1
|
Duhon BH, Thompson K, Fisher M, Kaul VF, Nguyen HT, Harris MS, Varadarajan V, Adunka OF, Prevedello DM, Kolipaka A, Ren Y. Tumor biomechanical stiffness by magnetic resonance elastography predicts surgical outcomes and identifies biomarkers in vestibular schwannoma and meningioma. Sci Rep 2024; 14:14561. [PMID: 38914647 PMCID: PMC11196577 DOI: 10.1038/s41598-024-64597-1] [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: 02/08/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024] Open
Abstract
Variations in the biomechanical stiffness of brain tumors can not only influence the difficulty of surgical resection but also impact postoperative outcomes. In a prospective, single-blinded study, we utilize pre-operative magnetic resonance elastography (MRE) to predict the stiffness of intracranial tumors intraoperatively and assess the impact of increased tumor stiffness on clinical outcomes following microsurgical resection of vestibular schwannomas (VS) and meningiomas. MRE measurements significantly correlated with intraoperative tumor stiffness and baseline hearing status of VS patients. Additionally, MRE stiffness was elevated in patients that underwent sub-total tumor resection compared to gross total resection and those with worse postoperative facial nerve function. Furthermore, we identify tumor microenvironment biomarkers of increased stiffness, including αSMA + myogenic fibroblasts, CD163 + macrophages, and HABP (hyaluronic acid binding protein). In a human VS cell line, a dose-dependent upregulation of HAS1-3, enzymes responsible for hyaluronan synthesis, was observed following stimulation with TNFα, a proinflammatory cytokine present in VS. Taken together, MRE is an accurate, non-invasive predictor of tumor stiffness in VS and meningiomas. VS with increased stiffness portends worse preoperative hearing and poorer postoperative outcomes. Moreover, inflammation-mediated hyaluronan deposition may lead to increased stiffness.
Collapse
Affiliation(s)
- Bailey H Duhon
- Division of Otology, Neurotology, and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Otology, Neurotology, and Lateral Skull Base Surgery Program, Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - Kristin Thompson
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Melanie Fisher
- Division of Otology, Neurotology, and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Vivian F Kaul
- Otology, Neurotology, and Lateral Skull Base Surgery Program, Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School at the University of Texas at Houston, Houston, TX, USA
| | - Han Tn Nguyen
- Division of Otology, Neurotology, and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael S Harris
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Varun Varadarajan
- Division of Otology, Neurotology, and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Oliver F Adunka
- Division of Otology, Neurotology, and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Arunark Kolipaka
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Yin Ren
- Division of Otology, Neurotology, and Cranial Base Surgery, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| |
Collapse
|
2
|
Kren J, Skambath I, Kuppler P, Buschschlüter S, Detrez N, Burhan S, Huber R, Brinkmann R, Bonsanto MM. Mechanical characteristics of glioblastoma and peritumoral tumor-free human brain tissue. Acta Neurochir (Wien) 2024; 166:102. [PMID: 38396016 PMCID: PMC10891200 DOI: 10.1007/s00701-024-06009-x] [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: 12/12/2023] [Accepted: 02/16/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The diagnosis of brain tumor is a serious event for the affected patient. Surgical resection is a crucial part in the treatment of brain tumors. However, the distinction between tumor and brain tissue can be difficult, even for experienced neurosurgeons. This is especially true in the case of gliomas. In this project we examined whether the biomechanical parameters elasticity and stress relaxation behavior are suitable as additional differentiation criteria between tumorous (glioblastoma multiforme; glioblastoma, IDH-wildtype; GBM) and non-tumorous, peritumoral tissue. METHODS Indentation measurements were used to examine non-tumorous human brain tissue and GBM samples for the biomechanical properties of elasticity and stress-relaxation behavior. The results of these measurements were then used in a classification algorithm (Logistic Regression) to distinguish between tumor and non-tumor. RESULTS Differences could be found in elasticity spread and relaxation behavior between tumorous and non-tumorous tissue. Classification was successful with a sensitivity/recall of 83% (sd = 12%) and a precision of 85% (sd = 9%) for detecting tumorous tissue. CONCLUSION The findings imply that the data on mechanical characteristics, with particular attention to stress relaxation behavior, can serve as an extra element in differentiating tumorous brain tissue from non-tumorous brain tissue.
Collapse
Affiliation(s)
- Jessica Kren
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Luebeck, Germany.
| | - Isabelle Skambath
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Patrick Kuppler
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Luebeck, Germany
| | | | - Nicolas Detrez
- Medizinisches Laserzentrum Lübeck GmbH, Luebeck, Germany
| | - Sazgar Burhan
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Robert Huber
- Institute of Biomedical Optics, University of Luebeck, Luebeck, Germany
| | - Ralf Brinkmann
- Medizinisches Laserzentrum Lübeck GmbH, Luebeck, Germany
| | - Matteo Mario Bonsanto
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Luebeck, Germany
| |
Collapse
|
3
|
Behzadi F, Ruiz GM, Tran DH, Schaible PA, Allen MB, Germanwala AV. Evaluation of Retrospective Patient Preference on Extent of Resection of Nonfunctioning Pituitary Adenomas. World Neurosurg 2024; 182:e98-e106. [PMID: 37995987 DOI: 10.1016/j.wneu.2023.11.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Neurosurgeons treat nonfunctioning pituitary adenomas by surgical resection. Based on the adherence of the tumor to the normal pituitary gland, operative risks may include hormone replacement therapy for postoperative hypopituitarism with gross total resection that injures the gland or recurrent tumor with subtotal resection and purposeful avoidance of gland manipulation. None of the patients presented in this article had a preoperative preference regarding extent of resection. This study aimed to evaluate postoperative patient preferences regarding extent of resection. METHODS Adult patients who underwent resection of adenomas between 2015 and 2023 were retrospectively reviewed and surveyed. After surgery, participating patients were asked for their preference regarding 100% tumor resection with lifelong daily hormone replacement therapy versus 90% tumor resection with a chance of recurrence in the hypothetical situation where the neurosurgeon encounters tumor adherent to the normal gland. RESULTS Of the 73 patients included, 54 (74.0%) responded to the survey, with the majority (36 [66.7%]) preferring 90% resection with the chance of tumor recurrence. Tumor recurrence (odds ratio 2.3, 95% confidence interval 2.1-2.5, P = 0.03) and steroid avoidance (odds ratio 2.2, 95% confidence interval 2.0-2.4, P = 0.04) were the 2 variables that were significant predictors of patient preference in multivariate regression analysis. CONCLUSIONS Although patients may not have the preoperative insight or experience to have a strong conviction regarding the extent of adenoma resection, the consequences following surgery clearly influence their preference. Most patients in our study, including patients with gross total resection and especially patients who experienced side effects of steroid therapy, preferred subtotal resection with the chance of tumor recurrence over hormone replacement therapy.
Collapse
Affiliation(s)
- Faraz Behzadi
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Gianna M Ruiz
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA
| | - Dana H Tran
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Peter A Schaible
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, Illinois, USA
| | - Matthew B Allen
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Anand V Germanwala
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, USA; Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA.
| |
Collapse
|
4
|
Ahmed ANA. Preoperative Magnetic Resonance Elastography (MRE) of Skull Base Tumours: A Review. Indian J Otolaryngol Head Neck Surg 2023; 75:4173-4178. [PMID: 37974805 PMCID: PMC10645913 DOI: 10.1007/s12070-023-03955-3] [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: 02/28/2023] [Accepted: 06/08/2023] [Indexed: 11/19/2023] Open
Abstract
Conventional magnetic resonance imaging (MRI) can detect tumors consistency, but it can't predict tumor stiffness or adherence of the tumor to nearby structures. Magnetic resonance elastography (MRE) is a known non-invasive MRI based imaging technique used to assess the viscoelasticity of the tissues particularly liver fibrosis. This study discussed the importance of preoperative MRE in skull base tumors and the future implications of this new imaging modality. We did review of the English literature (by searching PubMed) regarding the use of MRE in preoperative assessment of skull base tumours stiffness and adherence to surrounding tissues. Recent research demonstrated that MRE can detect the stiffness and adherence of skull base tumors to surrounding structures by recording the spread of mechanical waves in the different tissues. In addition to non-radiation exposure, this technique is fast and can be incorporated into the conventional (MRI) study. MRE can palpate skull base tumours by imaging, allowing the stiffness of the tumour to be assessed. Preoperative assessment of brain tumours consistency, stiffness, and adherence to surrounding tissues is critical to avoid injury of important nearby structures and better preoperative patient counselling regarding surgical approach (endoscopic or open), operative time, and suspected surgical complications. However, the accuracy of MRE is less in small and highly vascular tumors. Also, MRE can't accurately detect tumour-brain adherence, but the new modality (slip-interface imaging) can. Hence, adding MRE to the conventional MRI study may help in preoperative diagnosis and treatment of skull base tumours.
Collapse
Affiliation(s)
- Ahmed Nabil Abdelhamid Ahmed
- Department of Otorhinolaryngology, Faculty of Medicine, Ain Shams University, 6th Nile Valley Street, Hadayek Alkoba, Cairo, 11331 Egypt
| |
Collapse
|
5
|
Kumarapuram S, Yu R, Manchiraju P, Attard C, Escamilla J, Navin A, Khuroo M, Elmogazy O, Gupta G, Sun H, Roychowdhury S. Applying Shear Wave and Magnetic Resonance Elastography to Grade Brain Tumors: Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:e147-e155. [PMID: 37442538 DOI: 10.1016/j.wneu.2023.07.014] [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: 05/01/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Reports find that magnetic resonance elastography (MRE) and shear wave elastography (SWE) can classify intracranial tumors according to stiffness. However, systematic syntheses of these articles are lacking. In this report, a systematic review and meta-analysis was performed to evaluate whether SWE and MRE can predict meningioma and glioma grades. METHODS PubMed and Scopus were searched between February 10, 2022. and March 2, 2022. using manual search criteria. Eight out of 106 non-duplicate records were included, encompassing 84 patients with low-grade tumors (age 42 ± 13 years, 71% female) and 92 patients with high-grade tumors (age 50 ± 13 years, 42% female). Standardized mean difference in stiffness between high-grade and low-grade tumors were measured using a forest plot. The I2, χ2, and t tests were performed, and bubble plots were constructed to measure heterogeneity. An adapted QUADAS-2 scale evaluated study quality. Additionally, a funnel plot was constructed, and an Egger's intercept test determined study bias. RESULTS Low-grade tumors were stiffer than high-grade tumors (Cohen's D = -1.25; 95% CI -1.88, -0.62). Moderate heterogeneity was observed (I2 = 67%; P = 0.006) but controlling for publication year (I2 = 0.2%) and age (I2 = 0.0%-17%) reduced heterogeneity. Included studies revealed unclear or high bias for the reference standard and flow and timing (>50%). CONCLUSIONS Elastography techniques have potential to grade tumors intraoperatively and postoperatively. More studies are needed to evaluate the clinical utility of these technologies.
Collapse
Affiliation(s)
- Siddhant Kumarapuram
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA.
| | - Richard Yu
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Pranav Manchiraju
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Casey Attard
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Escamilla
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Apurva Navin
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mohammad Khuroo
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Omar Elmogazy
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gaurav Gupta
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Hai Sun
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sudipta Roychowdhury
- Department of Radiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA; Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| |
Collapse
|
6
|
Aunan-Diop JS, Poulsen FR. Reply: A transvenous pressure gradient can explain the MR elastography findings in normal pressure hydrocephalus. Neurosurg Rev 2022; 45:3841-3842. [PMID: 36190600 DOI: 10.1007/s10143-022-01879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Jan Saip Aunan-Diop
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, 5000, Odense C, Denmark.
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Kløvervænget 47, 5000, Odense C, Denmark.,University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| |
Collapse
|
7
|
Aunan-Diop JS, Andersen MCS, Friimose AI, Halle B, Pedersen CB, Mussmann B, Grønhøj MH, Nielsen TH, Jensen U, Poulsen FR. Virtual magnetic resonance elastography predicts the intraoperative consistency of meningiomas. J Neuroradiol 2022; 50:396-401. [DOI: 10.1016/j.neurad.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
|
8
|
Substrate viscosity impairs temozolomide-mediated inhibition of glioblastoma cells' growth. Biochim Biophys Acta Mol Basis Dis 2022; 1868:166513. [PMID: 35932892 DOI: 10.1016/j.bbadis.2022.166513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/16/2022] [Accepted: 07/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The mechanical state of the extracellular environment of the brain cells considerably affects their phenotype during the development of central nervous system (CNS) pathologies, and when the cells respond to drugs. The reports on the evaluation of the viscoelastic properties of different brain tumors have shown that both tissue stiffness and viscosity can be altered during cancer development. Although a compelling number of reports established the role of substrate stiffness on the proliferation, motility, and drug sensitivity of brain cancer cells, there is a lack of parallel data in terms of alterations in substrate viscosity. METHODS Based on viscoelasticity measurements of rat brain samples using strain rheometry, polyacrylamide (PAA) hydrogels mimicking elastic and viscous parameters of the tissues were prepared. Optical microscopy and flow cytometry were employed to assess the differences in glioblastoma cells morphology, proliferation, and cytotoxicity of anticancer drug temozolomide (TZM) due to increased substrate viscosity. RESULTS Our results indicate that changes in substrate viscosity affect the proliferation of untreated glioma cells to a lesser extent, but have a significant impact on the apoptosis-associated depolarization of mitochondria and level of DNA fragmentation. This suggests that viscosity sensing and stiffness sensing machinery can activate different signaling pathways in glioma cells. CONCLUSION Collected data indicate that viscosity should be considered an important parameter in in vitro polymer-based cell culture systems used for drug screening.
Collapse
|
9
|
Afternoon Thoughts About a New Beginning, the Value of MRI, and the Need for Curiosity. Top Magn Reson Imaging 2022; 31:1-2. [PMID: 35225838 DOI: 10.1097/rmr.0000000000000293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|