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Argyropoulos GD, Christidi F, Karavasilis E, Bede P, Velonakis G, Antoniou A, Seimenis I, Kelekis N, Smyrnis N, Papakonstantinou O, Efstathopoulos E, Ferentinos P. A Magnetic Resonance Spectroscopy Study on Polarity Subphenotypes in Bipolar Disorder. Diagnostics (Basel) 2024; 14:1170. [PMID: 38893696 PMCID: PMC11172378 DOI: 10.3390/diagnostics14111170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/27/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Although magnetic resonance spectroscopy (MRS) has provided in vivo measurements of brain chemical profiles in bipolar disorder (BD), there are no data on clinically and therapeutically important onset polarity (OP) and predominant polarity (PP). We conducted a proton MRS study in BD polarity subphenotypes, focusing on emotion regulation brain regions. Forty-one euthymic BD patients stratified according to OP and PP and sixteen healthy controls (HC) were compared. 1H-MRS spectra of the anterior and posterior cingulate cortex (ACC, PCC), left and right hippocampus (LHIPPO, RHIPPO) were acquired at 3.0T to determine metabolite concentrations. We found significant main effects of OP in ACC mI, mI/tNAA, mI/tCr, mI/tCho, PCC tCho, and RHIPPO tNAA/tCho and tCho/tCr. Although PP had no significant main effects, several medium and large effect sizes emerged. Compared to HC, manic subphenotypes (i.e., manic-OP, manic-PP) showed greater differences in RHIPPO and PCC, whereas depressive suphenotypes (i.e., depressive-OP, depressive-PP) in ACC. Effect sizes were consistent between OP and PP as high intraclass correlation coefficients (ICC) were confirmed. Our findings support the utility of MRS in the study of the neurobiological underpinnings of OP and PP, highlighting that the regional specificity of metabolite changes within the emotion regulation network consistently marks both polarity subphenotypes.
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Affiliation(s)
- Georgios D. Argyropoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece (E.K.); (G.V.); (N.K.); (O.P.); (E.E.)
| | - Foteini Christidi
- 2nd Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.A.); (N.S.); (P.F.)
- School of Medicine, Democritus University of Alexandroupolis, 681 00 Alexandroupolis, Greece
- Computational Neuroimaging Group, Trinity College Dublin, D08 NHY1 Dublin, Ireland;
| | - Efstratios Karavasilis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece (E.K.); (G.V.); (N.K.); (O.P.); (E.E.)
- School of Medicine, Democritus University of Alexandroupolis, 681 00 Alexandroupolis, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, D08 NHY1 Dublin, Ireland;
- Department of Neurology, St James’s Hospital, D08 W9RT Dublin, Ireland
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece (E.K.); (G.V.); (N.K.); (O.P.); (E.E.)
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.A.); (N.S.); (P.F.)
| | - Ioannis Seimenis
- Medical Physics Laboratory, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece;
| | - Nikolaos Kelekis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece (E.K.); (G.V.); (N.K.); (O.P.); (E.E.)
| | - Nikolaos Smyrnis
- 2nd Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.A.); (N.S.); (P.F.)
| | - Olympia Papakonstantinou
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece (E.K.); (G.V.); (N.K.); (O.P.); (E.E.)
| | - Efstathios Efstathopoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece (E.K.); (G.V.); (N.K.); (O.P.); (E.E.)
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, School of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece; (A.A.); (N.S.); (P.F.)
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Kosteria I, Gavra MM, Verganelakis DA, Dikaiakou E, Vartzelis G, Vlachopapadopoulou EA. In vivo magnetic resonance spectroscopy for the differential diagnosis of a cerebral mass in a boy with precocious puberty: a case report and review of the literature. Hormones (Athens) 2023; 22:507-513. [PMID: 37365434 DOI: 10.1007/s42000-023-00458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/06/2023] [Indexed: 06/28/2023]
Abstract
PURPOSE To highlight the role of in vivo magnetic resonance spectroscopy (MRS) as a non-invasive tool that can clarify the etiology of sellar tumors by presenting the case of a boy with central precocious puberty (CPP) and to review the current literature. METHODS A 4-year-old boy was admitted to our hospital due to repeated episodes of focal and gelastic seizures in the previous year. Clinical examination (testicular volume 4-5 ml bilaterally, penile length of 7.5 cm, and absence of axillary or pubic hair) and laboratory tests (FSH, LH, and testosterone) were indicative of CPP. The combination of gelastic seizures with CPP in a 4-year-old boy raised the suspicion of hypothalamic hamartoma (HH). Brain MRI revealed a lobular mass in the suprasellar-hypothalamic region. The differential diagnosis included glioma, HH, and craniopharyngioma. To further investigate the CNS mass, an in vivo brain MRS was performed. RESULTS Οn conventional MRI, the mass demonstrated isointensity to gray matter on T1 weighted images but slight hyperintensity on T2-weighted images. It did not show restricted diffusion or contrast enhancement. On MRS, it showed reduced N-acetyl aspartate (NAA) and slightly elevated myoinositol (MI) compared with values in normal deep gray matter. The MRS spectrum, in combination with the conventional MRI findings, were consistent with the diagnosis of a HH. CONCLUSION MRS is a state-of-the-art, non-invasive imaging technique that compares the chemical composition of normal tissue to that of abnormal regions by juxtaposing the frequency of measured metabolites. MRS, in combination with clinical evaluation and classic MRI, can provide identification of CNS masses, thus eliminating the need for an invasive biopsy.
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Affiliation(s)
- Ioanna Kosteria
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece.
| | - Maria M Gavra
- Department of Paediatric Radiology (CT, MRI) & Nuclear Medicine, Aghia Sophia Children's Hospital, Athens, Greece
| | - Dimitrios A Verganelakis
- Nuclear Medicine Unit, Oncology Clinic "Marianna V. Vardinoyiannis-ELPIDA", Aghia Sophia Children's Hospital, Athens, Greece
| | - Eirini Dikaiakou
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Georgios Vartzelis
- Second Department of Pediatrics, National and Kapodistrian University of Athens, Medical School, "P&A Kyriakou" Children's Hospital, Athens, Greece
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Hippocampal Metabolic Alterations in Amyotrophic Lateral Sclerosis: A Magnetic Resonance Spectroscopy Study. Life (Basel) 2023; 13:life13020571. [PMID: 36836928 PMCID: PMC9965919 DOI: 10.3390/life13020571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Magnetic resonance spectroscopy (MRS) in amyotrophic lateral sclerosis (ALS) has been overwhelmingly applied to motor regions to date and our understanding of frontotemporal metabolic signatures is relatively limited. The association between metabolic alterations and cognitive performance in also poorly characterised. MATERIAL AND METHODS In a multimodal, prospective pilot study, the structural, metabolic, and diffusivity profile of the hippocampus was systematically evaluated in patients with ALS. Patients underwent careful clinical and neurocognitive assessments. All patients were non-demented and exhibited normal memory performance. 1H-MRS spectra of the right and left hippocampi were acquired at 3.0T to determine the concentration of a panel of metabolites. The imaging protocol also included high-resolution T1-weighted structural imaging for subsequent hippocampal grey matter (GM) analyses and diffusion tensor imaging (DTI) for the tractographic evaluation of the integrity of the hippocampal perforant pathway zone (PPZ). RESULTS ALS patients exhibited higher hippocampal tNAA, tNAA/tCr and tCho bilaterally, despite the absence of volumetric and PPZ diffusivity differences between the two groups. Furthermore, superior memory performance was associated with higher hippocampal tNAA/tCr bilaterally. Both longer symptom duration and greater functional disability correlated with higher tCho levels. CONCLUSION Hippocampal 1H-MRS may not only contribute to a better academic understanding of extra-motor disease burden in ALS, but given its sensitive correlations with validated clinical metrics, it may serve as practical biomarker for future clinical and clinical trial applications. Neuroimaging protocols in ALS should incorporate MRS in addition to standard structural, functional, and diffusion sequences.
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Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers (Basel) 2022; 14:cancers14143401. [PMID: 35884462 PMCID: PMC9318188 DOI: 10.3390/cancers14143401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/08/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary After leukemias, brain tumors are the most common cancers in children, and early, accurate diagnosis is critical to improve patient outcomes. Beyond the conventional imaging methods of computed tomography (CT) and magnetic resonance imaging (MRI), advanced neuroimaging techniques capable of both structural and functional imaging are moving to the forefront to improve the early detection and differential diagnosis of tumors of the central nervous system. Here, we review recent developments in neuroimaging techniques for pediatric brain tumors. Abstract Central nervous system tumors are the most common pediatric solid tumors; they are also the most lethal. Unlike adults, childhood brain tumors are mostly primary in origin and differ in type, location and molecular signature. Tumor characteristics (incidence, location, and type) vary with age. Children present with a variety of symptoms, making early accurate diagnosis challenging. Neuroimaging is key in the initial diagnosis and monitoring of pediatric brain tumors. Conventional anatomic imaging approaches (computed tomography (CT) and magnetic resonance imaging (MRI)) are useful for tumor detection but have limited utility differentiating tumor types and grades. Advanced MRI techniques (diffusion-weighed imaging, diffusion tensor imaging, functional MRI, arterial spin labeling perfusion imaging, MR spectroscopy, and MR elastography) provide additional and improved structural and functional information. Combined with positron emission tomography (PET) and single-photon emission CT (SPECT), advanced techniques provide functional information on tumor metabolism and physiology through the use of radiotracer probes. Radiomics and radiogenomics offer promising insight into the prediction of tumor subtype, post-treatment response to treatment, and prognostication. In this paper, a brief review of pediatric brain cancers, by type, is provided with a comprehensive description of advanced imaging techniques including clinical applications that are currently utilized for the assessment and evaluation of pediatric brain tumors.
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Bruschi M, Petretto A, Cama A, Pavanello M, Bartolucci M, Morana G, Ramenghi LA, Garré ML, Ghiggeri GM, Panfoli I, Candiano G. Potential biomarkers of childhood brain tumor identified by proteomics of cerebrospinal fluid from extraventricular drainage (EVD). Sci Rep 2021; 11:1818. [PMID: 33469081 PMCID: PMC7815722 DOI: 10.1038/s41598-020-80647-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
Brain tumors are the most common solid tumors in childhood. There is the need for biomarkers of residual disease, therapy response and recurrence. Cerebrospinal fluid (CSF) is a source of brain tumor biomarkers. We analyzed the proteome of waste CSF from extraventricular drainage (EVD) from 29 children bearing different brain tumors and 17 controls needing EVD insertion for unrelated causes. 1598 and 1526 proteins were identified by liquid chromatography-coupled tandem mass spectrometry proteomics in CSF control and brain tumor patients, respectively, 263 and 191 proteins being exclusive of either condition. Bioinformatic analysis revealed promising protein biomarkers for the discrimination between control and tumor (TATA-binding protein-associated factor 15 and S100 protein B). Moreover, Thymosin beta-4 (TMSB4X) and CD109, and 14.3.3 and HSP90 alpha could discriminate among other brain tumors and low-grade gliomas plus glyoneuronal tumors/pilocytic astrocytoma, or embryonal tumors/medulloblastoma. Biomarkers were validated by ELISA assay. Our method was able to distinguish among brain tumor vs non-tumor/hemorrhagic conditions (controls) and to differentiate two large classes of brain tumors. Further prospective studies may assess whether the biomarkers proposed by our discovery approach can be identified in other bodily fluids, therefore less invasively, and are useful to guide therapy and predict recurrences.
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Affiliation(s)
- Maurizio Bruschi
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Andrea Petretto
- Core Facilities-Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Armando Cama
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Martina Bartolucci
- Core Facilities-Clinical Proteomics and Metabolomics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giovanni Morana
- Unit of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Maria Luisa Garré
- Department of Neuroncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gian Marco Ghiggeri
- UO of Nephrology, Dialysis and Transplantation, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabella Panfoli
- Dipartimento di Farmacia (DIFAR), Università di Genova, V.le Benedetto XV, 3, 16132, Genoa, Italy.
| | - Giovanni Candiano
- Laboratory of Molecular Nephrology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Cecil KM, Naidu P. Advances in Pediatric Neuroimaging. MR Spectroscopy. Semin Pediatr Neurol 2020; 33:100798. [PMID: 32331612 DOI: 10.1016/j.spen.2020.100798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The basic principles of proton magnetic resonance spectroscopy are presented in this work to briefly familiarize the clinician and to distinguish spectroscopy from magnetic resonance imaging. For those knowledgeable about proton magnetic resonance spectroscopy, this article will also provide the reader an update on recent technical and translational developments relevant to pediatric neurologic conditions. These developments were selected for their potential impact towards the clinical care of patients in pediatric-based practices. At this point in time, these new spectroscopic approaches are currently applied to established populations with known diseases. This information will inform our knowledge about diseases and guide therapeutic options for the future.
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Affiliation(s)
- Kim M Cecil
- Professor of Radiology, Pediatrics, Neuroscience and Environmental Health, Imaging Research Center, Cincinnati Children's Hospital Medical Center, Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Padmaja Naidu
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Distinguishing between paediatric brain tumour types using multi-parametric magnetic resonance imaging and machine learning: A multi-site study. NEUROIMAGE-CLINICAL 2020; 25:102172. [PMID: 32032817 PMCID: PMC7005468 DOI: 10.1016/j.nicl.2020.102172] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 12/04/2019] [Accepted: 01/10/2020] [Indexed: 12/12/2022]
Abstract
The imaging and subsequent accurate diagnosis of paediatric brain tumours presents a radiological challenge, with magnetic resonance imaging playing a key role in providing tumour specific imaging information. Diffusion weighted and perfusion imaging are commonly used to aid the non-invasive diagnosis of children's brain tumours, but are usually evaluated by expert qualitative review. Quantitative studies are mainly single centre and single modality. The aim of this work was to combine multi-centre diffusion and perfusion imaging, with machine learning, to develop machine learning based classifiers to discriminate between three common paediatric tumour types. The results show that diffusion and perfusion weighted imaging of both the tumour and whole brain provide significant features which differ between tumour types, and that combining these features gives the optimal machine learning classifier with >80% predictive precision. This work represents a step forward to aid in the non-invasive diagnosis of paediatric brain tumours, using advanced clinical imaging.
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Carlin D, Babourina-Brooks B, Arvanitis TN, Wilson M, Peet AC. Short-acquisition-time JPRESS and its application to paediatric brain tumours. MAGMA (NEW YORK, N.Y.) 2019; 32:247-258. [PMID: 30460431 PMCID: PMC6424926 DOI: 10.1007/s10334-018-0716-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To develop and assess a short-duration JPRESS protocol for detection of overlapping metabolite biomarkers and its application to paediatric brain tumours at 3 Tesla. MATERIALS AND METHODS The short-duration protocol (6 min) was optimised and compared for spectral quality to a high-resolution (38 min) JPRESS protocol in a phantom and five healthy volunteers. The 6-min JPRESS was acquired from four paediatric brain tumours and compared with short-TE PRESS. RESULTS Metabolite identification between the 6- and 38-min protocols was comparable in phantom and volunteer data. For metabolites with Cramer-Rao lower bounds > 50%, interpretation of JPRESS increased confidence in assignment of lactate, myo-Inositol and scyllo-Inositol. JPRESS also showed promise for the detection of glycine and taurine in paediatric brain tumours when compared to short-TE MRS. CONCLUSION A 6-min JPRESS protocol is well tolerated in paediatric brain tumour patients. Visual inspection of a 6-min JPRESS spectrum enables identification of a range of metabolite biomarkers of clinical interest.
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Affiliation(s)
- Dominic Carlin
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Ben Babourina-Brooks
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Theodoros N Arvanitis
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
- Institute of Digital Healthcare, WMG, University of Warwick, Coventry, UK
| | - Martin Wilson
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, West Midlands, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.
- Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK.
- Clinical Research Block, Institute of Child Health, Whittall Street, Birmingham, B4 6NH, UK.
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Manias KA, Peet A. What is MR spectroscopy? Arch Dis Child Educ Pract Ed 2018; 103:213-216. [PMID: 28844055 DOI: 10.1136/archdischild-2017-312839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/03/2017] [Accepted: 07/17/2017] [Indexed: 11/03/2022]
Abstract
1H-Magnetic Resonance Spectroscopy (MRS) is a novel advanced imaging technique used as an adjunct to MRI to reveal complementary non-invasive information about the biochemical composition of imaged tissue. Clinical uses in paediatrics include aiding diagnosis of brain tumours, neonatal disorders such as hypoxic-ischaemic encephalopathy, inherited metabolic diseases, traumatic brain injury, demyelinating conditions and infectious brain lesions. MRS has potential to improve diagnosis and treatment monitoring of childhood brain tumours and other CNS diseases, facilitate biopsy and surgical planning, and provide prognostic biomarkers. MRS is employed as a research tool outside the brain in liver disease and disorders of muscle metabolism. The range of clinical uses is likely to increase with growing evidence for added value. Multicentre trials are needed to definitively establish the benefits of MRS in specific clinical scenarios and integrate this promising new technique into routine practice to improve patient care. This article gives a brief overview of MRS and its potential clinical applications, and addresses challenges surrounding translation into practice.
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Affiliation(s)
- Karen Angela Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
| | - Andrew Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK.,Department of Paediatric Oncology, Birmingham Children's Hospital, Birmingham, West Midlands, UK
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Babourina-Brooks B, Kohe S, Gill SK, MacPherson L, Wilson M, Davies NP, Peet AC. Glycine: a non-invasive imaging biomarker to aid magnetic resonance spectroscopy in the prediction of survival in paediatric brain tumours. Oncotarget 2018; 9:18858-18868. [PMID: 29721167 PMCID: PMC5922361 DOI: 10.18632/oncotarget.24789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/25/2018] [Indexed: 11/25/2022] Open
Abstract
Paediatric brain tumours have a high mortality rate and are the most common solid tumour of childhood. Identification of high risk patients may allow for better treatment stratification. Magnetic Resonance Spectroscopy (MRS) provides a non-invasive measure of brain tumour metabolism and quantifies metabolite survival markers to aid in the clinical management of patients. Glycine can be identified using MRS and has been recently found to be important for cancer cell proliferation in tumours making it a valuable prognostic marker. The aims of this study were to investigate glycine and its added value to MRS as a prognostic marker for paediatric brain tumours in a clinical setting. 116 children with newly diagnosed brain tumours were examined with short echo-time MRS at the Birmingham Children’s Hospital and followed up for five years. Survival analysis was performed using Cox regression on the entire metabolite basis set with focus on glycine and three other established survival markers for comparison: n-acetylaspartate, scyllo-inositol and lipids at 1.3 ppm. Multivariate Cox regression was used in conjunction with risk values to establish if glycine added prognostic power when combined to the established survival markers. Glycine was found to be a marker of poor prognosis in the cohort (p < 0.05) and correlated with tumour grade (p < 0.01). The addition of glycine improved the prognostic power of MRS compared to using the combination of established survival markers alone. Tumour glycine was found to improve the MRS prediction of reduced survival in paediatric brain tumours aiding the non-invasive assessment of these children.
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Affiliation(s)
- Ben Babourina-Brooks
- School of Cancer and Genomic Sciences, University of Birmingham, Birmingham UK.,Birmingham Children's Hospital NHS foundation Trust, Birmingham, UK
| | - Sarah Kohe
- School of Cancer and Genomic Sciences, University of Birmingham, Birmingham UK.,Birmingham Children's Hospital NHS foundation Trust, Birmingham, UK
| | - Simrandip K Gill
- School of Cancer and Genomic Sciences, University of Birmingham, Birmingham UK.,Birmingham Children's Hospital NHS foundation Trust, Birmingham, UK
| | | | - Martin Wilson
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Nigel P Davies
- Medical Physics and Imaging, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew C Peet
- School of Cancer and Genomic Sciences, University of Birmingham, Birmingham UK.,Birmingham Children's Hospital NHS foundation Trust, Birmingham, UK
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Milani ACC, Foerster B, Cogo-Moreira H, Farias TMDB, Salido F, Carrete H, Mello MF, Jackowski AP. A Longitudinal 1H-MRS Study of the Anterior Cingulate Gyrus in Child and Adolescent Victims of Multiple Forms of Violence. CHRONIC STRESS 2018; 2:2470547018763359. [PMID: 32440581 PMCID: PMC7219876 DOI: 10.1177/2470547018763359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
Background The anterior cingulate gyrus is involved in the extinction of conditioned fear responses and is implicated in the pathophysiology of posttraumatic stress disorder. The expression of N-acetylaspartate and choline may be altered in the anterior cingulate gyri of children and adolescents with posttraumatic stress disorder. Methods We conducted a proton magnetic resonance spectroscopy study, longitudinally investigating N-acetylaspartate/creatine and choline/creatine ratios in the anterior cingulate gyri of children and adolescents, aged from 8 to 12 years, who had been exposed to various forms of violence or were non-trauma control. Based on baseline posttraumatic stress symptoms ("sub-clinical"), participants were divided into two groups: posttraumatic stress (n = 19) and control (n = 19). Proton magnetic resonance spectroscopy scans were repeated a year later in trauma exposed participants. Trauma assessments included the Childhood Trauma Questionnaire. Results Exploratory analyses revealed a significant negative correlation between follow-up anterior cingulate gyrus N-acetylaspartate/creatine and Childhood Trauma Questionnaire scores in posttraumatic stress (r = -0.62, p = 0.01) but not control group (r = 0.16, p = 0.66). However, we found no significant differences in anterior cingulate gyrus N-acetylaspartate/creatine or choline/creatine between posttraumatic stress and control. In addition, there were no significant effects of time, group, or time-by-group interactions. Conclusions In this pediatric population, anterior cingulate gyrus N-acetylaspartate/creatine and choline/creatine were not affected by posttraumatic stress and on average these metabolites remained stable over time. However, the study provided intriguing preliminary evidence revealing that participants suffering from posttraumatic stress at baseline have shown, a year later, reduced anterior cingulate gyrus N-acetylaspartate/creatine among those with high trauma severity. This pilot evidence warrants replication in future studies to confirm these findings and to determine the longitudinal effects and interactions between childhood posttraumatic stress and trauma.
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Affiliation(s)
| | - Bernd Foerster
- 1Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
| | - Hugo Cogo-Moreira
- 1Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
| | | | - Francisco Salido
- 2Department of Radiology, Federal University of São Paulo, Sao Paulo, Brazil
| | - Henrique Carrete
- 2Department of Radiology, Federal University of São Paulo, Sao Paulo, Brazil
| | - Marcelo Feijo Mello
- 1Department of Psychiatry, Federal University of São Paulo, Sao Paulo, Brazil
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Manias KA, Gill SK, MacPherson L, Foster K, Oates A, Peet AC. Magnetic resonance imaging based functional imaging in paediatric oncology. Eur J Cancer 2016; 72:251-265. [PMID: 28011138 DOI: 10.1016/j.ejca.2016.10.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/26/2016] [Accepted: 10/30/2016] [Indexed: 12/16/2022]
Abstract
Imaging is central to management of solid tumours in children. Conventional magnetic resonance imaging (MRI) is the standard imaging modality for tumours of the central nervous system (CNS) and limbs and is increasingly used in the abdomen. It provides excellent structural detail, but imparts limited information about tumour type, aggressiveness, metastatic potential or early treatment response. MRI based functional imaging techniques, such as magnetic resonance spectroscopy, diffusion and perfusion weighted imaging, probe tissue properties to provide clinically important information about metabolites, structure and blood flow. This review describes the role of and evidence behind these functional imaging techniques in paediatric oncology and implications for integrating them into routine clinical practice.
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Affiliation(s)
- Karen A Manias
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Simrandip K Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Lesley MacPherson
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Katharine Foster
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Adam Oates
- Department of Radiology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Department of Paediatric Oncology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
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13
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Marner L, Henriksen OM, Lundemann M, Larsen VA, Law I. Clinical PET/MRI in neurooncology: opportunities and challenges from a single-institution perspective. Clin Transl Imaging 2016; 5:135-149. [PMID: 28936429 PMCID: PMC5581366 DOI: 10.1007/s40336-016-0213-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 10/31/2016] [Indexed: 01/17/2023]
Abstract
Purpose Magnetic resonance imaging (MRI) plays a key role in neurooncology, i.e., for diagnosis, treatment evaluation and detection of recurrence. However, standard MRI cannot always separate malignant tissue from other pathologies or treatment-induced changes. Advanced MRI techniques such as diffusion-weighted imaging, perfusion imaging and spectroscopy show promising results in discriminating malignant from benign lesions. Further, supplemental imaging with amino acid positron emission tomography (PET) has been shown to increase accuracy significantly and is used routinely at an increasing number of sites. Several centers are now implementing hybrid PET/MRI systems allowing for multiparametric imaging, combining conventional MRI with advanced MRI and amino acid PET imaging. Neurooncology is an obvious focus area for PET/MR imaging. Methods Based on the literature and our experience from more than 300 PET/MRI examinations of brain tumors with 18F-fluoro-ethyl-tyrosine, the clinical use of PET/MRI in adult and pediatric neurooncology is critically reviewed. Results Although the results are increasingly promising, the added value and range of indications for multiparametric imaging with PET/MRI are yet to be established. Robust solutions to overcome the number of issues when using a PET/MRI scanner are being developed, which is promising for a more routine use in the future. Conclusions In a clinical setting, a PET/MRI scan may increase accuracy in discriminating recurrence from treatment changes, although sequential same-day imaging on separate systems will often constitute a reliable and cost-effective alternative. Pediatric patients who require general anesthesia will benefit the most from simultaneous PET and MR imaging.
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Affiliation(s)
- Lisbeth Marner
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Otto M Henriksen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Michael Lundemann
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Radiology, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, 9 Blegdamsvej, 2100 Copenhagen, Denmark
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14
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Armitage EG, Southam AD. Monitoring cancer prognosis, diagnosis and treatment efficacy using metabolomics and lipidomics. Metabolomics 2016; 12:146. [PMID: 27616976 PMCID: PMC4987388 DOI: 10.1007/s11306-016-1093-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/02/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cellular metabolism is altered during cancer initiation and progression, which allows cancer cells to increase anabolic synthesis, avoid apoptosis and adapt to low nutrient and oxygen availability. The metabolic nature of cancer enables patient cancer status to be monitored by metabolomics and lipidomics. Additionally, monitoring metabolic status of patients or biological models can be used to greater understand the action of anticancer therapeutics. OBJECTIVES Discuss how metabolomics and lipidomics can be used to (i) identify metabolic biomarkers of cancer and (ii) understand the mechanism-of-action of anticancer therapies. Discuss considerations that can maximize the clinical value of metabolic cancer biomarkers including case-control, prognostic and longitudinal study designs. METHODS A literature search of the current relevant primary research was performed. RESULTS Metabolomics and lipidomics can identify metabolic signatures that associate with cancer diagnosis, prognosis and disease progression. Discriminatory metabolites were most commonly linked to lipid or energy metabolism. Case-control studies outnumbered prognostic and longitudinal approaches. Prognostic studies were able to correlate metabolic features with future cancer risk, whereas longitudinal studies were most effective for studying cancer progression. Metabolomics and lipidomics can help to understand the mechanism-of-action of anticancer therapeutics and mechanisms of drug resistance. CONCLUSION Metabolomics and lipidomics can be used to identify biomarkers associated with cancer and to better understand anticancer therapies.
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Affiliation(s)
- Emily G. Armitage
- Centre for Metabolomics and Bioanalysis (CEMBIO), Faculty of Pharmacy, Universidad CEU San Pablo, Campus Monteprincipe, Boadilla del Monte, 28668 Madrid, Spain
- Wellcome Trust Centre for Molecular Parasitology, Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G12 8TA UK
- Glasgow Polyomics, Wolfson Wohl Cancer Research Centre, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH UK
| | - Andrew D. Southam
- School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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15
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Zarifi M, Tzika AA. Proton MRS imaging in pediatric brain tumors. Pediatr Radiol 2016; 46:952-62. [PMID: 27233788 DOI: 10.1007/s00247-016-3547-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 11/30/2015] [Accepted: 01/13/2016] [Indexed: 12/14/2022]
Abstract
Magnetic resonance (MR) techniques offer a noninvasive, non-irradiating yet sensitive approach to diagnosing and monitoring pediatric brain tumors. Proton MR spectroscopy (MRS), as an adjunct to MRI, is being more widely applied to monitor the metabolic aspects of brain cancer. In vivo MRS biomarkers represent a promising advance and may influence treatment choice at both initial diagnosis and follow-up, given the inherent difficulties of sequential biopsies to monitor therapeutic response. When combined with anatomical or other types of imaging, MRS provides unique information regarding biochemistry in inoperable brain tumors and can complement neuropathological data, guide biopsies and enhance insight into therapeutic options. The combination of noninvasively acquired prognostic information and the high-resolution anatomical imaging provided by conventional MRI is expected to surpass molecular analysis and DNA microarray gene profiling, both of which, although promising, depend on invasive biopsy. This review focuses on recent data in the field of MRS in children with brain tumors.
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Affiliation(s)
- Maria Zarifi
- Department of Radiology, Aghia Sophia Children's Hospital, Athens, Greece
| | - A Aria Tzika
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Shriners Burn Hospital, 51 Blossom St., Room #261, Boston, MA, 02114, USA.
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16
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Julià-Sapé M, Griffiths JR, Tate AR, Howe FA, Acosta D, Postma G, Underwood J, Majós C, Arús C. Classification of brain tumours from MR spectra: the INTERPRET collaboration and its outcomes. NMR IN BIOMEDICINE 2015; 28:1772-1787. [PMID: 26768492 DOI: 10.1002/nbm.3439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 07/15/2015] [Accepted: 10/01/2015] [Indexed: 06/05/2023]
Abstract
The INTERPRET project was a multicentre European collaboration, carried out from 2000 to 2002, which developed a decision-support system (DSS) for helping neuroradiologists with no experience of MRS to utilize spectroscopic data for the diagnosis and grading of human brain tumours. INTERPRET gathered a large collection of MR spectra of brain tumours and pseudo-tumoural lesions from seven centres. Consensus acquisition protocols, a standard processing pipeline and strict methods for quality control of the aquired data were put in place. Particular emphasis was placed on ensuring the diagnostic certainty of each case, for which all cases were evaluated by a clinical data validation committee. One outcome of the project is a database of 304 fully validated spectra from brain tumours, pseudotumoural lesions and normal brains, along with their associated images and clinical data, which remains available to the scientific and medical community. The second is the INTERPRET DSS, which has continued to be developed and clinically evaluated since the project ended. We also review here the results of the post-INTERPRET period. We evaluate the results of the studies with the INTERPRET database by other consortia or research groups. A summary of the clinical evaluations that have been performed on the post-INTERPRET DSS versions is also presented. Several have shown that diagnostic certainty can be improved for certain tumour types when the INTERPRET DSS is used in conjunction with conventional radiological image interpretation. About 30 papers concerned with the INTERPRET single-voxel dataset have so far been published. We discuss stengths and weaknesses of the DSS and the lessons learned. Finally we speculate on how the INTERPRET concept might be carried into the future.
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Affiliation(s)
- Margarida Julià-Sapé
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain
- Departament de Bioquímica i Biologia Molecular, Unitat de Bioquímica de Biociències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
| | | | - A Rosemary Tate
- School of Informatics, University of Sussex, Falmer, Brighton, UK
| | - Franklyn A Howe
- Cardiovascular and Cell Sciences Research Institute, St George's, University of London, London, UK
| | - Dionisio Acosta
- CHIME, University College London, The Farr Institute of Health Informatics Research, London, UK
| | - Geert Postma
- Radboud University Nijmegen, Institute for Molecules and Materials, Analytical Chemistry, Nijmegen, The Netherlands
| | | | - Carles Majós
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain
- Institut de Diagnòstic per la Imatge (IDI), CSU de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Arús
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Cerdanyola del Vallès, Spain
- Departament de Bioquímica i Biologia Molecular, Unitat de Bioquímica de Biociències, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
- Institut de Biotecnologia i de Biomedicina (IBB), Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, Spain
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17
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Peet AC. Magnetic resonance spectroscopy and beyond for pediatric brain tumors. CNS Oncol 2015; 3:195-7. [PMID: 25055127 DOI: 10.2217/cns.14.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Wilson M, Gill SK, MacPherson L, English M, Arvanitis TN, Peet AC. Noninvasive detection of glutamate predicts survival in pediatric medulloblastoma. Clin Cancer Res 2014; 20:4532-9. [PMID: 24947932 DOI: 10.1158/1078-0432.ccr-13-2320] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Medulloblastoma is the most common malignant brain tumor occurring in childhood and is a significant cause of morbidity and mortality in pediatric oncology. More intense treatment strategies are recommended for patients displaying high-risk factors; however, considerable variation in outcome remains, indicating a need for improved predictive markers. In this study, 1H magnetic resonance spectroscopy (MRS) was used to investigate noninvasive molecular biomarkers of survival in medulloblastoma. EXPERIMENTAL DESIGN MRS was performed on a series of 35 biopsy-confirmed medulloblastoma cases. One case was excluded because of poor quality MRS. The prognostic value of MRS detectable biomarkers was investigated using Cox regression, retrospectively (N=15). A subsequent validation analysis (N=19) was also performed to reduce the chance of type I errors. Where available, high-resolution ex vivo MRS of biopsy tissue was used to confirm biomarker assignments. RESULTS The retrospective analysis revealed that creatine, glutamate, and glycine were markers of survival (P<0.01). The validation analysis showed that glutamate was a robust marker, with a hazard ration (HR) of 8.0 for the full dataset (P=0.0003, N=34). A good correlation between in vivo and ex vivo MRS glutamate/total-choline was found (P=0.001), validating the in vivo assignment. Ex vivo glutamate/total-choline was also associated with survival (P<0.01). CONCLUSION The identification of glutamate as a predictive biomarker of survival in pediatric medulloblastoma provides a clinically viable risk factor and highlights the importance of more detailed studies into the metabolism of this disease. Noninvasive biomarker detection using MRS may offer improved disease monitoring and potential for widespread use following multicenter validation.
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Affiliation(s)
- Martin Wilson
- School of Cancer Sciences, University of Birmingham, Birmingham; Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Simrandip K Gill
- School of Cancer Sciences, University of Birmingham, Birmingham; Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Lesley MacPherson
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Martin English
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
| | - Theodoros N Arvanitis
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and Institute of Digital Healthcare, WMG, University of Warwick, Coventry, United Kingdom
| | - Andrew C Peet
- School of Cancer Sciences, University of Birmingham, Birmingham; Birmingham Children's Hospital NHS Foundation Trust, Birmingham; and
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