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Al-Thani AN, Jan AG, Abbas M, Geetha M, Sadasivuni KK. Nanoparticles in cancer theragnostic and drug delivery: A comprehensive review. Life Sci 2024; 352:122899. [PMID: 38992574 DOI: 10.1016/j.lfs.2024.122899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/27/2024] [Accepted: 07/06/2024] [Indexed: 07/13/2024]
Abstract
This comprehensive review provides an in-depth analysis of how nanotechnology has revolutionized cancer theragnostic, which combines diagnostic and therapeutic methods to customize cancer treatment. The study examines the unique attributes, uses, and difficulties linked to different types of nanoparticles, including gold, iron oxide, silica, Quantum dots, Carbon nanotubes, and liposomes, in the context of cancer treatment. In addition, the paper examines the progression of nanotheranostics, emphasizing its uses in precise medication administration, photothermal therapy, and sophisticated diagnostic methods such as MRI, CT, and fluorescence imaging. Moreover, the article highlights the capacity of nanoparticles to improve the effectiveness of drugs, reduce the overall toxicity in the body, and open up new possibilities for treating cancer by releasing drugs in a controlled manner and targeting specific areas. Furthermore, it tackles concerns regarding the compatibility of nanoparticles and their potential harmful effects, emphasizing the significance of continuous study to improve nanotherapeutic methods for use in medical treatments. The review finishes by outlining potential future applications of nanotechnology in predictive oncology and customized medicine.
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Affiliation(s)
- Alshayma N Al-Thani
- College of Arts and Sciences, Department of Biological and Environmental Science, Qatar
| | - Asma Ghafoor Jan
- College of Arts and Sciences, Department of Biological and Environmental Science, Qatar
| | - Mohamed Abbas
- Centre for Advanced Materials, Qatar University, Qatar.
| | - Mithra Geetha
- Centre for Advanced Materials, Qatar University, Qatar
| | - Kishor Kumar Sadasivuni
- Centre for Advanced Materials, Qatar University, Qatar; Centre for Advanced Materials, Qatar University, Qatar Department of Mechanical and Industrial Engineering, Qatar
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2
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Tóth A, Chetta JA, Yazdani M, Matheus MG, O'Doherty J, Tipnis SV, Spampinato MV. Neurovascular Imaging with Ultra-High-Resolution Photon-Counting CT: Preliminary Findings on Image-Quality Evaluation. AJNR Am J Neuroradiol 2024:ajnr.A8350. [PMID: 38760079 DOI: 10.3174/ajnr.a8350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND AND PURPOSE The first-generation photon-counting detector CT was recently introduced into clinical practice and represents a promising innovation in high-resolution CT imaging. The purpose of this study was to assess the image quality of ultra-high-resolution photon-counting detector CT compared with energy-integrating detector CT and to explore different reconstruction kernel sharpness levels for the evaluation of intracranial aneurysms. MATERIALS AND METHODS Ten patients with intracranial saccular aneurysms who had previously undergone conventional energy-integrating detector CT were prospectively enrolled. CT angiograms were acquired on a clinical dual-source photon-counting detector CT in ultra-high-resolution mode and reconstructed with 4 vascular kernels (Bv36, Bv40, Bv44, Bv48). Quantitative and qualitative image-quality parameters of the intracranial arteries were evaluated. For the quantitative analysis (image noise, SNR, contrast-to-noise ratio), ROIs were manually placed at standard anatomic intracranial and extracranial locations by 1 author. In addition, vessel border sharpness was evaluated quantitatively. For the qualitative analysis, 3 blinded neuroradiologists rated photon-counting detector CT and energy-integrating detector CT image quality for the evaluation of the intracranial vessels (ie, the aneurysms and 9 standard vascular branching locations) on a 5-point Likert-type scale. Additionally, readers independently selected their preferred kernel among the 4 kernels evaluated on photon-counting detector CT. RESULTS In terms of quantitative image quality, Bv48, the sharpest kernel, yielded increased image noise and decreased SNR and contrast-to-noise ratio parameters compared with Bv36, the smoothest kernel. Compared with energy-integrating detector CT, the Bv48 kernel offered better quantitative image quality for the evaluation of small intracranial vessels (P < .001). Image-quality ratings of the Bv48 were superior to those of the energy-integrating detector CT and not significantly different from ratings of the B44 reconstruction kernel. When comparing side by side all 4 photon-counting detector reconstruction kernels, readers selected the B48 kernel as the best to visualize the aneurysms in 80% of cases. CONCLUSIONS Ultra-high-resolution photon-counting detector CT provides improved image quality for neurovascular imaging. Although the less sharp kernels provided superior SNR and contrast-to-noise ratio, the sharpest kernels delivered the best subjective image quality on photon-counting detector CT for the evaluation of intracranial aneurysms.
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Affiliation(s)
- Adrienn Tóth
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - Justin A Chetta
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - Milad Yazdani
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - M Gisele Matheus
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - Jim O'Doherty
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
- Siemens Medical Solutions (J.O.), Malvern, Pennsylvania
| | - Sameer V Tipnis
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - M Vittoria Spampinato
- From the Department of Radiology and Radiological Science (A.T., J.A.C., M.Y., M.G.M., J.O., S.V.T., M.V.S.), Medical University of South Carolina, Charleston, South Carolina
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Suh PS, Jung SC, Moon HH, Roh YH, Song Y, Kim M, Lee J, Choi KM. Diagnosis of Unruptured Intracranial Aneurysms Using Proton-Density Magnetic Resonance Angiography: A Comparison With High-Resolution Time-of-Flight Magnetic Resonance Angiography. Korean J Radiol 2024; 25:575-588. [PMID: 38807339 PMCID: PMC11136948 DOI: 10.3348/kjr.2023.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/08/2024] [Accepted: 04/03/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE Differentiating intracranial aneurysms from normal variants using CT angiography (CTA) or MR angiography (MRA) poses significant challenges. This study aimed to evaluate the efficacy of proton-density MRA (PD-MRA) compared to high-resolution time-of-flight MRA (HR-MRA) in diagnosing aneurysms among patients with indeterminate findings on conventional CTA or MRA. MATERIALS AND METHODS In this retrospective analysis, we included patients who underwent both PD-MRA and HR-MRA from August 2020 to July 2022 to assess lesions deemed indeterminate on prior conventional CTA or MRA examinations. Three experienced neuroradiologists independently reviewed the lesions using HR-MRA and PD-MRA with reconstructed voxel sizes of 0.253 mm3 or 0.23 mm3, respectively. A neurointerventionist established the gold standard with digital subtraction angiography. We compared the performance of HR-MRA, PD-MRA (0.253-mm3 voxel), and PD-MRA (0.23-mm3 voxel) in diagnosing aneurysms, both per lesion and per patient. The Fleiss kappa statistic was used to calculate inter-reader agreement. RESULTS The study involved 109 patients (average age 57.4 ± 11.0 years; male:female ratio, 11:98) with 141 indeterminate lesions. Of these, 78 lesions (55.3%) in 69 patients were confirmed as aneurysms by the reference standard. PD-MRA (0.253-mm3 voxel) exhibited significantly higher per-lesion diagnostic performance compared to HR-MRA across all three readers: sensitivity ranged from 87.2%-91.0% versus 66.7%-70.5%; specificity from 93.7%-96.8% versus 58.7%-68.3%; and accuracy from 90.8%-92.9% versus 63.8%-69.5% (P ≤ 0.003). Furthermore, PD-MRA (0.253-mm3 voxel) demonstrated significantly superior per-patient specificity and accuracy compared to HR-MRA across all evaluators (P ≤ 0.013). The diagnostic accuracy of PD-MRA (0.23-mm3 voxel) surpassed that of HR-MRA and was comparable to PD-MRA (0.253-mm3 voxel). The kappa values for inter-reader agreements were significantly higher in PD-MRA (0.820-0.938) than in HR-MRA (0.447-0.510). CONCLUSION PD-MRA outperformed HR-MRA in diagnostic accuracy and demonstrated almost perfect inter-reader consistency in identifying intracranial aneurysms among patients with lesions initially indeterminate on CTA or MRA.
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Affiliation(s)
- Pae Sun Suh
- Department of Radiology, Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Hye Hyeon Moon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Yun Hwa Roh
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yunsun Song
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Minjae Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jungbok Lee
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Keum Mi Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Hosseini EM, Zafarshamspour S, Ghasemi-Rad M, Benndorf G, Rasekhi A, Rafieossadat R. Endoluminal flow diversion as a primary treatment strategy for pediatric traumatic intracranial aneurysms: a case-based review of literature. Childs Nerv Syst 2024; 40:345-357. [PMID: 37750891 DOI: 10.1007/s00381-023-06161-2] [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: 08/15/2023] [Accepted: 09/18/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Traumatic intracranial aneurysms (TICAs) constitute a notable portion of pediatric intracranial aneurysms. Their unstable structure dictates a high incidence of rupture or mass effect from enlarging unruptured aneurysms, necessitating prompt diagnosis and treatment. TICAs often lack a true neck or are wide-necked, making them unsuitable for coil embolization and surgical clipping, and their fragile nature poses a risk of rupture during surgical and intrasaccular interventions. Endoluminal flow diverters (FD), deployed without requiring direct access to the aneurysmal sac, have emerged as an appealing sole treatment modality for TICAs. However, the clinical experience with this technique remains limited in the pediatric population. METHOD We describe the successful treatment of a paraclinoid TICA in a 4-year-old female using an endoluminal FD alone. Additionally, we conducted a literature review to assess the safety and effectiveness of this treatment modality in pediatric TICAs. RESULTS Endoluminal flow diversion led to complete aneurysm obliteration in our case, with no observed complication, at the 9-month follow-up. Our review of the previously reported pediatric TICAs managed by standalone flow diversion highlights this technique as safe, efficient, and promising as a sole treatment modality, particularly in the anterior circulation, with a high rate of persistent total obliteration and a low rate of complications. However, the requirement for long-term antiplatelet therapy with the possibility of frequent dose monitoring and adjustments warrants special attention when using endoluminal FDs. Until guidelines specifically addressing optimal antiplatelet therapy in children with intracranial FDs are formulated, adherence to existing protocols is imperative to avoid in-stent thrombosis. CONCLUSION Our literature review and personal experience indicate that endoluminal flow diversion can be a viable treatment approach for pediatric TICAs. However, prospective studies with extensive follow-ups are required to assess the durability of endoluminal FDs in treating pediatric TICAs, considering the long life expectancy of this demographic.
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Affiliation(s)
| | - Saber Zafarshamspour
- Department of Surgery, Rafsanjan University of Medical Sciences, Rafsanjan, Kerman, Iran
| | - Mohammad Ghasemi-Rad
- Department of Interventional Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Goetz Benndorf
- Department of Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Alireza Rasekhi
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Rafieossadat
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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Bizjak Ž, Choi JH, Park W, Pernuš F, Špiclin Ž. Deep geometric learning for intracranial aneurysm detection: towards expert rater performance. J Neurointerv Surg 2023:jnis-2023-020905. [PMID: 37833055 DOI: 10.1136/jnis-2023-020905] [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: 08/10/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Early detection of intracranial aneurysms (IAs) is crucial for patient outcomes. Typically identified on angiographic scans such as CT angiography (CTA) or MR angiography (MRA), the sensitivity of experts in studies on small IAs (diameter <3 mm) was moderate (64-74.1% for CTAs and 70-92.8% for MRAs), and these figures could be lower in a routine clinical setting. Recent research shows that the expert level of sensitivity might be achieved using deep learning approaches. METHODS A large multisite dataset including 1054 MRA and 2174 CTA scans with expert IA annotations was collected. A novel modality-agnostic two-step IA detection approach was proposed. The first step used nnU-Net for segmenting vascular structures, with model training performed separately for each modality. In the second step, segmentations were converted to vascular surface that was parcellated by sampling point clouds and, using a PointNet++ model, each point was labeled as an aneurysm or vessel class. RESULTS Quantitative validation of the test data from different sites than the training data showed that the proposed approach achieved pooled sensitivity of 85% and 90% on 157 MRA scans and 1338 CTA scans, respectively, while the sensitivity for small IAs was 72% and 83%, respectively. The corresponding number of false findings per image was low at 1.54 and 1.57, and 0.4 and 0.83 on healthy subject data. CONCLUSIONS The proposed approach achieved a state-of-the-art balance between the sensitivity and the number of false findings, matched the expert-level sensitivity to small (and other) IAs on external data, and therefore seems fit for computer-assisted detection of IAs in a clinical setting.
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Affiliation(s)
- Žiga Bizjak
- Laboratory of Imaging Technologies, University of Ljubljana Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - June Ho Choi
- Department of Neurological Surgery, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, Songpa-gu, Seoul, Korea
| | - Franjo Pernuš
- Laboratory of Imaging Technologies, University of Ljubljana Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Žiga Špiclin
- Laboratory of Imaging Technologies, University of Ljubljana Faculty of Electrical Engineering, Ljubljana, Slovenia
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Christodoulides A, Burket NJ, Virtanen P, Lane BC. Subarachnoid haemorrhage associated with pituitary apoplexy and radiographically occult supraclinoid internal carotid artery aneurysms. BMJ Case Rep 2023; 16:e254123. [PMID: 37723095 PMCID: PMC10510930 DOI: 10.1136/bcr-2022-254123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 09/20/2023] Open
Abstract
In patients with pituitary adenomas, incidental intracranial aneurysms have been documented. Previous studies have highlighted the importance of preoperative imaging in these patients. However, imaging may be limited and fail to show the presence of vascular abnormalities. In this report, we discuss a case of a man in his 30s presenting with a newly diagnosed pituitary adenoma. CT and MRI, on admission, showed a pituitary mass with extension into the right cavernous sinus. After a sudden neurological deterioration, emergent CT/CT angiography revealed pituitary apoplexy with subarachnoid extension without vascular abnormalities. Successful emergency transsphenoidal hypophysectomy was followed by digital subtraction angiography which revealed the presence of two right supraclinoid internal carotid artery aneurysms. With this case, we aim to highlight the need for further vascular imaging in patients with pituitary apoplexy and subarachnoid haemorrhage, as preoperative imaging may be negative for vascular abnormalities especially in the setting of cavernous sinus invasion.
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Affiliation(s)
- Alexei Christodoulides
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Noah J Burket
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Piiamaria Virtanen
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brandon C Lane
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Malviya KK, Verma A. Importance of Anatomical Variation of the Hepatic Artery for Complicated Liver and Pancreatic Surgeries: A Review Emphasizing Origin and Branching. Diagnostics (Basel) 2023; 13:diagnostics13071233. [PMID: 37046451 PMCID: PMC10093498 DOI: 10.3390/diagnostics13071233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
Knowledge of anatomical variations of the hepatic artery from its origin to intrahepatic segmentation is of utmost importance for planning upper abdominal surgeries including liver transplantation, pancreatoduodenectomy, and biliary reconstruction. The origin and branching pattern of the hepatic artery was thoroughly described by the classification of Michels and Hiatt. Some rare variations of the hepatic artery were classified by Kobayashi and Koops. By the use of the multidetector computed tomography (MDCT) technique, the branching pattern of the hepatic artery can be visualized quite accurately. Unawareness of these arterial variations may lead to intraoperative injuries such as necrosis, abscess, and failure of the liver and pancreas. The origin and course of the aberrant hepatic arteries are crucial in the surgical planning of carcinoma of the head of the pancreas and hepatobiliary surgeries. In liver transplant surgeries, to minimize intraoperative bleeding complications and postoperative thrombosis, exact anatomy of the branching of the hepatic artery, its variations and intrahepatic course is of utmost importance. This review discusses variations in the anatomy of the hepatic artery from its origin to branching by the use of advanced imaging techniques and its effect on the liver, pancreatic, biliary and gastric surgeries.
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Affiliation(s)
- Kapil Kumar Malviya
- Department of Anatomy, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
| | - Ashish Verma
- Department of Radiodiagnosis and Imaging, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, Uttar Pradesh, India
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Liu X, Mao J, Sun N, Yu X, Chai L, Tian Y, Wang J, Liang J, Tao H, Yuan L, Lu J, Wang Y, Zhang B, Wu K, Wang Y, Chen M, Wang Z, Lu L. Deep Learning for Detection of Intracranial Aneurysms from Computed Tomography Angiography Images. J Digit Imaging 2023; 36:114-123. [PMID: 36085330 PMCID: PMC9984635 DOI: 10.1007/s10278-022-00698-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 07/31/2022] [Accepted: 08/23/2022] [Indexed: 10/14/2022] Open
Abstract
The accuracy of computed tomography angiography (CTA) image interpretation depends on the radiologist. This study aims to develop a new method for automatically detecting intracranial aneurysms from CTA images using deep learning, based on a convolutional neural network (CNN) implemented on the DeepMedic platform. Ninety CTA scans of patients with intracranial aneurysms are collected and divided into two datasets: training (80 subjects) and test (10 subjects) datasets. Subsequently, a deep learning architecture with a three-dimensional (3D) CNN model is implemented on the DeepMedic platform for the automatic segmentation and detection of intracranial aneurysms from the CTA images. The samples in the training dataset are used to train the CNN model, and those in the test dataset are used to assess the performance of the established system. Sensitivity, positive predictive value (PPV), and false positives are evaluated. The overall sensitivity and PPV of this system for detecting intracranial aneurysms from CTA images are 92.3% and 100%, respectively, and the segmentation sensitivity is 92.3%. The performance of the system in the detection of intracranial aneurysms is closely related to their size. The detection sensitivity for small intracranial aneurysms (≤ 3 mm) is 66.7%, whereas the sensitivity of detection for large (> 10 mm) and medium-sized (3-10 mm) intracranial aneurysms is 100%. The deep learning architecture with a 3D CNN model on the DeepMedic platform can reliably segment and detect intracranial aneurysms from CTA images with high sensitivity.
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Affiliation(s)
- Xiujuan Liu
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Jun Mao
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Ning Sun
- Engineering Research Center of Wideband Wireless Communication Technology, Ministry of Education, Nanjing University of Posts and Telecommunications, Jiangsu, Nanjing, 210000, China
| | - Xiangrong Yu
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Lei Chai
- Engineering Research Center of Wideband Wireless Communication Technology, Ministry of Education, Nanjing University of Posts and Telecommunications, Jiangsu, Nanjing, 210000, China
| | - Ye Tian
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Jianming Wang
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Jianchao Liang
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China
| | - Haiquan Tao
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University) Zhuhai, Guangdong, 519000, China
| | - Lihua Yuan
- Department of Radiology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210000, Jiangsu, China
| | - Jiaming Lu
- Department of Radiology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210000, Jiangsu, China
| | - Yang Wang
- Department of Radiology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210000, Jiangsu, China
| | - Bing Zhang
- Department of Radiology, The Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, 210000, Jiangsu, China
| | - Kaihua Wu
- Department of Neurosurgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University) Zhuhai, Guangdong, 519000, China
| | - Yiding Wang
- CT Room, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China
| | - Mengjiao Chen
- CT Room, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China
| | - Zhishun Wang
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, NY, 10032, USA.
| | - Ligong Lu
- Department of Radiology, Zhuhai People's Hospital (Zhuhai Hospital Affiliated With Jinan University), Kangning Road, Xiangzhou District, Zhuhai, Guangdong, 519000, China.
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Towards Automated Brain Aneurysm Detection in TOF-MRA: Open Data, Weak Labels, and Anatomical Knowledge. Neuroinformatics 2023; 21:21-34. [PMID: 35982364 PMCID: PMC9931814 DOI: 10.1007/s12021-022-09597-0] [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] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
Brain aneurysm detection in Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) has undergone drastic improvements with the advent of Deep Learning (DL). However, performances of supervised DL models heavily rely on the quantity of labeled samples, which are extremely costly to obtain. Here, we present a DL model for aneurysm detection that overcomes the issue with "weak" labels: oversized annotations which are considerably faster to create. Our weak labels resulted to be four times faster to generate than their voxel-wise counterparts. In addition, our model leverages prior anatomical knowledge by focusing only on plausible locations for aneurysm occurrence. We first train and evaluate our model through cross-validation on an in-house TOF-MRA dataset comprising 284 subjects (170 females / 127 healthy controls / 157 patients with 198 aneurysms). On this dataset, our best model achieved a sensitivity of 83%, with False Positive (FP) rate of 0.8 per patient. To assess model generalizability, we then participated in a challenge for aneurysm detection with TOF-MRA data (93 patients, 20 controls, 125 aneurysms). On the public challenge, sensitivity was 68% (FP rate = 2.5), ranking 4th/18 on the open leaderboard. We found no significant difference in sensitivity between aneurysm risk-of-rupture groups (p = 0.75), locations (p = 0.72), or sizes (p = 0.15). Data, code and model weights are released under permissive licenses. We demonstrate that weak labels and anatomical knowledge can alleviate the necessity for prohibitively expensive voxel-wise annotations.
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Radiation Dose Reduction Opportunities in Vascular Imaging. Tomography 2022; 8:2618-2638. [PMID: 36287818 PMCID: PMC9607049 DOI: 10.3390/tomography8050219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Computed tomography angiography (CTA) has been the gold standard imaging modality for vascular imaging due to a variety of factors, including the widespread availability of computed tomography (CT) scanners, the ease and speed of image acquisition, and the high sensitivity of CTA for vascular pathology. However, the radiation dose experienced by the patient during imaging has long been a concern of this image acquisition method. Advancements in CT image acquisition techniques in combination with advancements in non-ionizing radiation imaging techniques including magnetic resonance angiography (MRA) and contrast-enhanced ultrasound (CEUS) present growing opportunities to reduce total radiation dose to patients. This review provides an overview of advancements in imaging technology and acquisition techniques that are helping to minimize radiation dose associated with vascular imaging.
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Abstract
Klinisches Problem Rauchen beeinflusst das kardiovaskuläre System des Körpers. Primär führt es entweder zu atheromatösen Plaques mit potenzieller Gefäßstenosierung oder zu aneurysmatischen Gefäßveränderungen mit potenzieller Rupturgefahr. Radiologische Standardverfahren Je nach Lokalisation ermöglicht die Sonographie eine initiale Einschätzung der Veränderungen. Eine Angiographie in Kombination mit Computertomographie (CT) oder Magnetresonanztomographie (MRT) ermöglicht die weiterführende Beurteilung und ggf. Therapieplanung. Ohne klinische Symptomatik wird bei Rauchern ohne sonstige Risikofaktoren oder Komorbiditäten keine bildgebende Diagnostik lediglich aufgrund des Rauchens empfohlen. Methodische Innovationen Aktuelle Leitlinien der entsprechenden Pathologien erkennen das Rauchen einstimmig als modifizierbaren Risikofaktor für kardiovaskuläre Erkrankungen an, weshalb stets eine Raucherentwöhnung als erster Schritt zur Prävention sekundärer Akutereignisse empfohlen wird. Bei Verdacht auf ein chronisches Koronarsyndrom erhöht das Rauchen die klinische Wahrscheinlichkeit, wodurch eher eine bildgebende Diagnostik indiziert werden sollte. Leistungsfähigkeit Obwohl das Rauchen weitreichende Folgen am gesamten kardiovaskulären System zeigt, bleibt zu klären, ob Raucher durch eine Modifikation aktueller Leitlinien zur Vorsorge und Diagnose hinsichtlich harter klinischer Endpunkte profitieren würden. Empfehlung für die Praxis Raucher sollten aufgrund des deutlich erhöhten kardiovaskulären Risikos zu einer Raucherentwöhnung beraten werden. Hinsichtlich konkreter Krankheitsbilder bedingt das Rauchen keine prinzipielle Modifikation der bildgebenden Abklärung, bei intermediärem Risiko kann aber tendenziell früher zur Bildgebung geraten werden.
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Affiliation(s)
- Mathias Pamminger
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Agnes Mayr
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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12
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Dimensions and forms of artefacts in 1.5 T and 3 T MRI caused by cochlear implants. Sci Rep 2022; 12:4884. [PMID: 35318407 PMCID: PMC8940987 DOI: 10.1038/s41598-022-08988-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/28/2022] [Indexed: 11/09/2022] Open
Abstract
Cochlear implantation is a standard treatment option due to expanding indications. Cranial magnetic resonance imaging (cMRI) has become a widespread diagnostic tool. Therefore, an increased number of cochlear implant (CI) users are undergoing cMRI scans. This study aimed to investigate the issue of the CI magnet impacting MRI quality and artifacts. 1.5 T and 3 T MRI scans with 4 defined sequences (T2-TSE, T2-TIRM, T1-3D-MPRAGE, and TDI) were performed on a phantom with a CI (SYNCHRONY System by MED-EL Austria) in place. The resulting MRI artifacts were retrospectively compared to MRI artifacts observed in patients with a CI. All images were transferred to AMIRA and visualized by manual segmentation. Usable image quality was achieved in three sequences (T2-TSE, T2-TIRM and T1-mprage). Observed artifacts differed in shape and size depending on the sequence. Maximum diameters of signal void areas ranged from 58 × 108 × 98 mm to 127 × 123 × 153 mm. Image distortions were larger. MRI artifacts caused by the SYNCHRONY system are asymmetric with varying shape, depending on the sequence. The phantom artefacts are similar to those in CI users. Considering the observed asymmetry, the hypothesis of varying implantation locations resulting in varying positions of the signal void area needs to be further investigated.
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13
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Isolated third cranial nerve palsies-modern management principles. Eye (Lond) 2022; 36:232-233. [PMID: 33323979 PMCID: PMC8727561 DOI: 10.1038/s41433-020-01349-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 02/06/2023] Open
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14
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Galassi W, Yuyangkate W, Paholthep P, Tangsriwong T, Jaikon P, Leiwan T, Jiranukool J, Thiarawat P. Prevalence of unruptured intracranial aneurysms among first-degree relatives of Thai patients who had aneurysmal subarachnoid hemorrhage. Surg Neurol Int 2021; 12:566. [PMID: 34877052 PMCID: PMC8645480 DOI: 10.25259/sni_741_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The prevalence of familial unruptured intracranial aneurysm (UIA) in Thai population was unknown. Methods: Our study population comprised first-degree relatives of patients who were diagnosed with aneurysmal subarachnoid hemorrhage (aSAH) in two cerebrovascular neurosurgical centers from January 2018 to December 2018. The volunteers underwent three-dimensional time-of-flight magnetic resonance angiography for screening intracranial aneurysms (IA). Those who were reported positive or suspected of IA then underwent computed tomography angiography for confirmation. Results: We identified 12 patients who had 12 unruptured IAs (UIAs) from among 93 first-degree relatives. The prevalence of UIA among our study population was 12.9%. An estimated prevalence of UIA among Thai population was 9.05% (95% confidence interval [CI] 7.32–10.78). Of the 93 relatives, 84 had only one first-degree relative who suffered aSAH. Siblings posed a higher risk for UIA than offspring (16% vs. 9.5%), but the difference was not statistically significant (odds ratio 1.810, 95% CI 0.50–6.50, P = 0.274). The most common aneurysm location was the anterior cerebral artery territory (50%). Conclusion: The prevalence of familial UIA in a Thai population was relatively high. There was no significant between-group difference in the occurrence of UIA between the siblings and offspring of the aSAH patients.
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Affiliation(s)
| | - Warin Yuyangkate
- Department of Surgery Buddhashinnaraj Hospital, Mueang, Phitsanulok, Thailand
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15
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Demartini Z, Dos Santos de Alencar G, Cardoso-Demartini A, Sprengel SL, Zanine SC, Borba LAB. Delayed diagnosis of intracranial aneurysm in pediatrics: the risk of misdiagnosis-a case report. Childs Nerv Syst 2021; 37:3245-3249. [PMID: 33392649 DOI: 10.1007/s00381-020-05006-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Aneurysms in the pediatric population are uncommon, requiring a high index of suspicion for diagnosis. We report a case of a child with head trauma and delayed diagnosed cerebral aneurysm. METHODS A 2-year-old girl was brought to the emergency room with seizures. Head imaging showed acute intraventricular hemorrhage, hydrocephalus, and paraclinoid aneurysm of the right internal carotid artery. She had been hospitalized elsewhere 1 month prior for traumatic brain injury after falling to the ground with subarachnoid and intraventricular hemorrhage and good recovery, but without diagnosis of aneurysm. RESULTS The child was treated with aneurysm embolization and ventriculoperitoneal shunt, being discharged asymptomatic. CONCLUSION Most primary intraventricular hemorrhage in pediatric population has identifiable etiology. A high rate of clinical suspicion, associated with a low threshold for vascular neuroimaging studies for children with spontaneous or atypical intracranial hemorrhage allow accurate diagnosis, appropriate treatment, and improved outcome.
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Affiliation(s)
- Zeferino Demartini
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil.
| | | | | | - Sergio Luiz Sprengel
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil
| | - Simone Cristina Zanine
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil
| | - Luis Alencar Biurrum Borba
- Department of Neurosurgery, Hospital de Clínicas, Federal University of Paraná, 8th floor. Street General Carneiro, 181, Curitiba, PR, 80060-900, Brazil
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16
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Lv C, Wang J, Dai S, Chen Y, Jiang X, Li X. Long non-coding RNA NORAD induces phenotypic regulation of vascular smooth muscle cells through regulating microRNA-136-5p-targeted KDM1A. Cell Cycle 2021; 20:2137-2148. [PMID: 34583619 DOI: 10.1080/15384101.2021.1971351] [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: 10/20/2022] Open
Abstract
OBJECTIVE Effect of long non-coding RNAs (lncRNAs) on intracranial aneurysm (IA) development has been identified, while the role of noncoding RNA activated by DNA damage (NORAD) in IA remains unexplored. We aimed to verify the impact of NORAD on IA through sponging microRNA-136-5p (miR-136-5p). METHODS Ruptured and unruptured IAs were harvested from IA patients, and expression of NORAD, miR-136-5p, and KDM1A was determined. The vascular smooth muscle cells (VSMCs) were cultured and, respectively, transfected with altered NORAD, miR-136-5p, or lysine-specific demethylase 1 (KDM1A) to observe their effect on biological functions, as well as on contraction and synthesis-specific indices of VSMCs. Interactions between NORAD and miR-136-5p, and between miR-136-5p and KDM1A were confirmed. RESULTS NORAD and KDM1A were upregulated while miR-136-5p was downregulated in IA, especially in ruptured IA. NORAD overexpression or miR-136-5p inhibition accelerated proliferation and migration, and decelerated phenotypic switching and apoptosis of VSMCs. The effects of overexpressed NORAD on VSMCs were reserved by miR-136-5p upregulation or KDM1A knockdown. NORAD functioned as a competing endogenous RNA of miR-136-5p and miR-136-5p targeted KDM1A. CONCLUSION NORAD suppressed miR-136-5p, thus upregulating KDM1A to participate in IA formation and rupture by inducing phenotypic regulation of VSMCs.
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Affiliation(s)
- Chao Lv
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Jun Wang
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Shuhui Dai
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Yanwei Chen
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Xiaofan Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
| | - Xia Li
- Department of Neurosurgery, The First Affiliated Hospital of Airforce Medical University, Xi'an Shaanxi, China
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17
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The role of imaging in the management of non-traumatic subarachnoid hemorrhage: a practical review. Emerg Radiol 2021; 28:797-808. [PMID: 33580850 DOI: 10.1007/s10140-021-01900-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
The purpose of this review is to understand the role of imaging in the diagnosis and management of non-traumatic subarachnoid hemorrhage (SAH). SAH is a life-threatening emergency and a relatively common entity, the most common etiology being ruptured aneurysms. Multiple conundrums exist in literature at various steps of its imaging workup: diagnosis, management, and follow-up. We target our review to highlight the most effective practice and suggest efficient workup plans based on literature search, and describe in detail the clinical diagnostic and prognostic scales, role of CT scan, lumbar puncture, and MR, including angiography in the diagnosis and workup of SAH and its complications, and try to simplify the conundrums. Practical knowledge of imaging workup of SAH can help guide correct management of these patients, so as to reduce morbidity and mortality without resource overutilization.
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18
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Chernov IV, Kutin MA, Kheyreddin AS, Konovalov AN, Shekhtman OD, Eliava SS, Kalinin PL. [Combination of pituitary adenomas and intracranial aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2021; 85:94-103. [PMID: 33560625 DOI: 10.17116/neiro20218501194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The combination of intracranial tumors and asymptomatic brain aneurysms is an urgent problem, since it can significantly affect surgical intervention. Aneurysms are common in patients with meningioma, glioma and pituitary adenoma. According to certain authors, combination of aneurysms with pituitary adenomas is 7 times more common than with other tumors. In these cases, a comprehensive examination of the patient and decision-making on surgical strategy are required. This review is devoted to epidemiology, diagnosis and treatment of patients with a combination of pituitary adenomas and intracranial aneurysms detected intraoperatively or at the preoperative stage. The manuscript is illustrated by cases observed at the Burdenko Neurosurgery Center.
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Affiliation(s)
- I V Chernov
- Burdenko Neurosurgery Center, Moscow, Russia
| | - M A Kutin
- Burdenko Neurosurgery Center, Moscow, Russia
| | | | | | | | | | - P L Kalinin
- Burdenko Neurosurgery Center, Moscow, Russia
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19
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Cai Y, Huang D, Ma W, Wang M, Qin Q, Jiang Z, Liu M. Histone deacetylase 9 inhibition upregulates microRNA-92a to repress the progression of intracranial aneurysm via silencing Bcl-2-like protein 11. J Drug Target 2021; 29:761-770. [PMID: 33480300 DOI: 10.1080/1061186x.2021.1878365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Histone deacetylases (HDACs) have been revealed to be involved in cerebrovascular diseases, while the role of HDAC9 in intracranial aneurysm (IA) remains seldom studied. We aim to explore the role of the HDAC9/microRNA-92a (miR-92a)/Bcl-2-like protein 11 (BCL2L11) axis in IA progression. METHODS Expression of HDAC9, miR-92a and BCL2L11 in IA tissues was assessed. IA rat models were established by ligation of left renal artery and common carotid artery, and the rats were respectively injected with relative plasmid vectors and/or oligonucleotides. The blood pressure was measured to estimate the IA degree, and the pathological changes were observed. The expression of matrix metalloproteinase (MMP)-2, MMP-9 and vascular endothelial growth factor (VEGF) was detected, and the levels of inflammatory factors were evaluated. Expression of apoptosis-related proteins, HDAC9, miR-92a and BCL2L11 was assessed. RESULTS HDAC9 and BCL2L11 were upregulated while miR-92a was downregulated in IA clinical samples and rat models. HDAC9 inhibition or miR-92a elevation improved pathological changes and repressed apoptosis and expression of MMP-2, MMP-9, VEGF and inflammatory factors in vascular tissues from IA rats. Oppositely, HDAC9 overexpression or miR-92a reduction had contrary effects. miR-92a downregulation reversed the effect of silenced HDAC9 on IA rats. CONCLUSION HDAC9 inhibition upregulates miR-92a to repress the progression of IA via silencing BCL2L11.
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Affiliation(s)
- Yang Cai
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Dezhi Huang
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wenjia Ma
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Wang
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qilin Qin
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhongzhong Jiang
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Min Liu
- Department of Neurosurgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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20
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Berg P, Saalfeld S, Voß S, Beuing O, Janiga G. A review on the reliability of hemodynamic modeling in intracranial aneurysms: why computational fluid dynamics alone cannot solve the equation. Neurosurg Focus 2020; 47:E15. [PMID: 31261119 DOI: 10.3171/2019.4.focus19181] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 04/09/2019] [Indexed: 12/23/2022]
Abstract
Computational blood flow modeling in intracranial aneurysms (IAs) has enormous potential for the assessment of highly resolved hemodynamics and derived wall stresses. This results in an improved knowledge in important research fields, such as rupture risk assessment and treatment optimization. However, due to the requirement of assumptions and simplifications, its applicability in a clinical context remains limited.This review article focuses on the main aspects along the interdisciplinary modeling chain and highlights the circumstance that computational fluid dynamics (CFD) simulations are embedded in a multiprocess workflow. These aspects include imaging-related steps, the setup of realistic hemodynamic simulations, and the analysis of multidimensional computational results. To condense the broad knowledge, specific recommendations are provided at the end of each subsection.Overall, various individual substudies exist in the literature that have evaluated relevant technical aspects. In this regard, the importance of precise vessel segmentations for the simulation outcome is emphasized. Furthermore, the accuracy of the computational model strongly depends on the specific research question. Additionally, standardization in the context of flow analysis is required to enable an objective comparison of research findings and to avoid confusion within the medical community. Finally, uncertainty quantification and validation studies should always accompany numerical investigations.In conclusion, this review aims for an improved awareness among physicians regarding potential sources of error in hemodynamic modeling for IAs. Although CFD is a powerful methodology, it cannot provide reliable information, if pre- and postsimulation steps are inaccurately carried out. From this, future studies can be critically evaluated and real benefits can be differentiated from results that have been acquired based on technically inaccurate procedures.
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Affiliation(s)
- Philipp Berg
- 1Department of Fluid Dynamics and Technical Flows.,2Research CampusSTIMULATE, and
| | - Sylvia Saalfeld
- 2Research CampusSTIMULATE, and.,3Department of Simulation and Graphics, University of Magdeburg; and
| | - Samuel Voß
- 1Department of Fluid Dynamics and Technical Flows.,2Research CampusSTIMULATE, and
| | - Oliver Beuing
- 2Research CampusSTIMULATE, and.,4Department of Neuroradiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Gábor Janiga
- 1Department of Fluid Dynamics and Technical Flows.,2Research CampusSTIMULATE, and
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21
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Asymptomatic Intracranial Aneurysms in the Elderly: Long-Term Clinical and Radiologic Follow-Up of 193 Consecutive Patients. World Neurosurg 2020; 133:e600-e608. [DOI: 10.1016/j.wneu.2019.09.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 11/19/2022]
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22
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Prevalence of Unruptured Intracranial Aneurysms Coexisting with Pituitary Adenomas. World Neurosurg 2019; 126:e526-e533. [DOI: 10.1016/j.wneu.2019.02.084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/18/2019] [Accepted: 02/19/2019] [Indexed: 12/20/2022]
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23
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Park W, Lopes G. Perspectives: Neutrophil-to-lymphocyte Ratio as a Potential Biomarker in Immune Checkpoint Inhibitor for Non-Small-Cell Lung Cancer. Clin Lung Cancer 2018; 20:143-147. [PMID: 30683629 DOI: 10.1016/j.cllc.2018.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 11/25/2018] [Accepted: 12/08/2018] [Indexed: 12/18/2022]
Abstract
There is a rising need for optimal biomarkers to better tailor treatments for patients with cancer in the era of immunotherapy. In addition to programmed death-ligand 1 (PD-L1) and tumor mutation burden (TMB), neutrophil-to-lymphocyte (NLR) is regaining interest as a biomarker in immunotherapy for its availability, accessibility, and reproducibility. High NLR, according to different thresholds, is consistently reported to correlate with poor prognosis in different treatments in several cancers. Yet, most data come from retrospective analysis, and proof of mechanism and principle evaluations are limited. Prospective studies or adequately sized retrospective analyses of prospectively collected data are required to best assess its role in clinical practice. Moreover, effective myeloid or neutrophil modulators in tumor microenvironment can potentially contribute as a new therapeutic strategy. This perspective will summarize our current knowledge and will discuss where we stand now and propose future directions.
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Affiliation(s)
- Wungki Park
- Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Weill Cornell Medical College, New York, NY; Divisions of Hematology and Medical Oncology, Departments of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL.
| | - Gilberto Lopes
- Divisions of Hematology and Medical Oncology, Departments of Medicine, Miller School of Medicine, University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL
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