969 and 0.924 respectively) than that derived from other exponential models. Conclusion Three exponential modes of DWI are useful for predicting the response to radiochemotherapy for cervical cancer, and SEM may be used as a potential optimal model for predicting treatment effect.
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Affiliation(s)
- Hui Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Yuyang Zhou
- Department of Cardiac Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan Province, China
| | - Jie Li
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Pengjuan Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Zhenzhen Li
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Junwu Guo
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China.
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Razek AAKA. Multi-parametric MR imaging using pseudo-continuous arterial-spin labeling and diffusion-weighted MR imaging in differentiating subtypes of parotid tumors. Magn Reson Imaging 2019; 63:55-59. [DOI: 10.1016/j.mri.2019.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/05/2019] [Accepted: 08/15/2019] [Indexed: 12/26/2022]
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Vitexin, an inhibitor of hypoxia-inducible factor-1α, enhances the radiotherapy sensitization of hyperbaric oxygen on glioma. Clin Transl Oncol 2019; 22:1086-1093. [PMID: 31677055 DOI: 10.1007/s12094-019-02234-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022]
Abstract
PURPOSE Vitexin, an inhibitor of hypoxia-inducible factor (HIF)-1α, has anti-tumor effect. However, whether it can enhance the radiotherapy sensitization of hyperbaric oxygen (HBO) on glioma is unclear. This study aimed to investigate the effect of vitexin. METHODS The nude mice with paw-transplanted glioma were divided into four groups: control group, HBO + radiation group, HBO + vitexin group, and HBO + vitexin + radiation group. The mice of last two groups were daily given vitexin 75 mg/kg by intraperitoneal injection. 30 min after administration of vitexin, the HBO-treated mice were daily placed in HBO chamber for 60 min. The radiation-treated mice were given local tumor irradiation once every week during the HBO treatment, and the dose of irradiation was 10 Gy/time. The experimental treatment lasted for 21 days. RESULTS Compared with the HBO + radiation group, the tumor volume, tumor weight, and tumor weight coefficient in the HBO + vitexin + radiation group were lower (p < 0.05). Importantly, the contents of reduced glutathione and glutathione peroxidase as well as expressions of HIF-1α, vascular endothelial growth factor, glucose transporter (GLUT)-1, and GLUT-3 proteins in tumor tissues were also lower in the HBO + vitexin + radiation group than in the HBO + radiation group (p < 0.01). CONCLUSIONS Vitexin can cooperate with HBO to sensitize the glioma radiotherapy, and its mechanisms may be correlated to the inhibition of HIF-1α protein expression and subsequent decrements of its downstream protein expressions, which finally cause the reduction of antioxidant capacity.
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Diagnostic accuracy of diffusion tensor imaging in differentiating malignant from benign compressed vertebrae. Neuroradiology 2019; 61:1291-1296. [DOI: 10.1007/s00234-019-02286-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/26/2019] [Indexed: 12/23/2022]
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