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Okon II, Gbayisomore TJ, Kankam SB, Jalloh M. Letter to the Editor Regarding Cerebral Blood Flow Role in Delineating Treatment Effect from True Tumor Progression in Glioblastoma Multiforme. World Neurosurg 2024; 186:269. [PMID: 38849997 DOI: 10.1016/j.wneu.2024.03.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Inibehe Ime Okon
- Department of Neurosurgery, Evoke Neurosurgery (ENS), Bukavu, DR Congo
| | | | - Samuel Berchi Kankam
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Harvard T.H Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
| | - Mohammad Jalloh
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Ma H, Zeng S, Xie D, Zeng W, Huang Y, Mazu L, Zhu N, Yang Z, Chu J, Zhao J. Looking through the imaging perspective: the importance of imaging necrosis in glioma diagnosis and prognostic prediction - single centre experience. Radiol Oncol 2024; 58:23-32. [PMID: 38378035 PMCID: PMC10878771 DOI: 10.2478/raon-2024-0014] [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: 09/19/2023] [Accepted: 12/01/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The aim of the study was to investigate the diagnostic value of imaging necrosis (Imnecrosis) in grading, predict the genotype and prognosis of gliomas, and further assess tumor necrosis by dynamic contrast-enhanced MR perfusion imaging (DCE-MRI). PATIENTS AND METHODS We retrospectively included 150 patients (104 males, mean age: 46 years old) pathologically proved as adult diffuse gliomas and all diagnosis was based on the 2021 WHO central nervous system (CNS) classification. The pathological necrosis (Panecrosis) and gene mutation information were collected. All patients underwent conventional and DCE-MRI examinations and had been followed until May 31, 2021. The Imnecrosis was determined by two experienced neuroradiologists. DCE-MRI derived metric maps have been post-processed, and the mean value of each metric in the tumor parenchyma, peritumoral and contralateral area were recorded. RESULTS There was a strong degree of inter-observer agreement in defining Imnecrosis (Kappa = 0.668, p < 0.001) and a strong degree of agreement between Imnecrosis and Panecrosis (Kappa = 0.767, p < 0.001). Compared to low-grade gliomas, high-grade gliomas had more Imnecrosis (85.37%, p < 0.001), and Imnecrosis significantly increased with the grade of gliomas increasing. And Imnecrosis was significantly more identified in IDH-wildtype, 1p19q-non-codeletion, and CDKN2A/B-homozygous-deletion gliomas. Using multivariate Cox regression analysis, Imnecrosis was an independent and unfavorable prognosis factor (Hazard Ratio = 2.113, p = 0.046) in gliomas. Additionally, extravascular extracellular volume fraction (ve) in tumor parenchyma derived from DCE-MRI demonstrated the highest diagnostic efficiency in identifying Panecrosis and Imnecrosis with high specificity (83.3% and 91.9%, respectively). CONCLUSIONS Imnecrosis can provide supplementary evidence beyond Panecrosis in grading, predicting the genotype and prognosis of gliomas, and ve in tumor parenchyma can help to predict tumor necrosis with high specificity.
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Affiliation(s)
- Hui Ma
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Shanmei Zeng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Dingxiang Xie
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Wenting Zeng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yingqian Huang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Liwei Mazu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Nengjin Zhu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zhiyun Yang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jianping Chu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Jing Zhao
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China
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Young JS, Morshed RA, Hervey-Jumper SL, Berger MS. The surgical management of diffuse gliomas: Current state of neurosurgical management and future directions. Neuro Oncol 2023; 25:2117-2133. [PMID: 37499054 PMCID: PMC10708937 DOI: 10.1093/neuonc/noad133] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Indexed: 07/29/2023] Open
Abstract
After recent updates to the World Health Organization pathological criteria for diagnosing and grading diffuse gliomas, all major North American and European neuro-oncology societies recommend a maximal safe resection as the initial management of a diffuse glioma. For neurosurgeons to achieve this goal, the surgical plan for both low- and high-grade gliomas should be to perform a supramaximal resection when feasible based on preoperative imaging and the patient's performance status, utilizing every intraoperative adjunct to minimize postoperative neurological deficits. While the surgical approach and technique can vary, every effort must be taken to identify and preserve functional cortical and subcortical regions. In this summary statement on the current state of the field, we describe the tools and technologies that facilitate the safe removal of diffuse gliomas and highlight intraoperative and postoperative management strategies to minimize complications for these patients. Moreover, we discuss how surgical resections can go beyond cytoreduction by facilitating biological discoveries and improving the local delivery of adjuvant chemo- and radiotherapies.
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Affiliation(s)
- Jacob S Young
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Ramin A Morshed
- Department of Neurological Surgery, University of California, San Francisco, USA
| | | | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, USA
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Fults DW. Commentary: Occurrence, Risk Factors, and Consequences of Postoperative Ischemia After Glioma Resection: A Retrospective Study. Neurosurgery 2023; 92:e5-e6. [PMID: 36170171 DOI: 10.1227/neu.0000000000002173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Daniel W Fults
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Waqar M, Van Houdt PJ, Hessen E, Li KL, Zhu X, Jackson A, Iqbal M, O’Connor J, Djoukhadar I, van der Heide UA, Coope DJ, Borst GR. Visualising spatial heterogeneity in glioblastoma using imaging habitats. Front Oncol 2022; 12:1037896. [PMID: 36505856 PMCID: PMC9731157 DOI: 10.3389/fonc.2022.1037896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022] Open
Abstract
Glioblastoma is a high-grade aggressive neoplasm characterised by significant intra-tumoral spatial heterogeneity. Personalising therapy for this tumour requires non-invasive tools to visualise its heterogeneity to monitor treatment response on a regional level. To date, efforts to characterise glioblastoma's imaging features and heterogeneity have focussed on individual imaging biomarkers, or high-throughput radiomic approaches that consider a vast number of imaging variables across the tumour as a whole. Habitat imaging is a novel approach to cancer imaging that identifies tumour regions or 'habitats' based on shared imaging characteristics, usually defined using multiple imaging biomarkers. Habitat imaging reflects the evolution of imaging biomarkers and offers spatially preserved assessment of tumour physiological processes such perfusion and cellularity. This allows for regional assessment of treatment response to facilitate personalised therapy. In this review, we explore different methodologies to derive imaging habitats in glioblastoma, strategies to overcome its technical challenges, contrast experiences to other cancers, and describe potential clinical applications.
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Affiliation(s)
- Mueez Waqar
- Department of Neurosurgery, Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Petra J. Van Houdt
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Eline Hessen
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Ka-Loh Li
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Xiaoping Zhu
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Alan Jackson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
- Department of Neuroradiology, Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Mudassar Iqbal
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - James O’Connor
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ibrahim Djoukhadar
- Department of Neuroradiology, Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Uulke A. van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, Netherlands
| | - David J. Coope
- Department of Neurosurgery, Geoffrey Jefferson Brain Research Centre, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
| | - Gerben R. Borst
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health and Manchester Cancer Research Centre, University of Manchester, Manchester, United Kingdom
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
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Scola E, Desideri I, Bianchi A, Gadda D, Busto G, Fiorenza A, Amadori T, Mancini S, Miele V, Fainardi E. Assessment of brain tumors by magnetic resonance dynamic susceptibility contrast perfusion-weighted imaging and computed tomography perfusion: a comparison study. LA RADIOLOGIA MEDICA 2022; 127:664-672. [PMID: 35441970 DOI: 10.1007/s11547-022-01470-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/11/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the association and agreement between magnetic resonance dynamic susceptibility contrast perfusion-weighted imaging (DSC-PWI) and computed tomography perfusion (CTP) in determining vascularity and permeability of primary and secondary brain tumors. MATERIAL AND METHODS DSC-PWI and CTP studies from 97 patients with high-grade glioma, low-grade glioma and solitary brain metastasis were retrospectively reviewed. Normalized cerebral blood flow (nCBF), cerebral blood volume (nCBV), capillary transfer constant (nK2) and permeability surface area product (nPS) values were obtained. Variables among groups were compared, and correlation and agreement between DSC-PWI and CTP were tested. RESULTS All DSC-PWI and CTP parameters were higher in high-grade than in low-grade gliomas (p < 0.01 and p < 0.001). Metastases had greater DSC-PWI nCBV (p < 0.05), nCTP-CBF (p < 0.05), nCTP-CBV (p < 0.01) and nCTP-PS (p < 0.0001) than low-grade gliomas and more elevated nCTP-PS (p < 0.01) than high-grade gliomas. The correlation was strong between DSC-PWI nCBF and CTP nCBF (r = 0.79; p < 0.00001) and between DSC-PWI nCBV and CTP nCBV (r = 0.83; p < 0.00001), weaker between DSC-PWI nK2 and CTP nPS (r = 0.29; p < 0.01). Bland-Altman plots indicated that the agreement was strong between DSC-PWI nCBF and CTP nCBF, good between DSC-PWI nCBV and CTP nCBV and poorer between DSC-PWI nK2 and CTP nPS. CONCLUSION DSC-PWI and CTP CBF and CBV maps were comparable and interchangeable in the assessment of tumor vascularity, unlike DSC-PWI K2 and CTP PS maps that were more discordant in the analysis of tumor permeability. CTP could be an alternative method to quantify tumor neoangiogenesis when MRI is not available or when the patient does not tolerate it.
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Affiliation(s)
- Elisa Scola
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy.
| | - Ilaria Desideri
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Bianchi
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Davide Gadda
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Giorgio Busto
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy
| | - Alessandro Fiorenza
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Amadori
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Sara Mancini
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Struttura Organizzativa Dipartimentale di Neuroradiologia, Dipartimento di Radiologia, Ospedale Universitario Careggi, Largo Brambilla 3, 50134, Florence, Italy.,Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
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Chakwizira A, Ahlgren A, Knutsson L, Wirestam R. Non-parametric deconvolution using Bézier curves for quantification of cerebral perfusion in dynamic susceptibility contrast MRI. MAGNETIC RESONANCE MATERIALS IN PHYSICS, BIOLOGY AND MEDICINE 2022; 35:791-804. [PMID: 35025071 PMCID: PMC9463354 DOI: 10.1007/s10334-021-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/03/2022]
Abstract
Objective Deconvolution is an ill-posed inverse problem that tends to yield non-physiological residue functions R(t) in dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI). In this study, the use of Bézier curves is proposed for obtaining physiologically reasonable residue functions in perfusion MRI. Materials and methods Cubic Bézier curves were employed, ensuring R(0) = 1, bounded-input, bounded-output stability and a non-negative monotonically decreasing solution, resulting in 5 parameters to be optimized. Bézier deconvolution (BzD), implemented in a Bayesian framework, was tested by simulation under realistic conditions, including effects of arterial delay and dispersion. BzD was also applied to DSC-MRI data from a healthy volunteer. Results Bézier deconvolution showed robustness to different underlying residue function shapes. Accurate perfusion estimates were observed, except for boxcar residue functions at low signal-to-noise ratio. BzD involving corrections for delay, dispersion, and delay with dispersion generally returned accurate results, except for some degree of cerebral blood flow (CBF) overestimation at low levels of each effect. Maps of mean transit time and delay were markedly different between BzD and block-circulant singular value decomposition (oSVD) deconvolution. Discussion A novel DSC-MRI deconvolution method based on Bézier curves was implemented and evaluated. BzD produced physiologically plausible impulse response, without spurious oscillations, with generally less CBF underestimation than oSVD. Supplementary Information The online version contains supplementary material available at 10.1007/s10334-021-00995-0.
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Affiliation(s)
- Arthur Chakwizira
- Department of Medical Radiation Physics, Skåne University Hospital, Lund University, 22185, Lund, Sweden
| | - André Ahlgren
- Department of Medical Radiation Physics, Skåne University Hospital, Lund University, 22185, Lund, Sweden
- AMRA Medical AB, Linköping, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Skåne University Hospital, Lund University, 22185, Lund, Sweden
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ronnie Wirestam
- Department of Medical Radiation Physics, Skåne University Hospital, Lund University, 22185, Lund, Sweden.
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