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Kumarasamy S, Garg K, Sharma MC, Chandra PS. Intracranial myeloid sarcoma as the first presentation of acute myeloid leukemia and literature review. Childs Nerv Syst 2023; 39:3607-3612. [PMID: 37300577 DOI: 10.1007/s00381-023-06016-w] [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: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Intracranial myeloid sarcoma is a rare extramedullary presentation of acute myeloid leukemia (AML). It can involve the meninges and ependyma presenting as extra-axial mass lesion. Rarely, it can also invade the brain parenchyma. It is commonly seen in children. It is usually misdiagnosed due to its close resemblance to other intracranial tumors (meningioma, metastasis, Ewing's sarcomas, and lymphoma). These are underdiagnosed if they precede the diagnosis of leukemia. CASE REPORT A 7-year-old boy with isolated intracranial myeloid sarcoma who presented with raised intracranial pressure (ICP) which was successfully managed by surgical excision. CONCLUSION Isolated intracranial myeloid sarcoma is a rare presentation of AML. Leukemia can be diagnosed early during the postoperative period and can be started on therapy timely. These patients requires regular follow-ups (clinical, laboratory and radiological) to detect relapses early.
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Affiliation(s)
- Sivaraman Kumarasamy
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - M C Sharma
- Department of Neuropathology, All India Institute of Medical Sciences, New Delhi, India
| | - P S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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An Y, Fan F, Jiang X, Sun K. Recent Advances in Liquid Biopsy of Brain Cancers. Front Genet 2021; 12:720270. [PMID: 34603383 PMCID: PMC8484876 DOI: 10.3389/fgene.2021.720270] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Brain cancers are among the top causes of death worldwide. Although, the survival rates vary widely depending on the type of the tumor, early diagnosis could generally benefit in better prognosis outcomes of the brain cancer patients. Conventionally, neuroimaging and biopsy are the most widely used approaches in diagnosis, subtyping, and prognosis monitoring of brain cancers, while emerging liquid biopsy assays using peripheral blood or cerebrospinal fluid have demonstrated many favorable characteristics in this task, especially due to their minimally invasive and easiness in sampling nature. Here, we review the recent studies in the liquid biopsy of brain cancers. We discuss the methodologies and performances of various assays on diagnosis, tumor subtyping, relapse prediction as well as prognosis monitoring in brain cancers, which approaches have made a big step toward clinical benefits of brain cancer patients.
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Affiliation(s)
- Yunyun An
- Shenzhen Bay Laboratory, Shenzhen, China
| | - Fei Fan
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobing Jiang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kun Sun
- Shenzhen Bay Laboratory, Shenzhen, China
- BGI-Shenzhen, Shenzhen, China
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Abstract
Magnetic resonance (MR) imaging is a crucial tool for evaluation of the skull base, enabling characterization of complex anatomy by utilizing multiple image contrasts. Recent technical MR advances have greatly enhanced radiologists' capability to diagnose skull base pathology and help direct management. In this paper, we will summarize cutting-edge clinical and emerging research MR techniques for the skull base, including high-resolution, phase-contrast, diffusion, perfusion, vascular, zero echo-time, elastography, spectroscopy, chemical exchange saturation transfer, PET/MR, ultra-high-field, and 3D visualization. For each imaging technique, we provide a high-level summary of underlying technical principles accompanied by relevant literature review and clinical imaging examples.
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Affiliation(s)
- Claudia F Kirsch
- Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY
| | - Mai-Lan Ho
- Associate Professor of Radiology, Director of Research, Department of Radiology, Director, Advanced Neuroimaging Core, Chair, Asian Pacific American Network, Secretary, Association for Staff and Faculty Women, Nationwide Children's Hospital and The Ohio State University, Columbus, OH; Division Chief, Neuroradiology, Professor of Neuroradiology and Otolaryngology, Department of Radiology, Northwell Health, Zucker Hofstra School of Medicine at Northwell, North Shore University Hospital, Manhasset, NY.
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Sun A, Liu S, Tang X, Pan Q, Zhang Z, Ma H, Nie D, Tang C, Tang G. N-(2-18F-fluoropropionyl)-l-glutamate as a potential oncology tracer for PET imaging of glioma. Appl Radiat Isot 2021; 168:109530. [DOI: 10.1016/j.apradiso.2020.109530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Accepted: 11/20/2020] [Indexed: 10/22/2022]
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Barbieri FR, De Luna A, Moschettoni L, Lunardi P. Isolated intracranial myeloid sarcoma: report of a case and review of the literature. Br J Neurosurg 2020:1-4. [PMID: 32351132 DOI: 10.1080/02688697.2020.1759782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Myeloid sarcoma is a rare malignant tumor of primitive myeloid cell origin often associated with hematologic disorders. The central nervous system is rarely involved and differentiating between myeloid sarcoma and other tumors is not possible on imaging. Here we present the rare case of an isolated intracranial myeloid sarcoma, initially misdiagnosed radiologically as a meningioma, treated with surgical total resection and subsequent chemotherapy, with no signs of any hematological disorder at follow up. Differential diagnosis and management strategies, as well as follow-up implications are discussed along with literature review, which pointed out that only five cases with no further signs of hematological disorders at follow up have been described in the literature so far and this case has the longest follow up of them at 9 years.
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Affiliation(s)
| | - Adolfo De Luna
- Department of Neurosurgery, Policlinico Tor Vergata, Rome, Italy
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Alasal SA, AL Bashabsheh E, Najadat H. Overview of Positron Emission Tomography (PET) for Brain Functions Degeneration Classification. 2020 11TH INTERNATIONAL CONFERENCE ON INFORMATION AND COMMUNICATION SYSTEMS (ICICS) 2020. [DOI: 10.1109/icics49469.2020.239500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Hua L, Hua F, Zhu H, Deng J, Wang D, Luan S, Tang H, Guan Y, Xie Q, Gong Y. The Diagnostic Value Of Using 18F-Fluorodeoxyglucose Positron Emission Tomography To Differentiate Between Low- And High-Grade Meningioma. Cancer Manag Res 2019; 11:9185-9193. [PMID: 31802943 PMCID: PMC6824206 DOI: 10.2147/cmar.s228129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/14/2019] [Indexed: 11/23/2022] Open
Abstract
Objective This study aims to evaluate the potential role of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in detecting high-grade meningiomas and predicting the prognosis of patients after meningioma surgery. Patients and methods A total of 124 patients met the final inclusion criterion. Tumor to gray ratio (TGR) was compared with Ki-67 labeling index, and its correlations with pre-operative neurological function and treatment status were also evaluated. Receiver-operating characteristic (ROC) curve was drawn to determine a cut-off value which could discriminate meningioma of different grades. Prognostic factors including TGR were analyzed using Kaplan-Meier survival curve and cox proportional model. Results The TGR of higher World Health Organization (WHO) grade meningioma was significantly higher than that in lower grade (p < 0.001), and it was correlated with the Ki-67 labeling index (p < 0.001, r = 0.1545). The TGR of 1.30 was the best cutoff value for the detection of high grade (WHO grade II&III) meningioma from low grade (WHO grade I) according to ROC analysis, with a sensitivity of 61.5%, the specificity of 86.7%, and accuracy of 81.5%. The TGR (p < 0.001), treatment status (p = 0.035), tumor grade (p < 0.001) and Ki-67 labeling index (p < 0.001) were significantly associated with progression-free survival (PFS). Cox proportional hazards model demonstrated that TGR (p = 0.013) was an independent prognostic factor for PFS. Conclusion A high uptake of FDG was correlated with a more proliferative biological behavior and is a risk factor for tumor recurrence.
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Affiliation(s)
- Lingyang Hua
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Fengchun Hua
- Department of Nuclear Medicine and PET Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Hongda Zhu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Jiaojiao Deng
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Daijun Wang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Shihai Luan
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Hailiang Tang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Yihui Guan
- Department of Nuclear Medicine and PET Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Qing Xie
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
| | - Ye Gong
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China.,Department of Critical Medicine, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, People's Republic of China
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Shao X, Xu M, Qiu C, Niu R, Wang Y, Wang X. Application of siemens SMART neuro attenuation correction in brain PET imaging. Medicine (Baltimore) 2018; 97:e12502. [PMID: 30235760 PMCID: PMC6160143 DOI: 10.1097/md.0000000000012502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Siemens SMART neuro attenuation correction (SNAC) is a new type of calculated attenuation correction (CAC) method. This article aimed to evaluate the effect of SNAC on the quantitative analysis of brain positron emission tomography (PET) imaging.Brain PET images of 52 healthy participants after reconstructed by SNAC and CT attenuation correction (CTAC) were analyzed qualitatively by visual analysis, and quantitatively by Scenium software to compare their contrast, signal-to-noise ratio (SNR) as well as the mean standardized uptake value (SUVmean) of different brain regions.Compared with CTAC, reconstruction of images by SNAC significantly reduced the SNR by 17.3% (P < .001), but not affected the contrast (P = .440). In addition, the SUVmean of different brain regions in images reconstructed by SNAC is increased, but still significantly correlated with that by CTAC (r = 0.988, P < .001), with a coefficient of R = 0.976 in linear regression analysis. Moreover, the mean percent difference of SUVmean between images reconstructed with SNAC and CTAC was 8.03% ± 5.38%, varying significantly in the range of -7.56% to 75.31% among 10 different brain regions (F = 35.702, P < .001) and showed greater percent difference in the peripheral brain regions than in the mesial brain regions.Image reconstruction by SNAC has greater effect on quantitative analysis by increasing SUVmean of different brain regions to varying degrees, but has little influence on the brain PET image quality. Moreover, it simplifies examination process and reduces radiation dose, which is beneficial to pediatric patients as well as serial scans to monitor therapy.
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Ly KI, Gerstner ER. The Role of Advanced Brain Tumor Imaging in the Care of Patients with Central Nervous System Malignancies. Curr Treat Options Oncol 2018; 19:40. [PMID: 29931476 DOI: 10.1007/s11864-018-0558-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT T1-weighted post-contrast and T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) constitute the gold standard for diagnosis and response assessment in neuro-oncologic patients but are limited in their ability to accurately reflect tumor biology and metabolism, particularly over the course of a patient's treatment. Advanced MR imaging methods are sensitized to different biophysical processes in tissue, including blood perfusion, tumor metabolism, and chemical composition of tissue, and provide more specific information on tissue physiology than standard MRI. This review provides an overview of the most common and emerging advanced imaging modalities in the field of brain tumor imaging and their applications in the care of neuro-oncologic patients.
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Affiliation(s)
- K Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Elizabeth R Gerstner
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA.
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Braun M, Häseli S, Rösch F, Piel M, Münnemann K. NMR Hyperpolarization of Established PET Tracers. ChemistrySelect 2018. [DOI: 10.1002/slct.201800364] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Manuel Braun
- Max Planck Institute for Polymer Research Ackermannweg 10 55128 Mainz Germany
| | - Sascha Häseli
- Inst. of Nuclear ChemistryJohannes Gutenberg-University Mainz Fritz-Strassmann-Weg 2 55128 Mainz Germany
| | - Frank Rösch
- Inst. of Nuclear ChemistryJohannes Gutenberg-University Mainz Fritz-Strassmann-Weg 2 55128 Mainz Germany
| | - Markus Piel
- Inst. of Nuclear ChemistryJohannes Gutenberg-University Mainz Fritz-Strassmann-Weg 2 55128 Mainz Germany
| | - Kerstin Münnemann
- Max Planck Institute for Polymer Research Ackermannweg 10 55128 Mainz Germany
- Dept. of Mechanical and Process Engineering, Lab. of Engineering ThermodynamicsUniversity of Kaiserslautern Erwin-Schrödinger-Straße 44 67663 Kaiserslautern Germany
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12
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Sun A, Liu X, Tang G. Carbon-11 and Fluorine-18 Labeled Amino Acid Tracers for Positron Emission Tomography Imaging of Tumors. Front Chem 2018; 5:124. [PMID: 29379780 PMCID: PMC5775220 DOI: 10.3389/fchem.2017.00124] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 12/12/2017] [Indexed: 12/12/2022] Open
Abstract
Tumor cells have an increased nutritional demand for amino acids (AAs) to satisfy their rapid proliferation. Positron-emitting nuclide labeled AAs are interesting probes and are of great importance for imaging tumors using positron emission tomography (PET). Carbon-11 and fluorine-18 labeled AAs include the [1-11C] AAs, labeling alpha-C- AAs, the branched-chain of AAs and N-substituted carbon-11 labeled AAs. These tracers target protein synthesis or amino acid (AA) transport, and their uptake mechanism mainly involves AA transport. AA PET tracers have been widely used in clinical settings to image brain tumors, neuroendocrine tumors, prostate cancer, breast cancer, non-small cell lung cancer (NSCLC) and hepatocellular carcinoma. This review focuses on the fundamental concepts and the uptake mechanism of AAs, AA PET tracers and their clinical applications.
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Affiliation(s)
- Aixia Sun
- Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiang Liu
- Department of Anesthesiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ganghua Tang
- Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Jung JH, Ahn BC. Current Radiopharmaceuticals for Positron Emission Tomography of Brain Tumors. Brain Tumor Res Treat 2018; 6:47-53. [PMID: 30381916 PMCID: PMC6212689 DOI: 10.14791/btrt.2018.6.e13] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 12/20/2022] Open
Abstract
Brain tumors represent a diverse spectrum of histology, biology, prognosis, and treatment options. Although MRI remains the gold standard for morphological tumor characterization, positron emission tomography (PET) can play a critical role in evaluating disease status. This article focuses on the use of PET with radiolabeled glucose and amino acid analogs to aid in the diagnosis of tumors and differentiate between recurrent tumors and radiation necrosis. The most widely used tracer is ¹⁸F-fluorodeoxyglucose (FDG). Although the intensity of FDG uptake is clearly associated with tumor grade, the exact role of FDG PET imaging remains debatable. Additionally, high uptake of FDG in normal grey matter limits its use in some low-grade tumors that may not be visualized. Because of their potential to overcome the limitation of FDG PET of brain tumors, ¹¹C-methionine and ¹⁸F-3,4-dihydroxyphenylalanine (FDOPA) have been proposed. Low accumulation of amino acid tracers in normal brains allows the detection of low-grade gliomas and facilitates more precise tumor delineation. These amino acid tracers have higher sensitivity and specificity for detecting brain tumors and differentiating recurrent tumors from post-therapeutic changes. FDG and amino acid tracers may be complementary, and both may be required for assessment of an individual patient. Additional tracers for brain tumor imaging are currently under development. Combinations of different tracers might provide more in-depth information about tumor characteristics, and current limitations may thus be overcome in the near future. PET with various tracers including FDG, ¹¹C-methionine, and FDOPA has improved the management of patients with brain tumors. To evaluate the exact value of PET, however, additional prospective large sample studies are needed.
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Affiliation(s)
- Ji Hoon Jung
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea
| | - Byeong Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
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Kunz WG, Jungblut LM, Kazmierczak PM, Vettermann FJ, Bollenbacher A, Tonn JC, Schichor C, Rominger A, Albert NL, Bartenstein P, Reiser MF, Cyran CC. Improved Detection of Transosseous Meningiomas Using 68Ga-DOTATATE PET/CT Compared with Contrast-Enhanced MRI. J Nucl Med 2017; 58:1580-1587. [DOI: 10.2967/jnumed.117.191932] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 04/11/2017] [Indexed: 11/16/2022] Open
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18F-FET PET prior to recurrent high-grade glioma re-irradiation—additional prognostic value of dynamic time-to-peak analysis and early static summation images? J Neurooncol 2017; 132:277-286. [DOI: 10.1007/s11060-016-2366-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 12/25/2016] [Indexed: 12/21/2022]
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Galldiks N, Law I, Pope WB, Arbizu J, Langen KJ. The use of amino acid PET and conventional MRI for monitoring of brain tumor therapy. Neuroimage Clin 2016; 13:386-394. [PMID: 28116231 PMCID: PMC5226808 DOI: 10.1016/j.nicl.2016.12.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 12/09/2016] [Accepted: 12/16/2016] [Indexed: 12/03/2022]
Abstract
Routine diagnostics and treatment monitoring of brain tumors is usually based on contrast-enhanced MRI. However, the capacity of conventional MRI to differentiate tumor tissue from posttherapeutic effects following neurosurgical resection, chemoradiation, alkylating chemotherapy, radiosurgery, and/or immunotherapy may be limited. Metabolic imaging using PET can provide relevant additional information on tumor metabolism, which allows for more accurate diagnostics especially in clinically equivocal situations. This review article focuses predominantly on the amino acid PET tracers 11C-methyl-l-methionine (MET), O-(2-[18F]fluoroethyl)-l-tyrosine (FET) and 3,4-dihydroxy-6-[18F]-fluoro-l-phenylalanine (FDOPA) and summarizes investigations regarding monitoring of brain tumor therapy.
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Affiliation(s)
- Norbert Galldiks
- Dept. of Neurology, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
- Center of Integrated Oncology (CIO), Universities of Cologne and Bonn, Cologne, Germany
| | - Ian Law
- Dept.of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Whitney B. Pope
- Dept. of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Javier Arbizu
- Dept. of Nuclear Medicine, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - Karl-Josef Langen
- Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
- Dept. of Nuclear Medicine, University of Aachen, Aachen, Germany
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Yang S, Zhao B, Wang G, Xiang J, Xu S, Liu Y, Zhao P, Pfeuffer J, Qian T. Improving the Grading Accuracy of Astrocytic Neoplasms Noninvasively by Combining Timing Information with Cerebral Blood Flow: A Multi-TI Arterial Spin-Labeling MR Imaging Study. AJNR Am J Neuroradiol 2016; 37:2209-2216. [PMID: 27561831 DOI: 10.3174/ajnr.a4907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 07/01/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Systematic and accurate glioma grading has clinical significance. We present the utility of multi-TI arterial spin-labeling imaging and provide the bolus arrival time maps for grading astrocytomas. MATERIALS AND METHODS Forty-three patients with astrocytomas (21 men; mean age, 51 years) were recruited. The classification abilities of conventional MR imaging features, normalized CBF value derived from multi-TI arterial spin-labeling imaging, normalized bolus arrival time, and normalized CBF derived from single-TI arterial spin-labeling were compared in patients with World Health Organization (WHO) grade II, III, and IV astrocytomas. RESULTS The normalized CBF value derived from multi-TI arterial spin-labeling imaging was higher in patients with higher grade astrocytoma malignancies compared with patients with lower grade astrocytomas, while the normalized bolus arrival time showed the opposite tendency. The normalized CBF value derived from the multi-TI arterial spin-labeling imaging showed excellent performance with areas under the receiver operating characteristic curve of 0.813 (WHO II versus III), 0.964 (WHO II versus IV), 0.872 (WHO III versus IV), and 0.883 (low-grade-versus-high-grade gliomas). The normalized CBF value derived from single-TI arterial spin-labeling imaging could statistically differentiate the WHO II and IV groups (area under the receiver operating characteristic curve = 0.826). The normalized bolus arrival time effectively identified the WHO grades II and III with an area under the receiver operating characteristic curve of 0.836. Combining the normalized CBF value derived from multi-TI arterial spin-labeling imaging and normalized bolus arrival time improved the diagnostic accuracy from 65.10% to 72.10% compared with the normalized CBF value derived from multi-TI arterial spin-labeling imaging being applied independently. The combination of multi-TI arterial spin-labeling imaging and conventional MR imaging had the best performance, with a diagnostic accuracy of 81.40%. CONCLUSIONS Multi-TI arterial spin-labeling imaging can evaluate perfusion dynamics by combining normalized bolus arrival time and normalized CBF values derived from multiple TIs. It is superior to single-TI arterial spin-labeling imaging and conventional MR imaging features when applied independently and can improve the diagnostic accuracy when combined with conventional MR imaging for grading astrocytomas.
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Affiliation(s)
- S Yang
- From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China
| | - B Zhao
- From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China
| | - G Wang
- From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China
| | - J Xiang
- From the Department of MR Imaging (S.Y., B.Z., G.W., J.X.), Shandong Medical Imaging Research Institute, Shandong University, Jinan, P.R. China
| | - S Xu
- Department of Neurosurgery (S.X., Y.L., P.Z.), Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - Y Liu
- Department of Neurosurgery (S.X., Y.L., P.Z.), Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - P Zhao
- Department of Neurosurgery (S.X., Y.L., P.Z.), Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, China
| | - J Pfeuffer
- Application Development (J.P.), Siemens, Erlangen, Germany
| | - T Qian
- MR Collaborations NE Asia (T.Q.), Siemens Healthcare, Beijing, China
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Feng Y, Clayton EH, Okamoto RJ, Engelbach J, Bayly PV, Garbow JR. A longitudinal magnetic resonance elastography study of murine brain tumors following radiation therapy. Phys Med Biol 2016; 61:6121-31. [PMID: 27461395 DOI: 10.1088/0031-9155/61/16/6121] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
An accurate and noninvasive method for assessing treatment response following radiotherapy is needed for both treatment monitoring and planning. Measurement of solid tumor volume alone is not sufficient for reliable early detection of therapeutic response, since changes in physiological and/or biomechanical properties can precede tumor volume change following therapy. In this study, we use magnetic resonance elastography to evaluate the treatment effect after radiotherapy in a murine brain tumor model. Shear modulus was calculated and compared between the delineated tumor region of interest (ROI) and its contralateral, mirrored counterpart. We also compared the shear modulus from both the irradiated and non-irradiated tumor and mirror ROIs longitudinally, sampling four time points spanning 9-19 d post tumor implant. Results showed that the tumor ROI had a lower shear modulus than that of the mirror ROI, independent of radiation. The shear modulus of the tumor ROI decreased over time for both the treated and untreated groups. By contrast, the shear modulus of the mirror ROI appeared to be relatively constant for the treated group, while an increasing trend was observed for the untreated group. The results provide insights into the tumor properties after radiation treatment and demonstrate the potential of using the mechanical properties of the tumor as a biomarker. In future studies, more closely spaced time points will be employed for detailed analysis of the radiation effect.
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Affiliation(s)
- Y Feng
- School of Mechanical and Electronic Engineering, Soochow University, Suzhou, Jiangsu, People's Republic of China. Robotics and Microsystems Center, Soochow University, Suzhou, Jiangsu, People's Republic of China. School of Computer Science and Engineering, Soochow University, Suzhou, Jiangsu, People's Republic of China
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Static FET-PET and MR Imaging in Anaplastic Gliomas (WHO III). World Neurosurg 2016; 91:524-531.e1. [PMID: 26947726 DOI: 10.1016/j.wneu.2016.02.094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/23/2016] [Accepted: 02/24/2016] [Indexed: 02/05/2023]
Abstract
OBJECTIVE O-(2-[18F]-fluoroethyl)-L-tyrosine-positron emission tomography (FET-PET) imaging is an additional tool for tumor grading and surgery planning. Up to now, not much is known about FET-PET imaging in anaplastic gliomas. Our objective was to assess the FET uptake in anaplastic gliomas, compared with magnetic resonance imaging (MRI), histopathologic markers, and its prognostic value. PATIENTS AND METHODS Forty-six patients (27 males/19 females) with an anaplastic glioma (WHO III) who received MRI and FET-PET imaging before surgery were retrospectively analyzed. Tumor volume was calculated in MRI and FET-PET imaging using a tumor-to-background ratio (TBR), and maximum FET uptake (TBRmax) was calculated. Overall survival (OS) and histopathologic markers (isocitrate-dehydrogenase 1/2-mutation, oligodendrial differentiation, and Ki67 proliferation index) were assessed. Univariate and multivariate analysis was performed for OS. RESULTS In univariate analysis a significant correlation of TBRmax to OS was observed (P = 0.031). Tumor volume in FET-PET imaging (TBR > 2.0) (P = 0.028) showed a higher correlation to OS than the volume of the contrast-enhancing tumor part (P = 0.031). The highest correlation was observed for intersection of volume TBR > 1.3 and the volume of the contrast-enhancing tumor part (P = 0.005); fluid-attenuated inversion recovery volume showed no significant correlation to OS (P = 0.401) in the univariate analysis. Anaplastic glioma with oligodendrial differentiation showed significantly higher TBRmax values (P = 0.029), while no significant difference was observed for isocitrate hydrogenase 1/2-mutation (P = 0.752). CONCLUSION Static FET-PET provides significant prognostic information in anaplastic gliomas, which adds to the value of MRI, supporting the use of both modalities preoperatively to assess individual risks and estimate prognosis. Definition of the histopathologic subtype using static FET-PET remains challenging.
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Galldiks N, Langen KJ, Pope WB. From the clinician's point of view - What is the status quo of positron emission tomography in patients with brain tumors? Neuro Oncol 2015; 17:1434-44. [PMID: 26130743 DOI: 10.1093/neuonc/nov118] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/31/2015] [Indexed: 12/13/2022] Open
Abstract
The most common type of primary brain tumor is malignant glioma. Despite intensive therapeutic efforts, the majority of these neoplasms remain incurable. Imaging techniques are important for initial tumor detection and comprise indispensable tools for monitoring treatment. Structural imaging using contrast-enhanced MRI is the method of choice for brain tumor surveillance, but its capacity to differentiate tumor from nonspecific tissue changes can be limited, particularly with posttreatment gliomas. Metabolic imaging using positron-emission-tomography (PET) can provide relevant additional information, which may allow for better assessment of tumor burden in ambiguous cases. Specific PET tracers have addressed numerous molecular targets in the last decades, but only a few have achieved relevance in routine clinical practice. At present, PET studies using radiolabeled amino acids appear to improve clinical decision-making as these tracers can offer better delineation of tumor extent as well as improved targeting of biopsies, surgical interventions, and radiation therapy. Amino acid PET imaging also appears useful for distinguishing glioma recurrence or progression from postradiation treatment effects, particularly radiation necrosis and pseudoprogression, and provides information on histological grading and patient prognosis. In the last decade, the tracers O-(2-[(18)F]fluoroethyl)-L-tyrosine (FET) and 3,4-dihydroxy-6-[(18)F]-fluoro-L-phenylalanine (FDOPA) have been increasingly used for these indications. This review article focuses on these tracers and summarizes their recent applications for patients with brain tumors. Current uses of tracers other than FET and FDOPA are also discussed, and the most frequent practical questions regarding PET brain tumor imaging are reviewed.
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Affiliation(s)
- Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Research Center Jülich, Institute of Neuroscience and Medicine, Jülich, Germany (N.G., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Nuclear Medicine, University of Aachen, Germany (K.-J.L.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA., Los Angeles (W.B.P.)
| | - Karl-Josef Langen
- Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Research Center Jülich, Institute of Neuroscience and Medicine, Jülich, Germany (N.G., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Nuclear Medicine, University of Aachen, Germany (K.-J.L.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA., Los Angeles (W.B.P.)
| | - Whitney B Pope
- Department of Neurology, University of Cologne, Cologne, Germany (N.G.); Research Center Jülich, Institute of Neuroscience and Medicine, Jülich, Germany (N.G., K.-J.L.); Center of Integrated Oncology (CIO), University of Cologne, Cologne, Germany (N.G.); Department of Nuclear Medicine, University of Aachen, Germany (K.-J.L.); Department of Radiological Sciences, David Geffen School of Medicine at UCLA., Los Angeles (W.B.P.)
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