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Witzmann K, Raschke F, Löck S, Wesemann T, Krause M, Linn J, Troost EGC. Unchanged perfusion in normal-appearing white and grey matter of glioma patients nine months after proton beam irradiation. Acta Oncol 2023; 62:141-149. [PMID: 36801809 DOI: 10.1080/0284186x.2023.2176254] [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: 02/23/2023]
Abstract
Purpose: Radio(chemo)therapy is used as a standard treatment for glioma patients. The surrounding normal tissue is inevitably affected by the irradiation. The aim of this longitudinal study was to investigate perfusion alterations in the normal-appearing tissue after proton irradiation and assess the dose sensitivity of the normal tissue perfusion.Methods: In 14 glioma patients, a sub-cohort of a prospective clinical trial (NCT02824731), perfusion changes in normal-appearing white matter (WM), grey matter (GM) and subcortical GM structures, i.e. caudate nucleus, hippocampus, amygdala, putamen, pallidum and thalamus, were evaluated before treatment and at three-monthly intervals after proton beam irradiation. The relative cerebral blood volume (rCBV) was assessed with dynamic susceptibility contrast MRI and analysed as the percentage ratio between follow-up and baseline image (ΔrCBV). Radiation-induced alterations were evaluated using Wilcoxon signed rank test. Dose and time correlations were investigated with univariate and multivariate linear regression models.Results: No significant ΔrCBV changes were found in any normal-appearing WM and GM region after proton beam irradiation. A positive correlation with radiation dose was observed in the multivariate regression model applied to the combined ΔrCBV values of low (1-20 Gy), intermediate (21-40 Gy) and high (41-60 Gy) dose regions of GM (p < 0.001), while no time dependency was detected in any normal-appearing area.Conclusion: The perfusion in normal-appearing brain tissue remained unaltered after proton beam therapy. In further studies, a direct comparison with changes after photon therapy is recommended to confirm the different effect of proton therapy on the normal-appearing tissue.
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Affiliation(s)
- Katharina Witzmann
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Felix Raschke
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Tim Wesemann
- Institute of Neuroradiology, University Hospital Carl Gustav Carus and Medical Faculty of Technische Universität, Dresden, Germany
| | - Mechthild Krause
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
| | - Jennifer Linn
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.,Institute of Neuroradiology, University Hospital Carl Gustav Carus and Medical Faculty of Technische Universität, Dresden, Germany
| | - Esther G C Troost
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany, and; Helmholtz Association / Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
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Baiocco G, Bartzsch S, Conte V, Friedrich T, Jakob B, Tartas A, Villagrasa C, Prise KM. A matter of space: how the spatial heterogeneity in energy deposition determines the biological outcome of radiation exposure. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2022; 61:545-559. [PMID: 36220965 PMCID: PMC9630194 DOI: 10.1007/s00411-022-00989-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/03/2022] [Indexed: 05/10/2023]
Abstract
The outcome of the exposure of living organisms to ionizing radiation is determined by the distribution of the associated energy deposition at different spatial scales. Radiation proceeds through ionizations and excitations of hit molecules with an ~ nm spacing. Approaches such as nanodosimetry/microdosimetry and Monte Carlo track-structure simulations have been successfully adopted to investigate radiation quality effects: they allow to explore correlations between the spatial clustering of such energy depositions at the scales of DNA or chromosome domains and their biological consequences at the cellular level. Physical features alone, however, are not enough to assess the entity and complexity of radiation-induced DNA damage: this latter is the result of an interplay between radiation track structure and the spatial architecture of chromatin, and further depends on the chromatin dynamic response, affecting the activation and efficiency of the repair machinery. The heterogeneity of radiation energy depositions at the single-cell level affects the trade-off between cell inactivation and induction of viable mutations and hence influences radiation-induced carcinogenesis. In radiation therapy, where the goal is cancer cell inactivation, the delivery of a homogenous dose to the tumour has been the traditional approach in clinical practice. However, evidence is accumulating that introducing heterogeneity with spatially fractionated beams (mini- and microbeam therapy) can lead to significant advantages, particularly in sparing normal tissues. Such findings cannot be explained in merely physical terms, and their interpretation requires considering the scales at play in the underlying biological mechanisms, suggesting a systemic response to radiation.
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Affiliation(s)
- Giorgio Baiocco
- Radiation Biophysics and Radiobiology Group, Physics Department, University of Pavia, Pavia, Italy.
| | - Stefan Bartzsch
- Institute for Radiation Medicine, Helmholtz Centre Munich, Munich, Germany
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany
| | - Valeria Conte
- Istituto Nazionale Di Fisica Nucleare INFN, Laboratori Nazionali Di Legnaro, Legnaro, Italy
| | - Thomas Friedrich
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Burkhard Jakob
- Department of Biophysics, GSI Helmholtz Centre for Heavy Ion Research, Darmstadt, Germany
| | - Adrianna Tartas
- Biomedical Physics Division, Institute of Experimental Physics, University of Warsaw, Warsaw, Poland
| | - Carmen Villagrasa
- IRSN, Institut de Radioprotection et de Sûreté Nucléaire, Fontenay aux Roses, France
| | - Kevin M Prise
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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3
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Jain V, de Godoy LL, Mohan S, Chawla S, Learned K, Jain G, Wehrli FW, Alonso-Basanta M. Cerebral hemodynamic and metabolic dysregulation in the postradiation brain. J Neuroimaging 2022; 32:1027-1043. [PMID: 36156829 DOI: 10.1111/jon.13053] [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: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/28/2022] Open
Abstract
Technological advances in the delivery of radiation and other novel cancer therapies have significantly improved the 5-year survival rates over the last few decades. Although recent developments have helped to better manage the acute effects of radiation, the late effects such as impairment in cognition continue to remain of concern. Accruing data in the literature have implicated derangements in hemodynamic parameters and metabolic activity of the irradiated normal brain as predictive of cognitive impairment. Multiparametric imaging modalities have allowed us to precisely quantify functional and metabolic information, enhancing the anatomic and morphologic data provided by conventional MRI sequences, thereby contributing as noninvasive imaging-based biomarkers of radiation-induced brain injury. In this review, we have elaborated on the mechanisms of radiation-induced brain injury and discussed several novel imaging modalities, including MR spectroscopy, MR perfusion imaging, functional MR, SPECT, and PET that provide pathophysiological and functional insights into the postradiation brain, and its correlation with radiation dose as well as clinical neurocognitive outcomes. Additionally, we explored some innovative imaging modalities, such as quantitative blood oxygenation level-dependent imaging, susceptibility-based oxygenation measurement, and T2-based oxygenation measurement, that hold promise in delineating the potential mechanisms underlying deleterious neurocognitive changes seen in the postradiation setting. We aim that this comprehensive review of a range of imaging modalities will help elucidate the hemodynamic and metabolic injury mechanisms underlying cognitive impairment in the irradiated normal brain in order to optimize treatment regimens and improve the quality of life for these patients.
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Affiliation(s)
- Varsha Jain
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Radiation Oncology, Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Laiz Laura de Godoy
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kim Learned
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gaurav Jain
- Department of Neurological Surgery, Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Felix W Wehrli
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Alonso-Basanta
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Şahin S, Ertekin E, Şahin T, Özsunar Y. Evaluation of normal-appearing white matter with perfusion and diffusion MRI in patients with treated glioblastoma. MAGMA (NEW YORK, N.Y.) 2022; 35:153-162. [PMID: 34951690 DOI: 10.1007/s10334-021-00990-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We tried to reveal how the normal appearing white matter (NAWM) was affected in patients with glioblastoma treated with chemo-radiotherapy (CRT) in the period following the treatment, by multiparametric MRI. MATERIALS AND METHODS 43 multiparametric MRI examinations of 17 patients with glioblastoma treated with CRT were examined. A total of six different series or maps were analyzed in the examinations: Apparent Diffusion Coefficient (ADC) and Fractional Anisotropy (FA) maps, Gradient Echo (GRE) sequence, Dynamic susceptibility contrast (DSC) and Arterial spin labeling (ASL) perfusion sequences. Each sequence in each examination was examined in detail with 14 Region of Interest (ROI) measurements. The obtained values were proportioned to the contralateral NAWM values and the results were recorded as normalized values. Time dependent changes of normalized values were statistically analyzed. RESULTS The most prominent changes in follow-up imaging occurred in the perilesional region. In perilesional NAWM, we found a decrease in normalized FA (nFA), rCBV (nrCBV), rCBF (nrCBF), ASL (nASL)values (p < 0.005) in the first 3 months after treatment, followed by a plateau and an increase approaching pretreatment values, although it did not reach. Similar but milder findings were present in other NAWM areas. In perilesional NAWM, nrCBV values were found to be positively high correlated with nrCBF and nASL, and negatively high correlated with nADC values (r: 0.963, 0.736, - 0.973, respectively). We also found high correlations between the mean values of nrCBV, nrCBF, nASL in other NAWM areas (r: 0.891, 0.864, respectively). DISCUSSION We showed that both DSC and ASL perfusion values decreased correlatively in the first 3 months and showed a plateau after 1 year in patients with glioblastoma treated with CRT, unlike the literature. Although it was not as evident as perfusion MRI, it was observed that the ADC values also showed a plateau pattern following the increase in the first 3 months. Further studies are needed to explain late pathophysiological changes. Because of the high correlation, our results support ASL perfusion instead of contrast enhanced perfusion methods.
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Affiliation(s)
- Sinan Şahin
- Department of Radiology, Adnan Menderes University, Aydın, Turkey
| | - Ersen Ertekin
- Department of Radiology, Adnan Menderes University, Aydın, Turkey.
| | - Tuna Şahin
- Department of Radiology, Adnan Menderes University, Aydın, Turkey
| | - Yelda Özsunar
- Department of Radiology, Adnan Menderes University, Aydın, Turkey
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Petr J, Hogeboom L, Nikulin P, Wiegers E, Schroyen G, Kallehauge J, Chmelík M, Clement P, Nechifor RE, Fodor LA, De Witt Hamer PC, Barkhof F, Pernet C, Lequin M, Deprez S, Jančálek R, Mutsaerts HJMM, Pizzini FB, Emblem KE, Keil VC. A systematic review on the use of quantitative imaging to detect cancer therapy adverse effects in normal-appearing brain tissue. MAGMA (NEW YORK, N.Y.) 2022; 35:163-186. [PMID: 34919195 PMCID: PMC8901489 DOI: 10.1007/s10334-021-00985-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/17/2022]
Abstract
Cancer therapy for both central nervous system (CNS) and non-CNS tumors has been previously associated with transient and long-term cognitive deterioration, commonly referred to as 'chemo fog'. This therapy-related damage to otherwise normal-appearing brain tissue is reported using post-mortem neuropathological analysis. Although the literature on monitoring therapy effects on structural magnetic resonance imaging (MRI) is well established, such macroscopic structural changes appear relatively late and irreversible. Early quantitative MRI biomarkers of therapy-induced damage would potentially permit taking these treatment side effects into account, paving the way towards a more personalized treatment planning.This systematic review (PROSPERO number 224196) provides an overview of quantitative tomographic imaging methods, potentially identifying the adverse side effects of cancer therapy in normal-appearing brain tissue. Seventy studies were obtained from the MEDLINE and Web of Science databases. Studies reporting changes in normal-appearing brain tissue using MRI, PET, or SPECT quantitative biomarkers, related to radio-, chemo-, immuno-, or hormone therapy for any kind of solid, cystic, or liquid tumor were included. The main findings of the reviewed studies were summarized, providing also the risk of bias of each study assessed using a modified QUADAS-2 tool. For each imaging method, this review provides the methodological background, and the benefits and shortcomings of each method from the imaging perspective. Finally, a set of recommendations is proposed to support future research.
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Affiliation(s)
- Jan Petr
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Louise Hogeboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pavel Nikulin
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Evita Wiegers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gwen Schroyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jesper Kallehauge
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Marek Chmelík
- Department of Technical Disciplines in Medicine, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Patricia Clement
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Ruben E Nechifor
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Liviu-Andrei Fodor
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Philip C De Witt Hamer
- Department of Neurosurgery, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Cyril Pernet
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Maarten Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Radim Jančálek
- St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Francesca B Pizzini
- Radiology, Deptartment of Diagnostic and Public Health, Verona University, Verona, Italy
| | - Kyrre E Emblem
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Vera C Keil
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
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Witzmann K, Raschke F, Troost EGC. MR Image Changes of Normal-Appearing Brain Tissue after Radiotherapy. Cancers (Basel) 2021; 13:cancers13071573. [PMID: 33805542 PMCID: PMC8037886 DOI: 10.3390/cancers13071573] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/13/2021] [Accepted: 03/23/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Radiotherapy is one of the most important treatment options against cancer. Irradiation of cancerous tissue either directly destroys the cancer cells or damages them such that they cannot reproduce. One side-effect of radiotherapy is that tumor-surrounding normal tissue is inevitably also irradiated, albeit at a lower dose. The resulting long-term damage can significantly affect cognitive performance and quality of life. Many studies investigated the effect of irradiation on normal-appearing brain tissues and some of these correlated imaging findings with functional outcome. This article provides an overview of the examination of radiation-induced injuries using conventional and enhanced MRI methods and summarizes conclusions about the underlying tissue changes. Radiation-induced morphologic, microstructural, vascular, and metabolic tissue changes have been observed, in which the effect of irradiation was evident in terms of decreased perfusion and neuronal health as well as increased diffusion and atrophy. Abstract Radiotherapy is part of the standard treatment of most primary brain tumors. Large clinical target volumes and physical characteristics of photon beams inevitably lead to irradiation of surrounding normal brain tissue. This can cause radiation-induced brain injury. In particular, late brain injury, such as cognitive dysfunction, is often irreversible and progressive over time, resulting in a significant reduction in quality of life. Since 50% of patients have survival times greater than six months, radiation-induced side effects become more relevant and need to be balanced against radiation treatment given with curative intent. To develop adequate treatment and prevention strategies, the underlying cause of radiation-induced side-effects needs to be understood. This paper provides an overview of radiation-induced changes observed in normal-appearing brains measured with conventional and advanced MRI techniques and summarizes the current findings and conclusions. Brain atrophy was observed with anatomical MRI. Changes in tissue microstructure were seen on diffusion imaging. Vascular changes were examined with perfusion-weighted imaging and susceptibility-weighted imaging. MR spectroscopy revealed decreasing N-acetyl aspartate, indicating decreased neuronal health or neuronal loss. Based on these findings, multicenter prospective studies incorporating advanced MR techniques as well as neurocognitive function tests should be designed in order to gain more evidence on radiation-induced sequelae.
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Affiliation(s)
- Katharina Witzmann
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany; (K.W.); (F.R.)
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Felix Raschke
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany; (K.W.); (F.R.)
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Esther G. C. Troost
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany; (K.W.); (F.R.)
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden of the German Cancer Research Center (DKFZ), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz Association/Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Correspondence:
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Nilsen LB, Digernes I, Grøvik E, Saxhaug C, Latysheva A, Geier O, Breivik B, Sætre DO, Jacobsen KD, Helland Å, Emblem KE. Responses in the diffusivity and vascular function of the irradiated normal brain are seen up until 18 months following SRS of brain metastases. Neurooncol Adv 2020; 2:vdaa028. [PMID: 32642687 PMCID: PMC7212876 DOI: 10.1093/noajnl/vdaa028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background MRI may provide insights into longitudinal responses in the diffusivity and vascular function of the irradiated normal-appearing brain following stereotactic radiosurgery (SRS) of brain metastases. Methods Forty patients with brain metastases from non-small cell lung cancer (N = 26) and malignant melanoma (N = 14) received SRS (15–25 Gy). Longitudinal MRI was performed pre-SRS and at 3, 6, 9, 12, and 18 months post-SRS. Measures of tissue diffusivity and vascularity were assessed by diffusion-weighted and perfusion MRI, respectively. All maps were normalized to white matter receiving less than 1 Gy. Longitudinal responses were assessed in normal-appearing brain, excluding tumor and edema, in the LowDose (1–10 Gy) and HighDose (>10 Gy) regions. The Eastern Cooperative Oncology Group (ECOG) performance status was recorded pre-SRS. Results Following SRS, the diffusivity in the LowDose region increased continuously for 1 year (105.1% ± 6.2%; P < .001), before reversing toward pre-SRS levels at 18 months. Transient reductions in microvascular cerebral blood volume (P < .05), blood flow (P < .05), and vessel densities (P < .05) were observed in LowDose at 6–9 months post-SRS. Correspondingly, vessel calibers in LowDose transiently increased at 3–9 months (P < .01). The responses in HighDose displayed similar trends as in LowDose, but with larger interpatient variations. Vascular responses followed pre-SRS ECOG status. Conclusions Our results imply that even low doses of radiation to normal-appearing brain following cerebral SRS induce increased diffusivity and reduced vascular function for up until 18 months. In particular, the vascular responses indicate the reduced ability of the normal-appearing brain tissue to form new capillaries. Assessing the potential long-term neurologic effects of SRS on the normal-appearing brain is warranted.
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Affiliation(s)
| | - Ingrid Digernes
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Endre Grøvik
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Cathrine Saxhaug
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Anna Latysheva
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Oliver Geier
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | - Birger Breivik
- Department of Radiology, Hospital of Southern Norway, Kristiansand, Norway
| | - Dag Ottar Sætre
- Department of Radiology, Østfold Hospital Trust, Klanes, Norway
| | | | - Åslaug Helland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kyrre Eeg Emblem
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
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8
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Wang B, Zhao B, Zhang Y, Ge M, Zhao P, Na Sun, Li C, Pang Q, Xu S, Liu Y. Absolute CBV for the differentiation of recurrence and radionecrosis of brain metastases after gamma knife radiotherapy: a comparison with relative CBV. Clin Radiol 2018; 73:758.e1-758.e7. [PMID: 29764622 DOI: 10.1016/j.crad.2018.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/11/2018] [Indexed: 11/29/2022]
Abstract
AIM To investigate the efficiency of absolute cerebral blood volume (CBV) in the differentiation of tumour recurrence (TR) and radionecrosis (RN) in brain metastases (BM) and to evaluate the performance of absolute CBV compared to relative CBV (rCBV). MATERIALS AND METHODS Between March 2015 and June 2017, 46 patients with BM underwent quantitative dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) because new enhancement had been demonstrated in irradiated lesions after gamma knife radiotherapy. The patients were assigned to either the TR group or RN group on the basis of MR perfusion follow-up or histopathological outcome. Absolute CBV of lesions (CBVlesion) and contralateral normal appearing white matter (CBVNAWM) in both groups were obtained. Mean rCBV were calculated as CBVlesion/CBVNAWM, which was equal to rCBV using traditional DSC-PWI. RESULTS CBVlesion of TR alone was significantly higher than the other parameters in both groups (p<0.001, separately). CBVlesion had smaller interobserver difference than CBVNAWM and rCBV (p<0.001, separately). Although CBVlesion significantly correlated with rCBV (r=0.914, p<0.001) and both had a similar specificity (96%) in differential diagnosis, CBVlesion had a higher sensitivity (96.9% versus 90.9%) to predict the treatment outcome. The best cut-off value of CBVlesion was 21.8 ml/100 g. CONCLUSION Quantitative DSC-PWI is a powerful method for the assessment of radiosurgically treated brain metastases. Absolute CBV has higher diagnostic efficiency than rCBV, which enables an absolute quantification of the regional CBV and prediction of tumour response. These advantages promote the intra- and inter-patient quantitative image comparison across different institutions.
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Affiliation(s)
- B Wang
- School of Medicine, Shandong University, Jinan, 250012, PR China
| | - B Zhao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250021, PR China
| | - Y Zhang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250021, PR China
| | - M Ge
- Department of Neurosurgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, PR China
| | - P Zhao
- Department of Neurosurgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, PR China
| | - Na Sun
- School of Medicine, Shandong University, Jinan, 250012, PR China
| | - C Li
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, 250021, PR China
| | - Q Pang
- Department of Neurosurgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, PR China
| | - S Xu
- Department of Neurosurgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, PR China
| | - Y Liu
- Department of Neurosurgery, Provincial Hospital Affiliated to Shandong University, Jinan, 250021, PR China.
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9
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Perfusion Magnetic Resonance Imaging Changes in Normal Appearing Brain Tissue after Radiotherapy in Glioblastoma Patients may Confound Longitudinal Evaluation of Treatment Response. Radiol Oncol 2018; 52:143-151. [PMID: 30018517 PMCID: PMC6043875 DOI: 10.2478/raon-2018-0022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/04/2018] [Indexed: 11/21/2022] Open
Abstract
Background The aim of this study was assess acute and early delayed radiation-induced changes in normal-appearing brain tissue perfusion as measured with perfusion magnetic resonance imaging (MRI) and the dependence of these changes on the fractionated radiotherapy (FRT) dose level. Patients and methods Seventeen patients with glioma WHO grade III-IV treated with FRT were included in this prospective study, seven were excluded because of inconsistent FRT protocol or missing examinations. Dynamic susceptibility contrast MRI and contrast-enhanced 3D-T1-weighted (3D-T1w) images were acquired prior to and in average (standard deviation): 3.1 (3.3), 34.4 (9.5) and 103.3 (12.9) days after FRT. Pre-FRT 3D-T1w images were segmented into white- and grey matter. Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were calculated and co-registered patient-wise to pre-FRT 3D-T1w images. Seven radiation dose regions were created for each tissue type: 0-5 Gy, 5-10 Gy, 10-20 Gy, 20-30 Gy, 30-40 Gy, 40-50 Gy and 50-60 Gy. Mean CBV and CBF were calculated in each dose region and normalised (nCBV and nCBF) to the mean CBV and CBF in 0-5 Gy white- and grey matter reference regions, respectively. Results Regional and global nCBV and nCBF in white- and grey matter decreased after FRT, followed by a tendency to recover. The response of nCBV and nCBF was dose-dependent in white matter but not in grey matter. Conclusions Our data suggest that radiation-induced perfusion changes occur in normal-appearing brain tissue after FRT. This can cause an overestimation of relative tumour perfusion using dynamic susceptibility contrast MRI, and can thus confound tumour treatment evaluation.
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10
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Leakage correction improves prognosis prediction of dynamic susceptibility contrast perfusion MRI in primary central nervous system lymphoma. Sci Rep 2018; 8:456. [PMID: 29323247 PMCID: PMC5765049 DOI: 10.1038/s41598-017-18901-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/19/2017] [Indexed: 12/20/2022] Open
Abstract
To evaluate whether the cerebral blood volume (CBV) measurement with leakage correction from dynamic susceptibility contrast perfusion weighted imaging can be useful in predicting prognosis for primary central nervous system lymphoma (PCNSL). 46 PCNSL patients were included and classified by radiation therapy (RT) stratification into RT (n = 30) and non-RT (n = 16) groups. The corresponding histogram parameters of normalized CBV (nCBV) maps with or without leakage correction were calculated on contrast-enhanced T1 weighted image (CE T1WI) or on fluid attenuated inversion recovery image. The 75th percentile nCBV with leakage correction based on CE T1WI (T1 nCBVL75%) had a significant difference between the short and long progression free survival (PFS) subgroups of the RT group and the non-RT group, respectively. Based on the survival analysis, patients in the RT group with high T1 nCBVL75% had earlier progression than the others with a low T1 nCBVL75%. However, patients in the non-RT group with a high T1 nCBVL75% had slower progression than the others with a low T1 nCBVL75%. Based on RT stratification, the CBV with leakage correction has potential as a noninvasive biomarker for the prognosis prediction of PCNSL to identify high risk patients and it has a different correlation with the PFS based on the presence of combined RT.
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11
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Ungvari Z, Tarantini S, Hertelendy P, Valcarcel-Ares MN, Fülöp GA, Logan S, Kiss T, Farkas E, Csiszar A, Yabluchanskiy A. Cerebromicrovascular dysfunction predicts cognitive decline and gait abnormalities in a mouse model of whole brain irradiation-induced accelerated brain senescence. GeroScience 2017; 39:33-42. [PMID: 28299642 DOI: 10.1007/s11357-017-9964-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/25/2017] [Indexed: 01/02/2023] Open
Abstract
Whole brain irradiation (WBI) is a mainstream therapy for patients with both identifiable brain metastases and prophylaxis for microscopic malignancies. However, it also promotes accelerated senescence in healthy tissues and leads to progressive cognitive dysfunction in up to 50% of tumor patients surviving long term after treatment, due to γ-irradiation-induced cerebromicrovascular injury. Moment-to-moment adjustment of cerebral blood flow (CBF) via neuronal activity-dependent cerebromicrovascular dilation (functional hyperemia) has a critical role in maintenance of healthy cognitive function. To determine whether cognitive decline induced by WBI associates with impaired cerebromicrovascular function, C56BL/6 mice (3 months) subjected to a clinically relevant protocol of fractionated WBI (5 Gy twice weekly for 4 weeks) and control mice were compared. Mice were tested for spatial memory performance (radial arm water maze), sensorimotor coordination (computerized gait analysis, CatWalk), and cerebromicrovascular function (whisker-stimulation-induced increases in CBF, measured by laser Doppler flowmetry) at 3 to 6 months post-irradiation. We found that mice with WBI exhibited impaired cerebromicrovascular function at 3 months post-irradiation, which was associated with impaired performance in the radial arm water maze. At 6 months, post-irradiation progressive impairment in gait coordination (including changes in the regularity index and phase dispersion) was also evident. Collectively, our findings provide evidence for early and persisting neurovascular impairment after a clinically relevant protocol of fractionated WBI, which predict early manifestations of cognitive impairment.
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Affiliation(s)
- Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Stefano Tarantini
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peter Hertelendy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - M Noa Valcarcel-Ares
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Gabor A Fülöp
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sreemathi Logan
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
| | - Tamas Kiss
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Eszter Farkas
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Medical Physics and Informatics, Faculty of Medicine and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Andriy Yabluchanskiy
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, 975 NE 10th Street, BRC 1311, Oklahoma City, OK, 73104, USA.
- Translational Geroscience Laboratory, Donald W. Reynolds Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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12
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Combs SE, Nüsslin F, Wilkens JJ. Individualized radiotherapy by combining high-end irradiation and magnetic resonance imaging. Strahlenther Onkol 2016; 192:209-15. [PMID: 26852244 DOI: 10.1007/s00066-016-0944-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 01/14/2016] [Indexed: 01/22/2023]
Abstract
Image-guided radiotherapy (IGRT) has been integrated into daily clinical routine and can today be considered the standard especially with high-dose radiotherapy. Currently imaging is based on MV- or kV-CT, which has clear limitations especially in soft-tissue contrast. Thus, combination of magnetic resonance (MR) imaging and high-end radiotherapy opens a new horizon. The intricate technical properties of MR imagers pose a challenge to technology when combined with radiation technology. Several solutions that are almost ready for routine clinical application have been developed. The clinical questions include dose-escalation strategies, monitoring of changes during treatment as well as imaging without additional radiation exposure during treatment.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany. .,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.
| | - Fridtjof Nüsslin
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, München, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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13
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Withey SB, Novak J, MacPherson L, Peet AC. Arterial input function and gray matter cerebral blood volume measurements in children. J Magn Reson Imaging 2015; 43:981-9. [PMID: 26514288 PMCID: PMC4864447 DOI: 10.1002/jmri.25060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 09/15/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
Purpose To investigate how arterial input functions (AIFs) vary with age in children and compare the use of individual and population AIFs for calculating gray matter CBV values. Quantitative measures of cerebral blood volume (CBV) using dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI) require measurement of an AIF. AIFs are affected by numerous factors including patient age. Few data presenting AIFs in the pediatric population exists. Materials and Methods Twenty‐two previously treated pediatric brain tumor patients (mean age, 6.3 years; range, 2.0–15.3 years) underwent DSC‐MRI scans on a 3T MRI scanner over 36 visits. AIFs were measured in the middle cerebral artery. A functional form of an adult population AIF was fitted to each AIF to obtain parameters reflecting AIF shape. The relationship between parameters and age was assessed. Correlations between gray matter CBV values calculated using the resulting population and individual patient AIFs were explored. Results There was a large variation in individual patient AIFs but correlations between AIF shape and age were observed. The center (r = 0.596, P < 0.001) and width of the first‐pass peak (r = 0.441, P = 0.007) were found to correlate significantly with age. Intrapatient coefficients of variation were significantly lower than interpatient values for all parameters (P < 0.001). Differences in CBV values calculated with an overall population and age‐specific population AIF compared to those calculated with individual AIFs were 31.3% and 31.0%, respectively. Conclusion Parameters describing AIF shape correlate with patient age in line with expected changes in cardiac output. In pediatric DSC‐MRI studies individual patient AIFs are recommended. J. Magn. Reson. Imaging 2016;43:981–989
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Affiliation(s)
- Stephanie B Withey
- RRPPS, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Birmingham Children's Hospital, Birmingham, UK.,Cancer Sciences, University of Birmingham, Birmingham, UK
| | - Jan Novak
- Birmingham Children's Hospital, Birmingham, UK.,Cancer Sciences, University of Birmingham, Birmingham, UK
| | | | - Andrew C Peet
- Birmingham Children's Hospital, Birmingham, UK.,Cancer Sciences, University of Birmingham, Birmingham, UK
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14
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Savelieva TA, Loshchenov VB, Goryainov SA, Shishkina LV, Potapov AA. A spectroscopic method for simultaneous determination of protoporphyrin IX and hemoglobin in the nerve tissues at intraoperative diagnosis. RUSS J GEN CHEM+ 2015. [DOI: 10.1134/s1070363215060341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Szwarc P, Kawa J, Rudzki M, Pietka E. Automatic brain tumour detection and neovasculature assessment with multiseries MRI analysis. Comput Med Imaging Graph 2015; 46 Pt 2:178-90. [PMID: 26183648 DOI: 10.1016/j.compmedimag.2015.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 12/01/2022]
Abstract
In this paper a novel multi-stage automatic method for brain tumour detection and neovasculature assessment is presented. First, the brain symmetry is exploited to register the magnetic resonance (MR) series analysed. Then, the intracranial structures are found and the region of interest (ROI) is constrained within them to tumour and peritumoural areas using the Fluid Light Attenuation Inversion Recovery (FLAIR) series. Next, the contrast-enhanced lesions are detected on the basis of T1-weighted (T1W) differential images before and after contrast medium administration. Finally, their vascularisation is assessed based on the Regional Cerebral Blood Volume (RCBV) perfusion maps. The relative RCBV (rRCBV) map is calculated in relation to a healthy white matter, also found automatically, and visualised on the analysed series. Three main types of brain tumours, i.e. HG gliomas, metastases and meningiomas have been subjected to the analysis. The results of contrast enhanced lesions detection have been compared with manual delineations performed independently by two experts, yielding 64.84% sensitivity, 99.89% specificity and 71.83% Dice Similarity Coefficient (DSC) for twenty analysed studies of subjects with brain tumours diagnosed.
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Affiliation(s)
- Pawel Szwarc
- Silesian University of Technology, Faculty of Biomedical Engineering, Zabrze, Poland
| | - Jacek Kawa
- Silesian University of Technology, Faculty of Biomedical Engineering, Zabrze, Poland.
| | - Marcin Rudzki
- Silesian University of Technology, Faculty of Biomedical Engineering, Zabrze, Poland
| | - Ewa Pietka
- Silesian University of Technology, Faculty of Biomedical Engineering, Zabrze, Poland
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16
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Shiroishi MS, Castellazzi G, Boxerman JL, D'Amore F, Essig M, Nguyen TB, Provenzale JM, Enterline DS, Anzalone N, Dörfler A, Rovira À, Wintermark M, Law M. Principles of T2*-weighted dynamic susceptibility contrast MRI technique in brain tumor imaging. J Magn Reson Imaging 2014; 41:296-313. [DOI: 10.1002/jmri.24648] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 04/03/2014] [Indexed: 01/17/2023] Open
Affiliation(s)
- Mark S. Shiroishi
- Keck School of Medicine; University of Southern California; Los Angeles California USA
| | - Gloria Castellazzi
- Department of Industrial and Information Engineering; University of Pavia; Pavia Italy
- Brain Connectivity Center, IRCCS “C. Mondino Foundation,”; Pavia Italy
| | - Jerrold L. Boxerman
- Warren Alpert Medical School of Brown University; Providence Rhode Island USA
| | - Francesco D'Amore
- Keck School of Medicine; University of Southern California; Los Angeles California USA
- Department of Neuroradiology; IRCCS “C. Mondino Foundation,” University of Pavia; Pavia Italy
| | - Marco Essig
- University of Manitoba's Faculty of Medicine; Winnipeg Manitoba Canada
| | - Thanh B. Nguyen
- Faculty of Medicine, Ottawa University; Ottawa Ontario Canada
| | - James M. Provenzale
- Duke University Medical Center; Durham North Carolina USA
- Emory University School of Medicine; Atlanta Georgia USA
| | | | | | - Arnd Dörfler
- University of Erlangen-Nuremberg, Erlangen; Germany
| | - Àlex Rovira
- Vall d'Hebron University Hospital; Barcelona Spain
| | - Max Wintermark
- School of Medicine; University of Virginia; Charlottesville Virginia USA
| | - Meng Law
- Keck School of Medicine; University of Southern California; Los Angeles California USA
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17
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Jakubovic R, Sahgal A, Ruschin M, Pejovic-Milic A, Milwid R, Aviv RI. Non Tumor Perfusion Changes Following Stereotactic Radiosurgery to Brain Metastases. Technol Cancer Res Treat 2014; 14:tcrtexpress.201. [PMID: 24749999 PMCID: PMC4639904 DOI: 10.7785/tcrtexpress.2013.600279] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/13/2014] [Accepted: 03/11/2014] [Indexed: 12/03/2022] Open
Abstract
Purpose: To evaluate early perfusion changes in normal tissue following stereotactic radiosurgery (SRS). Methods: Nineteen patients harboring twenty-two brain metastases treated with SRS were imaged with dynamic susceptibility magnetic resonance imaging (DSC MRI) at baseline, 1 week and 1 month post SRS. Relative cerebral blood volume and flow (rCBV and rCBF) ratios were evaluated outside of tumor within a combined region of interest (ROI) and separately within gray matter (GM) and white matter (WM) ROIs. Three-dimensional dose distribution from each SRS plan was divided into six regions: (1) <2 Gy; (2) 2-5 Gy; (3) 5-10 Gy; (4) 10-12 Gy; (5) 12-16 Gy; and (6) >16 Gy. rCBV and rCBF ratio differences between baseline, 1 week and 1 month were compared. Best linear fit plots quantified normal tissue dose-dependency. Results: Significant rCBV ratio increases were present between baseline and 1 month for all ROIs and dose ranges except for WM ROI receiving <2 Gy. rCBV ratio for all ROIs was maximally increased from baseline to 1 month with the greatest changes occurring within the 5-10 Gy dose range (53.1%). rCBF ratio was maximally increased from baseline to 1 month for all ROIs within the 5-10 Gy dose range (33.9-45.0%). Both rCBV and rCBF ratios were most elevated within GM ROIs. A weak, positive but not significant association between dose, rCBV and rCBF ratio was demonstrated. Progressive rCBV and rCBF ratio increased with dose up to 10 Gy at 1 month. Conclusion: Normal tissue response following SRS can be characterized by dose, tissue, and time specific increases in rCBV and rCBF ratio.
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Affiliation(s)
- R Jakubovic
- Department of Medical Imaging, Division of Neuroradiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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18
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Hong X, Liu L, Wang M, Ding K, Fan Y, Ma B, Lal B, Tyler B, Mangraviti A, Wang S, Wong J, Laterra J, Zhou J. Quantitative multiparametric MRI assessment of glioma response to radiotherapy in a rat model. Neuro Oncol 2013; 16:856-67. [PMID: 24366911 DOI: 10.1093/neuonc/not245] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The inability of structural MRI to accurately measure tumor response to therapy complicates care management for patients with gliomas. The purpose of this study was to assess the potential of several noninvasive functional and molecular MRI biomarkers for the assessment of glioma response to radiotherapy. METHODS Fourteen U87 tumor-bearing rats were irradiated using a small-animal radiation research platform (40 or 20 Gy), and 6 rats were used as controls. MRI was performed on a 4.7 T animal scanner, preradiation treatment, as well as at 3, 6, 9, and 14 days postradiation. Image features of the tumors, as well as tumor volumes and animal survival, were quantitatively compared. RESULTS Structural MRI showed that all irradiated tumors still grew in size during the initial days postradiation. The apparent diffusion coefficient (ADC) values of tumors increased significantly postradiation (40 and 20 Gy), except at day 3 postradiation, compared with preradiation. The tumor blood flow decreased significantly postradiation (40 and 20 Gy), but the relative blood flow (tumor vs contralateral) did not show a significant change at most time points postradiation. The amide proton transfer weighted (APTw) signals of the tumor decreased significantly at all time points postradiation (40 Gy), and also at day 9 postradiation (20 Gy). The blood flow and APTw maps demonstrated tumor features that were similar to those seen on gadolinium-enhanced T1-weighted images. CONCLUSIONS Tumor ADC, blood flow, and APTw were all useful imaging biomarkers by which to predict glioma response to radiotherapy. The APTw signal was most promising for early response assessment in this model.
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Affiliation(s)
- Xiaohua Hong
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Li Liu
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Meiyun Wang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Kai Ding
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Ying Fan
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Bo Ma
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Bachchu Lal
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Betty Tyler
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Antonella Mangraviti
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Silun Wang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - John Wong
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - John Laterra
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, Maryland (X.H., M.W., Y.F., B.M., S.W., J.Z.); Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China (X.H., L.L.); Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (K.D., J.W.); Department of Neurology, Kennedy Krieger Institute, Baltimore, Maryland (B.L., J.L.); Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland (B.T., A.M.); Department of Neurology, Johns Hopkins University, Baltimore, Maryland (J.L.); F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, Maryland (J.Z.)
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Warrington JP, Ashpole N, Csiszar A, Lee YW, Ungvari Z, Sonntag WE. Whole brain radiation-induced vascular cognitive impairment: mechanisms and implications. J Vasc Res 2013; 50:445-57. [PMID: 24107797 PMCID: PMC4309372 DOI: 10.1159/000354227] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/05/2013] [Indexed: 01/31/2023] Open
Abstract
Mild cognitive impairment is a well-documented consequence of whole brain radiation therapy (WBRT) that affects 40-50% of long-term brain tumor survivors. The exact mechanisms for the decline in cognitive function after WBRT remain elusive and no treatment or preventative measures are available for use in the clinic. Here, we review recent findings indicating how changes in the neurovascular unit may contribute to the impairments in learning and memory. In addition to affecting neuronal development, WBRT induces profound capillary rarefaction within the hippocampus - a region of the brain important for learning and memory. Therapeutic strategies such as hypoxia, which restore the capillary density, result in the rescue of cognitive function. In addition to decreasing vascular density, WBRT impairs vasculogenesis and/or angiogenesis, which may also contribute to radiation-induced cognitive decline. Further studies aimed at uncovering the specific mechanisms underlying these WBRT-induced changes in the cerebrovasculature are essential for developing therapies to mitigate the deleterious effects of WBRT on cognitive function.
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Affiliation(s)
- Junie P. Warrington
- Department of Physiology and Biophysics, University of Mississippi Medical Center, Jackson, MS 39216
| | - Nicole Ashpole
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Anna Csiszar
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - Yong Woo Lee
- School of Biomedical Engineering and Sciences Virginia Polytechnic Institute and State University, Blacksburg, VA 24061
| | - Zoltan Ungvari
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
| | - William E. Sonntag
- Reynolds Oklahoma Center on Aging, Department of Geriatric Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104
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Harreld JH, Helton KJ, Kaddoum RN, Reddick WE, Li Y, Glass JO, Sansgiri R, Ji Q, Feng T, Parish ME, Gajjar A, Patay Z. The effects of propofol on cerebral perfusion MRI in children. Neuroradiology 2013; 55:1049-1056. [PMID: 23673874 DOI: 10.1007/s00234-013-1187-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 04/03/2013] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The effects of anesthesia are infrequently considered when interpreting pediatric perfusion magnetic resonance imaging (MRI). The objectives of this study were to test for measurable differences in MR measures of cerebral blood flow (CBF) and cerebral blood volume (CBV) between non-sedated and propofol-sedated children, and to identify influential factors. METHODS Supratentorial cortical CBF and CBV measured by dynamic susceptibility contrast perfusion MRI in 37 children (1.8-18 years) treated for infratentorial brain tumors receiving propofol (IV, n = 19) or no sedation (NS, n = 18) were compared between groups and correlated with age, hematocrit (Hct), end-tidal CO₂ (ETCO₂), dose, weight, and history of radiation therapy (RT). The model most predictive of CBF and CBV was identified by multiple linear regression. RESULTS Anterior cerebral artery (ACA) and middle cerebral artery (MCA) territory CBF were significantly lower, and MCA territory CBV greater (p = 0.03), in IV than NS patients (p = 0.01, 0.04). The usual trend of decreasing CBF with age was reversed with propofol in ACA and MCA territories (r = 0.53, r = 0.47; p < 0.05). ACA and MCA CBF (r = 0.59, 0.49; p < 0.05) and CBV in ACA, MCA, and posterior cerebral artery territories (r = 0.73, 0.80, 0.52; p < 0.05) increased with weight in propofol-sedated children, with no significant additional influence from age, ETCO₂, hematocrit, or RT. CONCLUSION In propofol-sedated children, usual age-related decreases in CBF were reversed, and increases in CBF and CBV were weight-dependent, not previously described. Weight-dependent increases in propofol clearance may diminish suppression of CBF and CBV. Prospective study is required to establish anesthetic-specific models of CBF and CBV in children.
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Affiliation(s)
- Julie H Harreld
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA.
| | - Kathleen J Helton
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Roland N Kaddoum
- Department of Anesthesiology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Wilburn E Reddick
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Yimei Li
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - John O Glass
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Rakhee Sansgiri
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Qing Ji
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Tianshu Feng
- Department of Biostatistics, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Mary Edna Parish
- Department of Anesthesiology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
| | - Zoltan Patay
- Department of Radiological Sciences, St. Jude Children's Research Hospital, MS 220, 262 Danny Thomas Place, Memphis, TN, 38105-3678, USA
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21
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Choi YJ, Kim HS, Jahng GH, Kim SJ, Suh DC. Pseudoprogression in patients with glioblastoma: added value of arterial spin labeling to dynamic susceptibility contrast perfusion MR imaging. Acta Radiol 2013; 54:448-54. [PMID: 23592805 DOI: 10.1177/0284185112474916] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pseudoprogression is a treatment-related reaction with an increase in contrast-enhancing lesion size, followed by subsequent improvement. Differentiating tumor recurrence from pseudoprogression remains a problem in neuro-oncology. PURPOSE To validate the added value of arterial spin labeling (ASL), compared with dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) alone, in distinguishing early tumor progression from pseudoprogression in patients with newly diagnosed glioblastoma multiforme (GBM). MATERIAL AND METHODS We retrospectively evaluated 117 consecutive patients with newly diagnosed GBM who underwent surgical resection and concurrent chemoradiotherapy (CCRT) as standard treatment modality. Sixty-two patients who developed contrast-enhancing lesions were assessed by both ASL and DSC perfusion MRI and classified into groups of early tumor recurrence (n = 34) or pseudoprogression (n = 28) based on pathologic analysis or clinical-radiologic follow-up. We used a qualitative analysis and semi-quantitative grade system on the basis of the tumor perfusion signal intensity into those equal to white matter (grade I), gray matter (grade II), and blood vessels (grade III) on ASL imaging. ASL grade was correlated with histogram parameters derived from DSC perfusion MRI. RESULTS Pseudoprogression was observed in 15 (53.6%) patients with ASL grade I, 13 (46.4%) with grade II, and 0 (0%) with grade III, with early tumor progression observed in seven (20.6%) patients with ASL grade I, 11 (32.3%) with grade II, and 16 (47.1%) with grade III (P = 0.0022). DSC perfusion histogram parameters differed significantly among ASL grades. ASL grade was an independent predictor differentiating pseudoprogression from early tumor progression (odds ratio, 4.73; P = 0.0017). On qualitative review, adjunctive ASL produced eight (12.9%) more accurate results than DSC perfusion MRI alone. CONCLUSION ASL improves the diagnostic accuracy of DSC perfusion MRI in differentiating pseudoprogression from early tumor progression.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University Hospital-Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul
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22
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Thompson G, Mills SJ, Coope DJ, O'Connor JPB, Jackson A. Imaging biomarkers of angiogenesis and the microvascular environment in cerebral tumours. Br J Radiol 2012; 84 Spec No 2:S127-44. [PMID: 22433824 DOI: 10.1259/bjr/66316279] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Conventional contrast-enhanced CT and MRI are now in routine clinical use for the diagnosis, treatment and monitoring of diseases in the brain. The presence of contrast enhancement is a proxy for the pathological changes that occur in the normally highly regulated brain vasculature and blood-brain barrier. With recognition of the limitations of these techniques, and a greater appreciation for the nuanced mechanisms of microvascular change in a variety of pathological processes, novel techniques are under investigation for their utility in further interrogating the microvasculature of the brain. This is particularly important in tumours, where the reliance on angiogenesis (new vessel formation) is crucial for tumour growth, and the resulting microvascular configuration and derangement has profound implications for diagnosis, treatment and monitoring. In addition, novel therapeutic approaches that seek to directly modify the microvasculature require more sensitive and specific biological markers of baseline tumour behaviour and response. The currently used imaging biomarkers of angiogenesis and brain tumour microvascular environment are reviewed.
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Affiliation(s)
- G Thompson
- Wolfson Molecular Imaging Centre, University of Manchester, Withington, Manchester, UK
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23
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Allen AM, Pawlicki T, Dong L, Fourkal E, Buyyounouski M, Cengel K, Plastaras J, Bucci MK, Yock TI, Bonilla L, Price R, Harris EE, Konski AA. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol 2012; 103:8-11. [PMID: 22405807 DOI: 10.1016/j.radonc.2012.02.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/30/2012] [Accepted: 02/04/2012] [Indexed: 12/25/2022]
Abstract
Proton beam therapy (PBT) is a novel method for treating malignant disease with radiotherapy. The purpose of this work was to evaluate the state of the science of PBT and arrive at a recommendation for the use of PBT. The emerging technology committee of the American Society of Radiation Oncology (ASTRO) routinely evaluates new modalities in radiotherapy and assesses the published evidence to determine recommendations for the society as a whole. In 2007, a Proton Task Force was assembled to evaluate the state of the art of PBT. This report reflects evidence collected up to November 2009. Data was reviewed for PBT in central nervous system tumors, gastrointestinal malignancies, lung, head and neck, prostate, and pediatric tumors. Current data do not provide sufficient evidence to recommend PBT in lung cancer, head and neck cancer, GI malignancies, and pediatric non-CNS malignancies. In hepatocellular carcinoma and prostate cancer and there is evidence for the efficacy of PBT but no suggestion that it is superior to photon based approaches. In pediatric CNS malignancies PBT appears superior to photon approaches but more data is needed. In large ocular melanomas and chordomas, we believe that there is evidence for a benefit of PBT over photon approaches. PBT is an important new technology in radiotherapy. Current evidence provides a limited indication for PBT. More robust prospective clinical trials are needed to determine the appropriate clinical setting for PBT.
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Affiliation(s)
- Aaron M Allen
- Davidoff Center, Tel Aviv University, Petach Tikvah, Israel.
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Shi Y, Zhang X, Tang X, Wang P, Wang H, Wang Y. MiR-21 is Continually Elevated Long-Term in the Brain after Exposure to Ionizing Radiation. Radiat Res 2012; 177:124-8. [DOI: 10.1667/rr2764.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Shiroishi MS, Habibi M, Rajderkar D, Yurko C, Go JL, Lerner A, Mogensen MA, Kim PE, Boyko OB, Zee CS, Law M. Perfusion and permeability MR imaging of gliomas. Technol Cancer Res Treat 2011; 10:59-71. [PMID: 21214289 DOI: 10.7785/tcrt.2012.500180] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Conventional contrast-enhanced MR imaging is the current standard technique for the diagnosis and treatment evaluation of gliomas and other brain neoplasms. However, this method is quite limited in its ability to characterize the complex biology of gliomas and so there is a need to develop more quantitative imaging methods. Perfusion and permeability MR imaging are two such techniques that have shown promise in this regard. This review will highlight the underlying principles, applications, and pitfalls of these evolving advanced MRI methods.
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Affiliation(s)
- M S Shiroishi
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033, USA.
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Guan LM, Qi XX, Xia B, Li ZH, Zhao Y, Xu K. Early changes measured by CT perfusion imaging in tumor microcirculation following radiosurgery in rat C6 brain gliomas. J Neurosurg 2011; 114:1672-80. [DOI: 10.3171/2011.1.jns101513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
In this paper, the authors' aim was to use CT perfusion imaging to evaluate the early changes in tumor microcirculation following radiosurgery in rat C6 brain gliomas.
Methods
C6 glioma cells were inoculated into the right caudate nucleus of 25 Wistar rats using a stereotactic procedure. Tumor-bearing rats were randomly divided into 2 groups (tumor group and treatment group). Rats in the treatment group received maximal doses of 20 Gy delivered by the X-knife unit 16 days postimplantation. Computed tomography perfusion imaging was performed in all rats 3 weeks after tumor implantation prior to death and histopathological analysis.
Results
Hypocellular regions and tumor edema were increased in the treatment group compared with the tumor group. Parameters of CT perfusion imaging including cerebral blood volume (CBV) and mean transit time (MTT) of the tumors as well as the permeability surface area (PSA) product in the tumor-brain districts were decreased in the treatment group compared with the tumor group (p < 0.05). Although microvascular density (MVD) in the periphery of the tumors in the treatment group was higher than that in the normal contralateral brain (p < 0.05), MVD of the tumors in the treatment group was less than that in the tumor group (p < 0.01). There was a positive correlation between cerebral blood flow (CBF) and MVD as well as CBV and MVD in the center and periphery of tumors in both groups (p < 0.05).
Conclusions
A decrease in the perfusion volume of rat C6 brain gliomas was observed during the acute stage following X-knife treatment, and CBF and CBV were positively correlated with MVD of rat C6 brain gliomas. Thus, CT perfusion imaging can be used to evaluate the early changes in tumor microcirculation following radiosurgery.
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Affiliation(s)
| | | | | | - Zhen-hua Li
- 3Pathology, The No. 1 Hospital of China Medical University, Shenyang, China
| | | | - Ke Xu
- 1Departments of Radiology,
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Kesler SR, Lacayo NJ, Jo B. A pilot study of an online cognitive rehabilitation program for executive function skills in children with cancer-related brain injury. Brain Inj 2011; 25:101-12. [PMID: 21142826 DOI: 10.3109/02699052.2010.536194] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVES Children with a history of cancer are at increased risk for cognitive impairments, particularly in executive and memory domains. Traditional, in-person cognitive rehabilitation strategies may be unavailable and/or impractical for many of these children given difficulties related to resources and health status. The feasibility and efficacy of implementing a computerized, home-based cognitive rehabilitation curriculum designed to improve executive function skills was examined in these children. METHODS A one-arm open trial pilot study of an original executive function cognitive rehabilitation curriculum was conducted with 23 paediatric cancer survivors aged 7-19. RESULTS Compliance with the cognitive rehabilitation program was 83%, similar to that of many traditional programs. Following the cognitive intervention, participants showed significantly increased processing speed, cognitive flexibility, verbal and visual declarative memory scores as well as significantly increased pre-frontal cortex activation compared to baseline. CONCLUSIONS These results suggest that a program of computerized cognitive exercises can be successfully implemented at home in young children with cancer. These exercises may be effective for improving executive and memory skills in this group, with concurrent changes in neurobiologic status.
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Affiliation(s)
- Shelli R Kesler
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
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Tracer kinetic modelling of tumour angiogenesis based on dynamic contrast-enhanced CT and MRI measurements. Eur J Nucl Med Mol Imaging 2010; 37 Suppl 1:S30-51. [PMID: 20503049 DOI: 10.1007/s00259-010-1448-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE Technical developments in both magnetic resonance imaging (MRI) and computed tomography (CT) have helped to reduce scan times and expedited the development of dynamic contrast-enhanced (DCE) imaging techniques. Since the temporal change of the image signal following the administration of a diffusible, extracellular contrast agent (CA) is related to the local blood supply and the extravasation of the CA into the interstitial space, DCE imaging can be used to assess tissue microvasculature and microcirculation. It is the aim of this review to summarize the biophysical and tracer kinetic principles underlying this emerging imaging technique offering great potential for non-invasive characterization of tumour angiogenesis. METHODS In the first part, the relevant contrast mechanisms are presented that form the basis to relate signal variations measured by serial CT and MRI to local tissue concentrations of the administered CA. In the second part, the concepts most widely used for tracer kinetic modelling of concentration-time courses derived from measured DCE image data sets are described in a consistent and unified manner to highlight their particular structure and assumptions as well as the relationships among them. Finally, the concepts presented are exemplified by the analysis of representative DCE data as well as discussed with respect to present and future applications in cancer diagnosis and therapy. RESULTS Depending on the specific protocol used for the acquisition of DCE image data and the particular model applied for tracer kinetic analysis of the derived concentration-time courses, different aspects of tumour angiogenesis can be quantified in terms of well-defined physiological tissue parameters. CONCLUSIONS DCE imaging offers promising prospects for improved tumour diagnosis, individualization of cancer treatment as well as the evaluation of novel therapeutic concepts in preclinical and early-stage clinical trials.
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Kim YH, Oh SW, Lim YJ, Park CK, Lee SH, Kang KW, Jung HW, Chang KH. Differentiating radiation necrosis from tumor recurrence in high-grade gliomas: assessing the efficacy of 18F-FDG PET, 11C-methionine PET and perfusion MRI. Clin Neurol Neurosurg 2010; 112:758-65. [PMID: 20619531 DOI: 10.1016/j.clineuro.2010.06.005] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 05/31/2010] [Accepted: 06/09/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE The authors analyzed the characteristics of perfusion magnetic resonance imaging (MRI), (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) and (11)C-methionine (MET) PET to compare the efficacies of these modalities in making the distinction between radiation necrosis and tumor recurrence of high-grade glioma. PATIENTS AND METHODS Ten patients were evaluated with dynamic susceptibility contrast perfusion MRI, (11)C-MET PET and (18)F-FDG PET to visualize gadolinium-enhanced lesions during the post-radiation follow-up period. In the perfusion MRI, four regions of interest (ROIs) were identified and average values were calculated. A reference ROI of the same size was defined in the contralateral white matter to obtain the relative cerebral blood volume (rCBV). After coregistering the PET images with the MRI, we measured the maximum uptake values of the lesion and of the contralateral cerebral white matter as reference area to calculate the L(max)/R(max) ratio. RESULTS The rCBV was higher in the recurrence group than in the necrosis group (p=0.010). There was no difference between groups in terms of the L(max)/R(max) ratio as derived from the (18)F-FDG and (11)C-MET PET. CONCLUSION A quantitative rCBV as calculated from a perfusion MRI scan might be superior to the L(max)/R(max) ratio as derived from (18)F-FDG and (11)C-MET PET in order to distinguish a recurrence of high-grade glioma from radiation necrosis.
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Affiliation(s)
- Yong Hwy Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Republic of Korea
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30
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Gallagher F. An introduction to functional and molecular imaging with MRI. Clin Radiol 2010; 65:557-66. [DOI: 10.1016/j.crad.2010.04.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 04/22/2010] [Accepted: 04/30/2010] [Indexed: 11/25/2022]
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Giesel FL, Mehndiratta A, Essig M. High-relaxivity contrast-enhanced magnetic resonance neuroimaging: a review. Eur Radiol 2010; 20:2461-74. [PMID: 20567832 DOI: 10.1007/s00330-010-1805-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 03/01/2010] [Accepted: 03/04/2010] [Indexed: 11/25/2022]
Abstract
Evaluation of brain lesions using magnetic resonance imaging (MRI) provides information that is critical for accurate diagnosis, prognosis, therapeutic intervention and monitoring response. Conventional contrast-enhanced MR neuroimaging using gadolinium (Gd) contrast agents primarily depicts disruption of the blood-brain barrier, demonstrating location and extent of disease, and also the morphological details at the lesion site. However, conventional imaging results do not always accurately predict tumour aggressiveness. Advanced functional MRI techniques such as dynamic contrast-enhanced perfusion-weighted imaging utilise contrast agents to convey physiological information regarding the haemodynamics and neoangiogenic status of the lesion that is often complementary to anatomical information obtained through conventional imaging. Most of the Gd contrast agents available have similar T1 and T2 relaxivities, and thus their contrast-enhancing capabilities are comparable. Exceptions are gadobenate-dimeglumine, Gd-EOB-DTPA, Gadobutrol and gadofosveset, which, owing to their transient-protein-binding capability, possess almost twice (and more) the T1 and T2 relaxivities as other agents at all magnetic field strengths. Numerous comparative studies have demonstrated the advantages of the increased relaxivity in terms of enhanced image contrast, image quality and diagnostic confidence. Here we summarise the benefits of higher relaxivity for the most common neuroimaging applications including MRI, perfusion-weighted imaging and MRA for evaluation of brain tumours, cerebrovascular disease and other CNS lesions.
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Affiliation(s)
- Frederik L Giesel
- Department of Radiology E010, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany
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Bjørnerud A, Emblem KE. A fully automated method for quantitative cerebral hemodynamic analysis using DSC-MRI. J Cereb Blood Flow Metab 2010; 30:1066-78. [PMID: 20087370 PMCID: PMC2949177 DOI: 10.1038/jcbfm.2010.4] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Dynamic susceptibility contrast (DSC)-based perfusion analysis from MR images has become an established method for analysis of cerebral blood volume (CBV) in glioma patients. To date, little emphasis has, however, been placed on quantitative perfusion analysis of these patients, mainly due to the associated increased technical complexity and lack of sufficient stability in a clinical setting. The aim of our study was to develop a fully automated analysis framework for quantitative DSC-based perfusion analysis. The method presented here generates quantitative hemodynamic maps without user interaction, combined with automatic segmentation of normal-appearing cerebral tissue. Validation of 101 patients with confirmed glioma after surgery gave mean values for CBF, CBV, and MTT, extracted automatically from normal-appearing whole-brain white and gray matter, in good agreement with literature values. The measured age- and gender-related variations in the same parameters were also in agreement with those in the literature. Several established analysis methods were compared and the resulting perfusion metrics depended significantly on method and parameter choice. In conclusion, we present an accurate, fast, and automatic quantitative perfusion analysis method where all analysis steps are based on raw DSC data only.
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Affiliation(s)
- Atle Bjørnerud
- Department of Medical Physics, The Interventional Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
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Radiation dose-volume effects in the brain. Int J Radiat Oncol Biol Phys 2010; 76:S20-7. [PMID: 20171513 DOI: 10.1016/j.ijrobp.2009.02.091] [Citation(s) in RCA: 528] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Revised: 02/24/2009] [Accepted: 02/27/2009] [Indexed: 11/21/2022]
Abstract
We have reviewed the published data regarding radiotherapy (RT)-induced brain injury. Radiation necrosis appears a median of 1-2 years after RT; however, cognitive decline develops over many years. The incidence and severity is dose and volume dependent and can also be increased by chemotherapy, age, diabetes, and spatial factors. For fractionated RT with a fraction size of <2.5 Gy, an incidence of radiation necrosis of 5% and 10% is predicted to occur at a biologically effective dose of 120 Gy (range, 100-140) and 150 Gy (range, 140-170), respectively. For twice-daily fractionation, a steep increase in toxicity appears to occur when the biologically effective dose is >80 Gy. For large fraction sizes (>or=2.5 Gy), the incidence and severity of toxicity is unpredictable. For single fraction radiosurgery, a clear correlation has been demonstrated between the target size and the risk of adverse events. Substantial variation among different centers' reported outcomes have prevented us from making toxicity-risk predictions. Cognitive dysfunction in children is largely seen for whole brain doses of >or=18 Gy. No substantial evidence has shown that RT induces irreversible cognitive decline in adults within 4 years of RT.
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Ozsunar Y, Mullins ME, Kwong K, Hochberg FH, Ament C, Schaefer PW, Gonzalez RG, Lev MH. Glioma recurrence versus radiation necrosis? A pilot comparison of arterial spin-labeled, dynamic susceptibility contrast enhanced MRI, and FDG-PET imaging. Acad Radiol 2010; 17:282-90. [PMID: 20060750 DOI: 10.1016/j.acra.2009.10.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 10/21/2009] [Accepted: 10/21/2009] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES Distinguishing recurrent glial tumor from radiation necrosis can be challenging. The purpose of this pilot study was to preliminarily compare unenhanced arterial spin-labeled (ASL) imaging, dynamic susceptibility contrast-enhanced cerebral blood volume (DSCE-CBV) magnetic resonance imaging, and positron emission tomographic (PET) imaging in distinguishing predominant glioma recurrence or progression from predominant radiation necrosis in postoperative patients treated with proton-beam therapy. METHODS Patients with grade II to IV glioma previously treated with surgery and proton-beam therapy were enrolled on the basis of new enhancing nodules or masses with primary differential diagnoses of predominant tumor recurrence or progression versus radiation necrosis. ASL, DSCE-CBV, and PET examinations were assessed by visual qualitative and quantitative analysis for the detection of predominant tumor recurrence. Imaging results were correlated with a clinical-pathologic reference standard. RESULTS Thirty patients were studied, resulting in 33 ASL, 32 DSCE-CBV, and 26 PET examinations. On the basis of visual inspection, the sensitivities of PET, ASL, and DSCE-CBV examinations for detecting high-grade tumor foci were 81%, 88%, and 86%, respectively. The highest sensitivity values for quantitative ASL imaging were obtained using a normalized cutoff ratio of 1.3, resulting in sensitivity of 94% for ASL imaging and 71% for DSCE-CBV imaging. When predominant high-grade tumors with superimposed regions of predominant mixed radiation necrosis were excluded, DSCE-CBV sensitivity improved to 90%, but ASL sensitivity remained unchanged. CONCLUSIONS Compared with DSCE-CBV imaging, ASL imaging may more accurately distinguish predominant recurrent high-grade glioma from radiation necrosis, especially in regions with mixed radiation necrosis, for which DSCE-CBV imaging may underestimate true blood volume because of leakage artifacts.
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High-precision radiosurgical dose delivery by interlaced microbeam arrays of high-flux low-energy synchrotron X-rays. PLoS One 2010; 5:e9028. [PMID: 20140254 PMCID: PMC2815784 DOI: 10.1371/journal.pone.0009028] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 12/16/2009] [Indexed: 11/19/2022] Open
Abstract
Microbeam Radiation Therapy (MRT) is a preclinical form of radiosurgery dedicated to brain tumor treatment. It uses micrometer-wide synchrotron-generated X-ray beams on the basis of spatial beam fractionation. Due to the radioresistance of normal brain vasculature to MRT, a continuous blood supply can be maintained which would in part explain the surprising tolerance of normal tissues to very high radiation doses (hundreds of Gy). Based on this well described normal tissue sparing effect of microplanar beams, we developed a new irradiation geometry which allows the delivery of a high uniform dose deposition at a given brain target whereas surrounding normal tissues are irradiated by well tolerated parallel microbeams only. Normal rat brains were exposed to 4 focally interlaced arrays of 10 microplanar beams (52 µm wide, spaced 200 µm on-center, 50 to 350 keV in energy range), targeted from 4 different ports, with a peak entrance dose of 200Gy each, to deliver an homogenous dose to a target volume of 7 mm3 in the caudate nucleus. Magnetic resonance imaging follow-up of rats showed a highly localized increase in blood vessel permeability, starting 1 week after irradiation. Contrast agent diffusion was confined to the target volume and was still observed 1 month after irradiation, along with histopathological changes, including damaged blood vessels. No changes in vessel permeability were detected in the normal brain tissue surrounding the target. The interlacing radiation-induced reduction of spontaneous seizures of epileptic rats illustrated the potential pre-clinical applications of this new irradiation geometry. Finally, Monte Carlo simulations performed on a human-sized head phantom suggested that synchrotron photons can be used for human radiosurgical applications. Our data show that interlaced microbeam irradiation allows a high homogeneous dose deposition in a brain target and leads to a confined tissue necrosis while sparing surrounding tissues. The use of synchrotron-generated X-rays enables delivery of high doses for destruction of small focal regions in human brains, with sharper dose fall-offs than those described in any other conventional radiation therapy.
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Lacerda S, Law M. Magnetic Resonance Perfusion and Permeability Imaging in Brain Tumors. Neuroimaging Clin N Am 2009; 19:527-57. [DOI: 10.1016/j.nic.2009.08.007] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mehndiratta A, Knopp MV, Zechmann CM, Owsijewitsch M, von Tengg-Kobligk H, Zamecnik P, Kauczor HU, Choyke PL, Giesel FL. Comparison of diagnostic quality and accuracy in color-coded versus gray-scale DCE-MR imaging display. Int J Comput Assist Radiol Surg 2009; 4:457-62. [PMID: 20033528 DOI: 10.1007/s11548-009-0356-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 04/28/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic value and tumor-vascular display properties (microcirculation) of two different functional MRI post-processing and display (color and gray-scale display) techniques used in oncology. MATERIALS AND METHODS The study protocol was approved by the IRB and written informed consent was obtained from all patients. 38 dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) data sets of patients with malignant pleural-mesothelioma were acquired and post-processed. DCE-MRI was performed at 1.5 tesla with a T1-weighted 2D gradient-echo-sequence (TR 7.0 ms, TE 3.9 ms, 15 axial slices, 22 sequential repetitions), prior and during chemotherapy. Subtracting first image of contrast-enhanced-dynamic series from the last, produced gray-scale images. Color images were produced using a pharmacokinetic two-compartment model. Eight raters, blinded to diagnosis, by visual assessment of post-processed images evaluated both diagnostic quality of the images and vasculature of the tumor using a rating scale ranging from -5 to +5. The scores for vasculature were assessed by correlating with the maximum amplitude of the total-tumor-ROI for accuracy. RESULTS Color coded images were rated as significantly higher in diagnostic quality and tumor vascular score than gray-scale images (p < 0.001, 0.005). ROI signal amplitude analysis and vascular ratings on color coded images were better correlated compared to gray-scale images rating (p < 0.05). CONCLUSION Color coded images were shown to have higher diagnostic quality and accuracy with respect to tumor vasculature in DCE-MRI, therefore their implementation in clinical assessment and follow-up should be considered for wider application.
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Affiliation(s)
- A Mehndiratta
- Department of Radiology E 010, German Cancer Research Center (DKFZ), INF 280, 69120, Heidelberg, Germany.
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Hoefnagels FWA, Lagerwaard FJ, Sanchez E, Haasbeek CJA, Knol DL, Slotman BJ, Vandertop WP. Radiological progression of cerebral metastases after radiosurgery: assessment of perfusion MRI for differentiating between necrosis and recurrence. J Neurol 2009; 256:878-87. [PMID: 19274425 PMCID: PMC2698975 DOI: 10.1007/s00415-009-5034-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2008] [Revised: 11/03/2008] [Accepted: 11/19/2008] [Indexed: 11/29/2022]
Abstract
To assess the capability of perfusion MRI to differentiate between necrosis and tumor recurrence in patients showing radiological progression of cerebral metastases treated with stereotactic radiosurgery (SRS). From 2004 to 2006 dynamic susceptibility-weighted contrast-enhanced perfusion MRI scans were performed on patients with cerebral metastasis showing radiological progression after SRS during follow-up. Several perfusion MRI characteristics were examined: a subjective visual score of the relative cerebral blood volume (rCBV) map and quantitative rCBV measurements of the contrast-enhanced areas of maximal perfusion. For a total of 34 lesions in 31 patients a perfusion MRI was performed. Diagnoses were based on histology, definite radiological decrease or a combination of radiological and clinical follow-up. The diagnosis of tumor recurrence was obtained in 20 of 34 lesions, and tumor necrosis in 14 of 34. Regression analyses for all measures proved statistically significant (χ2 = 11.6–21.6, P < 0.001–0.0001). Visual inspection of the rCBV map yielded a sensitivity and specificity of 70.0 respectively 92.9%. The optimal cutoff point for maximal tumor rCBV relative to white matter was 2.00 (improving the sensibility to 85.0%) and 1.85 relative to grey matter (GM), improving the specificity to 100%, with a corresponding sensitivity of 70.0%. Perfusion MRI seems to be a useful tool in the differentiation of necrosis and tumor recurrence after SRS. For the patients displaying a rCBV-GM greater than 1.85, the diagnosis of necrosis was excluded. Salvage treatment can be initiated for these patients in an attempt to prolong survival.
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Affiliation(s)
- Friso W A Hoefnagels
- Department Neurosurgery, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Hu LS, Baxter LC, Smith KA, Feuerstein BG, Karis JP, Eschbacher JM, Coons SW, Nakaji P, Yeh RF, Debbins J, Heiserman JE. Relative cerebral blood volume values to differentiate high-grade glioma recurrence from posttreatment radiation effect: direct correlation between image-guided tissue histopathology and localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging measurements. AJNR Am J Neuroradiol 2009; 30:552-8. [PMID: 19056837 DOI: 10.3174/ajnr.a1377] [Citation(s) in RCA: 296] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating tumor growth from posttreatment radiation effect (PTRE) remains a common problem in neuro-oncology practice. To our knowledge, useful threshold relative cerebral blood volume (rCBV) values that accurately distinguish the 2 entities do not exist. Our prospective study uses image-guided neuronavigation during surgical resection of MR imaging lesions to correlate directly specimen histopathology with localized dynamic susceptibility-weighted contrast-enhanced perfusion MR imaging (DSC) measurements and to establish accurate rCBV threshold values, which differentiate PTRE from tumor recurrence. MATERIALS AND METHODS Preoperative 3T gradient-echo DSC and contrast-enhanced stereotactic T1-weighted images were obtained in patients with high-grade glioma (HGG) previously treated with multimodality therapy. Intraoperative neuronavigation documented the stereotactic location of multiple tissue specimens taken randomly from the periphery of enhancing MR imaging lesions. Coregistration of DSC and stereotactic images enabled calculation of localized rCBV within the previously recorded specimen locations. All tissue specimens were histopathologically categorized as tumor or PTRE and were correlated with corresponding rCBV values. All rCBV values were T1-weighted leakage-corrected with preload contrast-bolus administration and T2/T2*-weighted leakage-corrected with baseline subtraction integration. RESULTS Forty tissue specimens were collected from 13 subjects. The PTRE group (n = 16) rCBV values ranged from 0.21 to 0.71, tumor (n = 24) values ranged from 0.55 to 4.64, and 8.3% of tumor rCBV values fell within the PTRE group range. A threshold value of 0.71 optimized differentiation of the histopathologic groups with a sensitivity of 91.7% and a specificity of 100%. CONCLUSIONS rCBV measurements obtained by using DSC and the protocol we have described can differentiate HGG recurrence from PTRE with a high degree of accuracy.
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Affiliation(s)
- L S Hu
- Department of Radiology, Mayo Clinic, Phoenix/Scottsdale, AZ 85259, USA.
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Jackson A, O'Connor J, Thompson G, Mills S. Magnetic resonance perfusion imaging in neuro-oncology. Cancer Imaging 2008; 8:186-99. [PMID: 18980870 PMCID: PMC2590875 DOI: 10.1102/1470-7330.2008.0019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recent advances in magnetic resonance imaging (MRI) have seen the development of techniques that allow quantitative imaging of a number of anatomical and physiological descriptors. These techniques have been increasingly applied to cancer imaging where they can provide some insight into tumour microvascular structure and physiology. This review details technical approaches and application of quantitative MRI, focusing particularly on perfusion imaging and its role in neuro-oncology.
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Affiliation(s)
- Alan Jackson
- Division of Imaging Science, University of Manchester, Wolfson Molecular Imaging Centre, 27 Palatine Road, Manchester M203LJ, UK.
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Evaluation of MR markers that predict survival in patients with newly diagnosed GBM prior to adjuvant therapy. J Neurooncol 2008; 91:69-81. [PMID: 18810326 DOI: 10.1007/s11060-008-9685-3] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Accepted: 08/11/2008] [Indexed: 10/21/2022]
Abstract
Purpose Glioblastoma Multiforme (GBM) is the most common and lethal primary brain tumor in adults. The goal of this study was to test the predictive value of MR parameters in relation to the survival of patients with newly diagnosed GBM who were scanned prior to receiving adjuvant radiation and chemotherapy. Methods The study population comprised 68 patients who had surgical resection and were to be treated with fractionated external beam radiation therapy and chemotherapy. Imaging scans included anatomical MRI, diffusion and perfusion weighted imaging and (1)H MRSI. The MR data were acquired 3-5 weeks after surgery and approximately 1 week before treatment with radiation therapy. The diffusion, perfusion and spectroscopic parameter values were quantified and subjected to proportional hazards analysis that was adjusted for age and scanner field strength. Results The patients with larger lesion burden based upon volumes of anatomic lesions, volume of CNI2 (number of voxels within the T2 lesion having choline to NAA index >2), volume of CBV3 (number of pixels within the T2 lesion having relative cerebral blood volume >3), and volume of nADC1.5 (number of pixels within the T2 lesion having normalized apparent diffusion coefficient <1.5) had a higher risk for poor outcome. High intensities of combined measures of lactate and lipid in the T2 and CNI2 regions were also associated with poor survival. Conclusions Our study indicated that several pre-treatment anatomic, physiological and metabolic MR parameters are predictive of survival. This information may be important for stratifying patients to specific treatment protocols and for planning focal therapy.
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Ulmer S, Liess C, Kesari S, Otto N, Straube T, Jansen O. Use of dynamic susceptibility-contrast MRI (DSC-MRI) to assess perfusion changes in the ipsilateral brain parenchyma from glioblastoma. J Neurooncol 2008; 91:213-20. [DOI: 10.1007/s11060-008-9701-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2008] [Accepted: 09/08/2008] [Indexed: 10/21/2022]
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Thomas C, Di Maio S, Ma R, Vollans E, Chu C, M.Math., Clark B, Lee R, McKenzie M, Martin M, Toyota B. Hearing preservation following fractionated stereotactic radiotherapy for vestibular schwannomas: prognostic implications of cochlear dose. J Neurosurg 2007; 107:917-26. [DOI: 10.3171/jns-07/11/0917] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The goal in this study was to evaluate hearing preservation rates and to determine prognostic factors for this outcome following fractionated stereotactic radiotherapy (FSRT) of vestibular schwannoma.
Methods
Thirty-four consecutive patients with serviceable hearing who received FSRT between May 1998 and December 2003 were identified. Clinical and audiometry data were collected prospectively. The prescription dose was 45 Gy in 25 fractions prescribed to the 90% isodose line. The median follow-up duration was 36.5 months (range 12–85 months). The actuarial 2- and 4-year local control rates were 100 and 95.7%, respectively. Permanent trigeminal and facial nerve complications were 0 and 6%, respectively. The actuarial 2- and 3-year serviceable hearing preservation rates were both 63%. The median loss in speech reception threshold was 15 dB (range −10 to 65 dB). The radiotherapy dose to the cochlea was the only significant prognostic factor for hearing deterioration. Radiotherapy dose to the cochlear nucleus, patient age, sex, pre-FSRT hearing grade, tumor volume, and intracanalicular tumor volume failed to show any significance as prognostic factors.
Results
Five cases were replanned with four different radiotherapy techniques (namely arcs, dynamic arcs, static conformal fields, and intensity-modulated radiotherapy), with the cochlea defined as an organ at risk. In all cases, replanning resulted in statistically significant reduction in radiation to the cochlea (p = 0.001); however, no single replanning technique was found to be superior.
Conclusions
The radiation dose to the cochlea is strongly predictive for subsequent hearing deterioration. It is essential for the cochlea to be outlined as an organ at risk, and for radiation techniques to be optimized, to improve long-term hearing preservation.
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Affiliation(s)
| | - Salvatore Di Maio
- 2Department of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roy Ma
- 1Departments of Radiation Oncology,
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- 4Surveillance and Outcomes Unit, and
| | | | | | | | | | - Brian Toyota
- 2Department of Neurosurgery, University of British Columbia, Vancouver, British Columbia, Canada
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Price SJ, Jena R, Green HAL, Kirkby NF, Lynch AG, Coles CE, Pickard JD, Gillard JH, Burnet NG. Early radiotherapy dose response and lack of hypersensitivity effect in normal brain tissue: a sequential dynamic susceptibility imaging study of cerebral perfusion. Clin Oncol (R Coll Radiol) 2007; 19:577-87. [PMID: 17629467 DOI: 10.1016/j.clon.2007.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Revised: 02/15/2007] [Accepted: 04/27/2007] [Indexed: 11/19/2022]
Abstract
AIMS To determine if magnetic resonance perfusion markers can be used as an analytical marker of subclinical normal brain injury after radiotherapy, by looking for a dose-effect relationship. MATERIALS AND METHODS Four patients undergoing conformal radiotherapy to 54Gy in 30 fractions for low-grade gliomas were imaged with conventional T(2)-weighted and fluid attenuated inversion recovery imaging as well as dynamic contrast susceptibility perfusion imaging. Forty regions of interest were determined from the periventricular white matter. All conventional sequences were examined for evidence of radiation-induced changes. Patients were imaged before radiotherapy, after one fraction, at the end of treatment and then at 1 and 3 months from the end of radiotherapy. For each region the relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF) and mean transit time (MTT) expressed as a ratio of the baseline value, and radiotherapy dose were determined. RESULTS Of the 40 regions, seven occurred within the gross tumour volume and a further four occurred in regions later infiltrated by tumour, and were thus excluded. Regions within the 80% isodose showed a reduction in rCBV and rCBF over the 3 month period. There was no significant alteration in rCBV or rCBF in regions outside the 60% isodose (i.e. <32Gy). MTT did not alter in any region. There seemed to be a threshold effect at 132 days from the end of radiotherapy of 47% (standard error of the mean 11.5, about 25.4Gy) for rCBV and 59% (standard error of the mean 14.2, about 31.9Gy) for rCBF. CONCLUSIONS There was a dose-related reduction in rCBV and rCBF in normal brain after radiotherapy at higher dose levels. Although this study used a limited number of patients, it suggests that magnetic resonance perfusion imaging seems to act as a marker of subclinical response of normal brain and that there is an absence of an early hypersensitivity effect with small doses per fraction. Further studies are required with larger groups of patients to show that these results are statistically robust.
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Affiliation(s)
- S J Price
- Academic Neurosurgical Unit, Cambridge University and Addenbrooke's Hospital, Cambridge, UK.
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Lee MC, Cha S, Chang SM, Nelson SJ. Partial-volume model for determining white matter and gray matter cerebral blood volume for analysis of gliomas. J Magn Reson Imaging 2006; 23:257-66. [PMID: 16456821 DOI: 10.1002/jmri.20506] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To model the partial voluming of gray matter (GM) and white matter (WM) in perfusion imaging, and to use this model to estimate the cerebral blood volume (CBV) of pure WM and GM, which could then be used to normalize data across patients in preparation for analyzing tumor perfusion. MATERIALS AND METHODS Dynamic susceptibility contrast (DSC) perfusion imaging was performed on 20 glioma patients. The perfusion data were registered to the T1 image using rigid-body and non-rigid algorithms. The rCBV for each voxel was computed by gamma-variate fitting and then fit as a linear function of the estimated fractional WM content. The estimated CBV of pure WM was used to normalize across patients, and the resulting tumor CBV values were compared with expectations. RESULTS Rigid registration improved the correlation between the fractional WM content and CBV for all patients, with non-rigid registration yielding further improvements for all but two patients. The mean GM-to-WM CBV ratio was estimated at 2.15 +/- 0.33 (mean +/- SD). Voxels that exhibited both T1-Gd contrast enhancement and an abnormal proton spectrum were found to have a CBV 2.53 +/- 0.89 times higher than that in the WM. CONCLUSION A partial-volume model is demonstrated for estimating pure WM and GM CBV. It is also shown that the relationship between the tumor CBV as estimated with this model is generally consistent with expectations based on spectroscopy and imaging.
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Affiliation(s)
- Michael C Lee
- Department of Radiology, University of California-San Francisco, UCSF Radiology Box 2532, 1700 4th Street, San Francisco, CA 94143, USA.
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Serduc R, Vérant P, Vial JC, Farion R, Rocas L, Rémy C, Fadlallah T, Brauer E, Bravin A, Laissue J, Blattmann H, van der Sanden B. In vivo two-photon microscopy study of short-term effects of microbeam irradiation on normal mouse brain microvasculature. Int J Radiat Oncol Biol Phys 2006; 64:1519-27. [PMID: 16580502 DOI: 10.1016/j.ijrobp.2005.11.047] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 11/21/2005] [Accepted: 11/23/2005] [Indexed: 11/21/2022]
Abstract
PURPOSE The purpose of this study was to assess the early effects of microbeam irradiation on the vascular permeability and volume in the parietal cortex of normal nude mice using two-photon microscopy and immunohistochemistry. METHODS AND MATERIALS The upper part of the left hemisphere of 55 mice was irradiated anteroposteriorly using 18 vertically oriented beams (width 25 microm, interdistance 211 microm; peak entrance doses: 312 or 1000 Gy). At different times after microbeam exposure, the microvasculature in the cortex was analyzed using intravital two-photon microscopy after intravascular injection of fluorescein isothiocyanate (FITC)-dextrans and sulforhodamine B (SRB). Changes of the vascular volume were observed at the FITC wavelength over a maximum depth of 650 mum from the dura. The vascular permeability was detected as extravasations of SRB. RESULTS For all times (12 h to 1 month) after microbeam irradiation and for both doses, the FITC-dextran remained in the vessels. No significant change in vascular volume was observed between 12 h and 3 months after irradiation. Diffusion of SRB was observed in microbeam irradiated regions from 12 h until 12 days only after a 1000 Gy exposure. CONCLUSION No radiation damage to the microvasculature was detected in normal brain tissue after a 312 Gy microbeam irradiation. This dose would be more appropriate than 1000 Gy for the treatment of brain tumors using crossfired microbeams.
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Affiliation(s)
- Raphaël Serduc
- INSERM, U 594, Functional and Metabolic Neuroimaging, Grenoble, France; Université Joseph Fourier Grenoble, Grenoble, France.
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Essig M, Lodemann KP, Le-Huu M, Brüning R, Kirchin M, Reith W. Intraindividual Comparison of Gadobenate Dimeglumine and Gadobutrol for Cerebral Magnetic Resonance Perfusion Imaging at 1.5 T. Invest Radiol 2006; 41:256-63. [PMID: 16481908 DOI: 10.1097/01.rli.0000191333.19068.6b] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVE The objective of this study was to compare 0.1 and 0.2 mmol/kg body weight (bw) doses gadobenate dimeglumine (Gd-BOPTA; MultiHance) and gadobutrol (Gd-BT-DO3A; Gadovist) for cerebral perfusion magnetic resonance (MR) imaging at 1.5 T. METHODS Twelve healthy male volunteers enrolled into a randomized intraindividual comparative study underwent 4 perfusion MR imaging examinations with 0.1 and 0.2 mmol/kg bw doses of each contrast agent. The imaging parameters, slice positioning, and contrast agent application were highly standardized. Quantitative determinations based on signal intensity/time (SI/T) curves at regions of interest (ROI) on the gray and white matter were made of the regional cerebral blood volume and flow (rCBV and rCBF, respectively), the percentage signal drop, and the full width half maximum (FWHM) of the SI/T curve. Qualitative evaluation of the quality of the rCBV and rCBF maps was assessed by an independent offsite blinded reader. RESULTS A single dose of both agents was sufficient to achieve high-quality, diagnostically valid perfusion maps at 1.5 T, and no significant benefit for one agent over the other was noted for quantitative or qualitative determinations. The susceptibility effect, described by percentage of signal loss (gadobutrol: 29.4% vs gadobenate dimeglumine: 28.3%) and the FWHM (gadobutrol: 6.4 seconds vs gadobenate dimeglumine: 7.0 seconds) were similar for 0.1 mmol/kg bw doses of the 2 agents. Double doses of the 2 agents produced better overall image quality but no clinical benefit over the single-dose examinations. CONCLUSION Both the 1 molar MR contrast agent gadobutrol and the weak protein-interacting agent gadobenate dimeglumine permit the acquisition of high-quality perfusion maps at doses of 0.1 mmol/kg bw. The susceptibility effect is comparable for both agents and stronger than for conventional MR contrast agents.
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Affiliation(s)
- Marco Essig
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.
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Qiu D, Leung LHT, Kwong DLW, Chan GCF, Khong PL. Mapping radiation dose distribution on the fractional anisotropy map: applications in the assessment of treatment-induced white matter injury. Neuroimage 2006; 31:109-15. [PMID: 16448821 DOI: 10.1016/j.neuroimage.2005.12.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2005] [Revised: 10/25/2005] [Accepted: 12/09/2005] [Indexed: 11/30/2022] Open
Abstract
We describe a method to map whole brain radiation dose distribution on to diffusion tensor MR (DT-MR) fractional anisotropy (FA) images and illustrate its applications for studying dose-effect relationships and regional susceptibility in two childhood medulloblastoma survivors. To determine the FA changes voxel-by-voxel in white matter, the post-treatment follow-up FA maps were coregistered to baseline pre-treatment FA maps and automatic segmentation for white matter was carried out. DeltaFA maps representing relative FA change in white matter were hence generated for visual inspection and quantitative analysis. The radiation dose distribution, calculated from radiotherapy plan and exported as images, was coregistered to baseline FA images. DT-MR imaging and processing noise was small with root mean square value of 1.49% for mean DeltaFA. We evaluated the mean DeltaFA changes of regions-of-interest according to radiation dose regions to provide an estimate of the dose-response and found increasing reduction in mean DeltaFA with increasing radiation dose up to 45 Gy after which there was a reversal in the mean FA trend and mean FA approached baseline value. We also found more severe mean FA reduction in the frontal lobes compared to the parietal lobes despite the same radiation dose, suggesting regional susceptibility in the frontal lobe, and mean FA increase in the brainstem after radiation in both patients. We conclude that the method described may be useful in estimating dose-effect relationships and studying regional susceptibility of the brain to radiation in medulloblastoma survivors.
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Affiliation(s)
- Deqiang Qiu
- Department of Diagnostic Radiology, Blk. K, Rm 406, Queen Mary Hospital, The University of Hong Kong, 102 Pokfulam Road, Hong Kong
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Abstract
In order to grow, tissues require additional nutrients and oxygen as well as removal of waste products. Tumors achieve this by up-regulating angiogenic cytokines and/or down-regulating natural inhibitory proteins that allow neovascularization to proceed. Brain tumors continue to account for significant morbidity and mortality, in spite of significant advances in neurosurgical and radiation techniques and new chemotherapy combinations. As such, there is a real and immediate need for novel biologic therapies that can target these tumors. A number of new drugs that target different aspects of the angiogenic cascade have been identified and are now in clinical trials in children with primary brain tumors. In many of these pre-clinical and clinical studies, anti-angiogenic therapy has been well tolerated, has lacked many of the traditional toxicities of radiation and chemotherapy, does not require blood-brain barrier penetration, and targets a critical pathway in central nervous system tumor development. This review will discuss what angiogenesis is, how pediatric brain tumors regulate angiogenesis to obtain a vascular supply, what types of inhibitors are available, how different classes of inhibitors work, the types of resistance possible, how rapidly these inhibitors may work, and what surrogate markers of activity are available to follow response.
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