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Panyaping T, Punpichet M, Tunlayadechanont P, Tritanon O. Usefulness of a Rim-Enhancing Pattern on the Contrast-Enhanced 3D-FLAIR Sequence and MRI Characteristics for Distinguishing Meningioma and Malignant Dural-Based Tumor. AJNR Am J Neuroradiol 2023; 44:247-253. [PMID: 36732030 PMCID: PMC10187810 DOI: 10.3174/ajnr.a7780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/03/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Meningiomas are the most common type of extra-axial dural-based tumors; however, malignant dural-based tumors can mimic meningiomas on imaging. The aim of this study was to determine the efficacy of differentiating meningiomas from malignant dural-based tumors by using rim-enhancement patterns on a contrast-enhanced FLAIR sequence and MR imaging characteristics. MATERIALS AND METHODS This retrospective study included 102 patients with meningiomas and 31 patients with malignant dural-based tumors who underwent pretreatment MR imaging. The rim-enhancement patterns on contrast-enhanced FLAIR and MR imaging characteristics, including the dural tail sign, hyperostosis, bony destruction, leptomeningeal enhancement, peritumoral edema, T2-weighted signal intensity, and tumor enhancement were evaluated. RESULTS Complete rim enhancement of the tumor-brain interface on contrast-enhanced FLAIR (contrast-enhanced-FLAIR rim sign) was present in most meningiomas (91/102, 89.2%) and at significantly greater frequency than in malignant dural-based tumors (2/31, 6.5%) (P < .001). Complete contrast-enhanced FLAIR rim enhancement provided high sensitivity (89.2%), specificity (93.5%), and accuracy (90.2%) for diagnosing meningioma. Additionally, hyperostosis was an MR imaging characteristic that suggested a diagnosis of meningioma. In contrast, bony destruction with cortical breakthrough and leptomeningeal enhancement suggested malignant dural-based tumors. There were limitations of meningiomas of <2.0 cm or at cavernous sinus locations that did not demonstrate contrast-enhanced FLAIR rim enhancement. CONCLUSIONS The rim-enhancement pattern on contrast-enhanced FLAIR could help differentiate meningiomas and malignant dural-based tumors. The presence of complete rim enhancement on contrast-enhanced FLAIR was a robust predictive sign for meningioma.
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Affiliation(s)
- T Panyaping
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
| | - M Punpichet
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
| | - P Tunlayadechanont
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
| | - O Tritanon
- From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
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Kiyose M, Herrmann E, Roesler J, Zeiner PS, Steinbach JP, Forster MT, Plate KH, Czabanka M, Vogl TJ, Hattingen E, Mittelbronn M, Breuer S, Harter PN, Bernatz S. MR imaging profile and histopathological characteristics of tumour vasculature, cell density and proliferation rate define two distinct growth patterns of human brain metastases from lung cancer. Neuroradiology 2023; 65:275-285. [PMID: 36184635 PMCID: PMC9859874 DOI: 10.1007/s00234-022-03060-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/26/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Non-invasive prediction of the tumour of origin giving rise to brain metastases (BMs) using MRI measurements obtained in radiological routine and elucidating the biological basis by matched histopathological analysis. METHODS Preoperative MRI and histological parameters of 95 BM patients (female, 50; mean age 59.6 ± 11.5 years) suffering from different primary tumours were retrospectively analysed. MR features were assessed by region of interest (ROI) measurements of signal intensities on unenhanced T1-, T2-, diffusion-weighted imaging and apparent diffusion coefficient (ADC) normalised to an internal reference ROI. Furthermore, we assessed BM size and oedema as well as cell density, proliferation rate, microvessel density and vessel area as histopathological parameters. RESULTS Applying recursive partitioning conditional inference trees, only histopathological parameters could stratify the primary tumour entities. We identified two distinct BM growth patterns depending on their proliferative status: Ki67high BMs were larger (p = 0.02), showed less peritumoural oedema (p = 0.02) and showed a trend towards higher cell density (p = 0.05). Furthermore, Ki67high BMs were associated with higher DWI signals (p = 0.03) and reduced ADC values (p = 0.004). Vessel density was strongly reduced in Ki67high BM (p < 0.001). These features differentiated between lung cancer BM entities (p ≤ 0.03 for all features) with SCLCs representing predominantly the Ki67high group, while NSCLCs rather matching with Ki67low features. CONCLUSION Interpretable and easy to obtain MRI features may not be sufficient to predict directly the primary tumour entity of BM but seem to have the potential to aid differentiating high- and low-proliferative BMs, such as SCLC and NSCLC.
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Affiliation(s)
- Makoto Kiyose
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany ,Department of Neurology, University Hospital, Frankfurt am Main, Germany ,Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany
| | - Eva Herrmann
- Institute for Biostatistics and Mathematical Modelling, University Hospital, Frankfurt am Main, Germany
| | - Jenny Roesler
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany
| | - Pia S. Zeiner
- Department of Neurology, University Hospital, Frankfurt am Main, Germany ,Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany ,Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Joachim P. Steinbach
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany ,Senckenberg Institute of Neurooncology, University Hospital, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | | | - Karl H. Plate
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University, Frankfurt am Main, Germany
| | - Thomas J. Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Esch-sur-Alzette, Luxembourg ,Laboratoire National de Santé (LNS), Dudelange, Luxembourg ,Luxembourg Center of Neuropathology (LCNP), Dudelange, Luxembourg ,Department of Cancer Research (DoCR), Luxembourg Institute of Health (L.I.H.), Luxembourg, Luxembourg ,Department of Life Sciences and Medicine (DLSM), University of Luxembourg, Esch-sur-Alzette, Luxembourg ,Faculty of Science, Technology and Medicine (FSTM)S, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Stella Breuer
- Institute of Neuroradiology, University Hospital, Goethe University, Frankfurt am Main, Germany
| | - Patrick N. Harter
- Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,German Cancer Consortium (DKTK), Heidelberg, Germany ,German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - Simon Bernatz
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital, Goethe University, 60590 Frankfurt am Main, Germany ,Neurological Institute (Edinger Institute), University Hospital, Frankfurt, Frankfurt am Main, Germany ,Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt Am Main, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Béresová M, Larroza A, Arana E, Varga J, Balkay L, Moratal D. 2D and 3D texture analysis to differentiate brain metastases on MR images: proceed with caution. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2017; 31:285-294. [DOI: 10.1007/s10334-017-0653-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/24/2017] [Accepted: 09/11/2017] [Indexed: 11/25/2022]
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Cao Y, Tseng CL, Balter JM, Teng F, Parmar HA, Sahgal A. MR-guided radiation therapy: transformative technology and its role in the central nervous system. Neuro Oncol 2017; 19:ii16-ii29. [PMID: 28380637 DOI: 10.1093/neuonc/nox006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This review article describes advancement of magnetic resonance imaging technologies in radiation therapy planning, guidance, and adaptation of brain tumors. The potential for MR-guided radiation therapy to improve outcomes and the challenges in its adoption are discussed.
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Affiliation(s)
- Yue Cao
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James M Balter
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Feifei Teng
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Sakaguchi M, Maebayashi T, Aizawa T, Ishibashi N, Saito T. Patient outcomes of whole brain radiotherapy for brain metastases versus leptomeningeal metastases: A retrospective study. Asia Pac J Clin Oncol 2016; 13:e449-e457. [PMID: 27620060 DOI: 10.1111/ajco.12597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 12/01/2022]
Abstract
AIM Important factors typically associated with prognosis in brain metastases include Karnofsky performance status (KPS), extracranial or cerebellar localization and combination chemotherapy. However, few studies investigated the prognostic role of leptomeningeal metastases (LM) following whole brain radiotherapy (WBRT). On the basis of our experience suggesting better survival of asymptomatic patients with LM than those with brain metastases, we herein evaluated LM as a prognostic factor after WBRT. METHODS Medical records of 206 patients (median age, 65 years) who received WBRT in 2007-2015 were retrospectively reviewed. The two most common cancers were of lung, breast origin in 78.5%, 10%, patients, respectively. Patients received parallel-opposed WBRT, with a dose of 20-40 Gy. Additional doses of 9-12 Gy were used in patients who were operated on or had single metastases. Overall survival (OS) was determined, and clinical parameters including age, KPS, symptoms, radiation dose, dose per fraction, type of metastasis, extracranial metastases, primary status and surgery plus WBRT were assessed as prognostic factors. RESULTS The median survival was 6 months (range, 1-100), and 1- and 2-year survival rates were 28% and 17%, respectively. In univariate analysis, improved survival was associated with KPS of ≥70, absence of symptoms, radiation dose of ≥37.5 Gy, favorable primary lesion, LM, and surgery plus WBRT. Multivariate analysis revealed that these factors with the exception of radiation dose was significant prognostic factors for OS. CONCLUSION We found that LM were independent prognostic factors for good clinical outcomes.
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Affiliation(s)
- M Sakaguchi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - T Maebayashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - T Aizawa
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - N Ishibashi
- Department of Radiology, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan
| | - T Saito
- Sonodakai Radiation Oncology Clinic, Adachi-ku, Tokyo, Japan
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Characterization of passive permeability at the blood-tumor barrier in five preclinical models of brain metastases of breast cancer. Clin Exp Metastasis 2016; 33:373-83. [PMID: 26944053 DOI: 10.1007/s10585-016-9784-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/23/2016] [Indexed: 02/07/2023]
Abstract
The blood-brain barrier (BBB) is compromised in brain metastases, allowing for enhanced drug permeation into brain. The extent and heterogeneity of BBB permeability in metastatic lesions is important when considering the administration of chemotherapeutics. Since permeability characteristics have been described in limited experimental models of brain metastases, we sought to define these changes in five brain-tropic breast cancer cell lines: MDA-MB-231BR (triple negative), MDA-MB-231BR-HER2, JIMT-1-BR3, 4T1-BR5 (murine), and SUM190 (inflammatory HER2 expressing). Permeability was assessed using quantitative autoradiography and fluorescence microscopy by co-administration of the tracers (14)C-aminoisobutyric acid (AIB) and Texas red conjugated dextran prior to euthanasia. Each experimental brain metastases model produced variably increased permeability to both tracers; additionally, the magnitude of heterogeneity was different among each model with the highest ranges observed in the SUM190 (up to 45-fold increase in AIB) and MDA-MB-231BR-HER2 (up to 33-fold in AIB) models while the lowest range was observed in the JIMT-1-BR3 (up to 5.5-fold in AIB) model. There was no strong correlation observed between lesion size and permeability in any of these preclinical models of brain metastases. Interestingly, the experimental models resulting in smaller mean metastases size resulted in shorter median survival while models producing larger lesions had longer median survival. These findings strengthen the evidence of heterogeneity in brain metastases of breast cancer by utilizing five unique experimental models and simultaneously emphasize the challenges of chemotherapeutic approaches to treat brain metastases.
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Pérez-Ramírez Ú, Arana E, Moratal D. Brain metastases detection on MR by means of three-dimensional tumor-appearance template matching. J Magn Reson Imaging 2016; 44:642-52. [DOI: 10.1002/jmri.25207] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 02/09/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Úrsula Pérez-Ramírez
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; Valencia Spain
| | - Estanislao Arana
- Department of Radiology; Fundación Instituto Valenciano de Oncología; Valencia Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering; Universitat Politècnica de València; Valencia Spain
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Lee EK, Lee EJ, Kim S, Lee YS. Importance of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Various Intracranial Pathologic Conditions. Korean J Radiol 2016; 17:127-41. [PMID: 26798225 PMCID: PMC4720800 DOI: 10.3348/kjr.2016.17.1.127] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022] Open
Abstract
Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea.; Department of Radiology, College of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Eun Ja Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Sungwon Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Yong Seok Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
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Ruiz-Espana S, Jimenez-Moya A, Arana E, Moratal D. Functional diffusion map: A biomarker of brain metastases response to treatment based on magnetic resonance image analysis. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2015:4282-4285. [PMID: 26737241 DOI: 10.1109/embc.2015.7319341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Validated biomarkers for treatment response in patients suffering from brain metastases are needed in daily clinical practice as they may improve survival by providing reliable prognostic information and allowing alternative therapies. This work presents a new analysis tool for an early and non-invasive evaluation of treatment response in patients with brain metastases. A set of twenty-five metastases from sixteen patients were examined by T1-weighted and diffusion magnetic resonance imaging before starting radiotherapy and at least once after treatment. Diffusion MRI can show a correlation between water diffusion variation within metastasis area and its clinical evolution. Images were co-registered to pretreatment scans. Diffusion changes, resulting in spatially varying changes in apparent diffusion coefficient values of metastatic lesions, were quantified and presented as a functional diffusion map (fDM). These functional maps were compared to two traditional criteria for assessing oncological response. Of the twenty-five metastases analyzed, seven were classified as partial response (PR), eight as stable disease (SD) and nine as progressive disease (PD). Normalized volume values of the metastases for each response group were obtained, disclosing that apparent diffusion coefficient increase was a good predictor of response. Sensitivity was 88%, specificity 100%, positive predictive value 100% and negative predictive value was 94%. Outcome reveals that the implemented tool, based on functional diffusion mapping as evolution biomarker, provides a reliable prediction of metastases response to treatment.
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Szymańska A, Szymański M, Czekajska-Chehab E, Szczerbo-Trojanowska M. Non-paraganglioma tumors of the jugular foramen – Growth patterns, radiological presentation, differential diagnosis. Neurol Neurochir Pol 2015; 49:156-63. [DOI: 10.1016/j.pjnns.2015.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Neuroimaging studies are a valuable diagnostic tool in the evaluation of a patient with neuro-ophthalmic disease. This review provides an approach to selecting an appropriate imaging study and interpreting the results. RECENT FINDINGS MRI and CT are the imaging studies most commonly employed in neuro-ophthalmology. Each modality has unique strengths that make it particularly suitable in certain clinical situations. SUMMARY In the current practice of neuro-ophthalmology, the clinician must be familiar with the uses and limitations of neuroimaging studies so they can be used appropriately to improve diagnostic accuracy.
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Abstract
High-resolution magnetic resonance imaging (MRI) is invaluable for identifying cerebral tumors that cause epilepsy. Serial voxel-based automated quantitative analyses are more sensitive than visual reading for detecting change in a lesion. Eloquent cortex can be identified with functional MRI (fMRI), with cautions about the precise location and extent of critical cortex. Tractography is useful for delineating critical white matter tracks as are MR venography and computerized tomography (CT) angiography for displaying veins and arteries. These data may be combined into a three-dimensional (3D) multimodal MR data presentation and displayed interoperatively to increase the precision and minimize the risk of neurosurgical treatment, and for the illustrations.
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Affiliation(s)
- John S Duncan
- Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London, United Kingdom
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Berghoff AS, Spanberger T, Ilhan-Mutlu A, Magerle M, Hutterer M, Woehrer A, Hackl M, Widhalm G, Dieckmann K, Marosi C, Birner P, Prayer D, Preusser M. Preoperative diffusion-weighted imaging of single brain metastases correlates with patient survival times. PLoS One 2013; 8:e55464. [PMID: 23393579 PMCID: PMC3564927 DOI: 10.1371/journal.pone.0055464] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/23/2012] [Indexed: 11/18/2022] Open
Abstract
Background MRI-based diffusion-weighted imaging (DWI) visualizes the local differences in water diffusion in vivo. The prognostic value of DWI signal intensities on the source images and apparent diffusion coefficient (ADC) maps respectively has not yet been studied in brain metastases (BM). Methods We included into this retrospective analysis all patients operated for single BM at our institution between 2002 and 2010, in whom presurgical DWI and BM tissue samples were available. We recorded relevant clinical data, assessed DWI signal intensity and apparent diffusion coefficient (ADC) values and performed histopathological analysis of BM tissues. Statistical analyses including uni- and multivariate survival analyses were performed. Results 65 patients (34 female, 31 male) with a median overall survival time (OS) of 15 months (range 0–99 months) were available for this study. 19 (29.2%) patients presented with hyper-, 3 (4.6%) with iso-, and 43 (66.2%) with hypointense DWI. ADCmean values could be determined in 32 (49.2%) patients, ranged from 456.4 to 1691.8*10−6 mm2/s (median 969.5) and showed a highly significant correlation with DWI signal intensity. DWI hyperintensity correlated significantly with high amount of interstitial reticulin deposition. In univariate analysis, patients with hyperintense DWI (5 months) and low ADCmean values (7 months) had significantly worse OS than patients with iso/hypointense DWI (16 months) and high ADCmean values (30 months), respectively. In multivariate survival analysis, high ADCmean values retained independent statistical significance. Conclusions Preoperative DWI findings strongly and independently correlate with OS in patients operated for single BM and are related to interstitial fibrosis. Inclusion of DWI parameters into established risk stratification scores for BM patients should be considered.
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Affiliation(s)
- Anna Sophie Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Thomas Spanberger
- Department of Radiology, Division of Neuroradiology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Aysegül Ilhan-Mutlu
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Manuel Magerle
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Markus Hutterer
- Department of Neurology, Wilhelm Sander NeuroOncology Therapy Unit, University Hospital Regensburg, Regensburg, Germany
| | - Adelheid Woehrer
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Monika Hackl
- Austrian National Cancer Registry, Statistics Austria, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Christine Marosi
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Peter Birner
- Clinical Institute of Clinical Pathology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Daniela Prayer
- Department of Radiology, Division of Neuroradiology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
| | - Matthias Preusser
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center CNS Tumors Unit, Medical University of Vienna, Vienna, Austria
- * E-mail:
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