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Liu J, Tu J, Xu L, Liu F, Lu Y, He F, Li A, Li Y, Liu S, Xiong J. MRI-based radiomics signatures for preoperative prediction of Ki-67 index in primary central nervous system lymphoma. Eur J Radiol 2024; 178:111603. [PMID: 38976966 DOI: 10.1016/j.ejrad.2024.111603] [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: 03/14/2024] [Revised: 04/30/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024]
Abstract
PURPOSE The aim of this study was to develop and validate radiomics signatures based on MRI for preoperative prediction of Ki-67 proliferative index (PI) expression in primary central nervous system lymphoma (PCNSL). METHODS A total of 341 patients with PCNSL were retrospectively analyzed, including 286 patients in one center as the training set and 55 patients in another two centers as the external validation set. Radiomics features were extracted and selected from preoperative contrast-enhanced T1-weighted images, fluid attenuation inversion recovery to build radiomics signatures according to the Ki-67 PI. The predictive performances of the radiomics model were evaluated using four classifiers including random forest, K-Nearest Neighbors, Neural Network and Decision Tree. A combined model was built by incorporating radiomics signature, clinical variables and MRI radiological characteristics using multivariate logistic regression analysis, and a nomogram was established to predict the expression of Ki-67 individually. The predictive performances of the models were evaluated using area under receiver operating characteristic curve (AUC) and decision curve analysis (DCA). RESULTS Radiomics signatures were independent predictors of the expression level of Ki-67 (OR: 2.523, P < 0.001). RF radiomics models had the highest accuracy (0.934 in the training set and 0.811 in the external validation set) and F1 Score (0.920 in the training set and 0.836 in the external validation set). The clinic-radiologic-radiomics nomogram showed better predictive performance with AUCs of 0.877(95 % CI: 0.837-0.918) in the training set and 0.866(95 % CI: 0.774-0.957) in the external validation set. The calibration curve and DCA demonstrated goodness-of-fit and improved benefits in clinical practice of the nomogram. CONCLUSIONS Nomograms integrating MRI-based radiomics and clinical-radiological characteristics could effectively predict Ki-67 PI in primary PCNSL.
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Affiliation(s)
- Jianpeng Liu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiaqi Tu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Linghui Xu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fangfei Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital, Shandong First Medical University, Tai'an, Shandong, China
| | - Yucheng Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Fanru He
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Anning Li
- Department of Radiology, Qilu Hospital, Shandong University, Jinan, Shandong, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuyong Liu
- Department of Nuclear Medicine, The Second Affiliated Hospital, Shandong First Medical University, Tai'an, Shandong, China.
| | - Ji Xiong
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China.
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Qi H, Zheng Y, Li J, Chen K, Zhou L, Luo D, Huang S, Zhang J, Lv Y, Tian Z. Correlation of functional magnetic resonance imaging features of primary central nervous system lymphoma with vasculogenic mimicry and reticular fibers. Heliyon 2024; 10:e32111. [PMID: 38947483 PMCID: PMC11214443 DOI: 10.1016/j.heliyon.2024.e32111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Objective To deepen the imaging-pathological mechanism of primary central nervous system lymphoma (PCNSL) and provide a theoretical basis for clinical diagnosis and treatment, the functional magnetic resonance imaging (fMRI) characteristics of PCNSL were analyzed, and the relationship between the fMRI characteristics and vasculogenic mimicry (VM) and reticular fiber in PCNSL was discussed. Methods Ninety-six patients with PCNSL treated in our hospital were divided into three groups according to the pathological examination results, including strong positive group of VM (n = 40), weak positive group of VM (n = 56), strong positive group of reticular fiber (n = 45) and weak positive group of reticular fiber (n = 51). The levels of augmentation index and apparent diffusion coefficient (ADC) were compared among the groups. receiver operator characteristic (ROC) curve analysis was used to analyze the clinical value of ADC value in differential diagnosis of PCNSL. Results The levels of augmentation index in the strong positive group of VM were significantly higher than that in the weak positive group of VM, and the ADC value in the strong positive group of VM was significantly lower than that in the weak positive group of VM (P < 0.001). The levels of augmentation index in the strong positive group of reticular fiber were significantly higher than that in the weak positive group of reticular fiber, and ADC value in the strong positive group of reticular fiber was significantly lower than that in reticular fiber weak positive group (P < 0.001). Pearson correlation analysis showed that the levels of augmentation index were positively correlated with VM and reticular fiber (r = 0.529, 0.548, P < 0.001) and the ADC value was negatively correlated with VM and reticular fiber (r = -0.485, -0.513, P < 0.001). There was a significant negative correlation between necrotic lesions and VM (r = -0.185, P < 0.05). The area under the curve (AUC) values of average ADC value, minimum ADC value, and maximum ADC value for individual differential diagnosis of PCNSL were 0.920, 0.901, and 0.702, while the AUC of the combined differential diagnosis was 0.985, with a sensitivity of 95.00 % and a specificity of 92.70 %. Conclusion The levels of augmentation index and the ADC value of PCNSL focus are significantly correlated with VM and reticular fiber, and there is a strong negative correlation between necrotic lesions and VM. MRI imaging technology is of great significance in revealing the biological behavior of PCNSL, which can effectively reveal the relationship between VM and reticular fibers and the MRI characteristics in PCNSL, thereby providing a new imaging basis for the clinical diagnosis and treatment of PCNSL.
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Affiliation(s)
- Huaiju Qi
- Department of Emergency, Shapingba Hospital, Chongqing University. people’s hospital of Shapingba district, 400033, Chongqing, China
| | - Yu Zheng
- Department of Oncology, Chongqing Hospital of Traditional Chinese Medicine, 400000, Chongqing, China
| | - Jiansheng Li
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Kaixuan Chen
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Li Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, China
| | - Dilin Luo
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Shan Huang
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Jiahui Zhang
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Yongge Lv
- Department of Radiology, Shenzhen Hospital of Integrated Traditional and Western Medicine, Shenzhen, Guangdong, 518104, China
| | - Zhu Tian
- Department of Emergency, Shapingba Hospital, Chongqing University. people’s hospital of Shapingba district, 400033, Chongqing, China
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Heo J, Choi HY, Park J. Successful Management of Refractory Kimura Disease with CVP Chemotherapy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e942753. [PMID: 38282341 PMCID: PMC10838562 DOI: 10.12659/ajcr.942753] [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: 10/03/2023] [Revised: 12/21/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Kimura disease is a rare, chronic inflammatory disorder typically presenting as a painless mass in the head or neck and associated with elevated serum immunoglobulin E and blood and tissue eosinophilia. Generally benign, its management is not well-defined, but corticosteroids are a common initial treatment. We detail a case of refractory Kimura disease successfully managed with CVP (Cyclophosphamide, Vincristine, Prednisone) chemotherapy and no recurrence during 6 rounds of treatment. CASE REPORT A 64-year-old woman, previously diagnosed with Kimura disease, returned to the hospital with upper eyelid ptosis. Upon examination, a solid mass was palpable in her left upper eyelid. Peripheral blood tests confirmed elevated IgE levels at 356.0 IU/ml. An excisional biopsy showed infiltration of lymphocytes and eosinophils, consistent with Kimura disease. Despite undergoing corticosteroid treatment, surgical debulking, radiation, and immunosuppressant therapy, her condition worsened. Concerns were raised due to imaging features suggestive of lymphoma, although no malignancy was evident in subsequent biopsies. It was decided to manage the disease using CVP chemotherapy, leading to significant symptom improvement. There have been no recurrences during the 12-month follow-up period. CONCLUSIONS Kimura disease is typically benign and responsive to treatment, but it often recurs and can progress. When symptoms are not controlled with conventional treatments, including corticosteroids, immunosuppressants, radiation, and surgical debulking, chemotherapy may be a reasonable option even when no definite signs of malignancy is identified. Further research is needed to explore the utility of CHOP and CVP in managing uncontrolled Kimura disease.
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Affiliation(s)
- Jun Heo
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
| | - Hee-young Choi
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Jungyul Park
- Department of Ophthalmology, Pusan National University College of Medicine, Busan, South Korea
- Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Würtemberger U, Diebold M, Rau A, Akgün V, Becker L, Beck J, Reinacher PC, Taschner CA, Reisert M, Fehrenbacher L, Erny D, Scherer F, Hohenhaus M, Urbach H, Demerath T. Advanced diffusion imaging reveals microstructural characteristics of primary CNS lymphoma, allowing differentiation from glioblastoma. Neurooncol Adv 2024; 6:vdae093. [PMID: 38946879 PMCID: PMC11214103 DOI: 10.1093/noajnl/vdae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024] Open
Abstract
Background Primary CNS lymphoma (PCNSL) and glioblastoma (GBM) both represent frequent intracranial malignancies with differing clinical management. However, distinguishing PCNSL from GBM with conventional MRI can be challenging when atypical imaging features are present. We employed advanced dMRI for noninvasive characterization of the microstructure of PCNSL and differentiation from GBM as the most frequent primary brain malignancy. Methods Multiple dMRI metrics including Diffusion Tensor Imaging, Neurite Orientation Dispersion and Density Imaging, and Diffusion Microstructure Imaging were extracted from the contrast-enhancing tumor component in 10 PCNSL and 10 age-matched GBM on 3T MRI. Imaging findings were correlated with cell density and axonal markers obtained from histopathology. Results We found significantly increased intra-axonal volume fractions (V-intra and intracellular volume fraction) and microFA in PCNSL compared to GBM (all P < .001). In contrast, mean diffusivity (MD), axial diffusivity (aD), and microADC (all P < .001), and also free water fractions (V-CSF and V-ISO) were significantly lower in PCNSL (all P < .01). Receiver-operating characteristic analysis revealed high predictive values regarding the presence of a PCNSL for MD, aD, microADC, V-intra, ICVF, microFA, V-CSF, and V-ISO (area under the curve [AUC] in all >0.840, highest for MD and ICVF with an AUC of 0.960). Comparative histopathology between PCNSL and GBM revealed a significantly increased cell density in PCNSL and the presence of axonal remnants in a higher proportion of samples. Conclusions Advanced diffusion imaging enables the characterization of the microstructure of PCNSL and reliably distinguishes PCNSL from GBM. Both imaging and histopathology revealed a relatively increased cell density and a preserved axonal microstructure in PCNSL.
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Affiliation(s)
- Urs Würtemberger
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Martin Diebold
- Institute of Neuropathology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
- IMM-PACT Clinician Scientist Program, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
- Department of Diagnostic and Interventional Radiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Veysel Akgün
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Lucas Becker
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Fraunhofer Institute for Laser Technology, Aachen, Germany
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christian A Taschner
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
- Department of Medical Physics, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Luca Fehrenbacher
- Institute of Neuropathology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Daniel Erny
- Institute of Neuropathology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Marc Hohenhaus
- Department of Neurosurgery, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center—University of Freiburg, University of Freiburg, Freiburg, Germany
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Onishi S, Yamasaki F, Amatya VJ, Takayasu T, Yonezawa U, Taguchi A, Ozono I, Khairunnisa NI, Takeshima Y, Horie N. Residual diffusion-weighted imaging hyperintense signal in primary central nervous system lymphoma can predict early recurrence. J Neurooncol 2023; 165:171-179. [PMID: 37831389 DOI: 10.1007/s11060-023-04473-6] [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: 08/22/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The treatment response of primary central nervous system lymphomas (PCNSLs) is mainly evaluated using postcontrast T1-weighted imaging (T1WI). Because poorly enhanced lesions may contain residual tumors, the combination of evaluation methods will potentially improve the accuracy of determining treatment effectiveness. In this study, we evaluated the usefulness of diffusion-weighted imaging (DWI) in predicting recurrence among patients with PCNSL who achieved complete response (CR)/unconfirmed CR (CRu). METHODS Fifty-four patients newly diagnosed with PCNSL who were treated at our institution and achieved CR/CRu at the end of treatment were included in this study. The patients were divided into two groups according to the presence or absence of residual DWI hyperintense signal at the tumor site at the end of treatment. Kaplan-Meier analysis was performed to analyze the median overall survival (OS) and progression-free survival (PFS). RESULTS The mean age of the 54 patients was 66.4 ± 13.3 years. The induction therapies were HD-MTX in 20 patients, R-MPV in 29 patients, and other chemotherapies in five patients. Radiotherapy was performed in 35 patients, high-dose cytarabine therapy in 14 patients, and autologous hematopoietic stem cell transplantation in one patient, and of the 54 patients, 10 had no consolidation therapy. The residual DWI hyperintense signal sign was observed in 18 patients. The R-MPV regimen was statistically associated with a lower rate of residual DWI hyperintense signal (p = 0.0453). The median PFS was statistically shorter in the residual DWI hyperintense signal group than in the non-residual DWI hyperintense signal group (14.0 months vs. 85.1 months) (p < 0.0001, log-rank test). CONCLUSION A residual DWI hyperintense signal at the end of treatment was statistically associated with shorter PFS. Among patients who achieved CR/CRu evaluated based on postcontrast T1WI, DWI could be a valuable additional sequence to predict the early recurrence of PCNSL.
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Affiliation(s)
- Shumpei Onishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Iori Ozono
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Novita Ikbar Khairunnisa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Chien HC, Yeh LR, Hung KC, Lim SW, Cheng CY, Lee YC, Chen JH, Ko CC. Pretreatment diffusion-weighted imaging for prediction of relapsed and refractory primary central nervous system lymphoma. Front Neurol 2023; 14:1227607. [PMID: 37638189 PMCID: PMC10447899 DOI: 10.3389/fneur.2023.1227607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives A subset of primary central nervous system lymphoma (PCNSL) has been shown to undergo an early relapsed/refractory (R/R) period after first-line chemotherapy. This study investigated the pretreatment clinical and MRI features to predict R/R in PCNSL, emphasizing the apparent diffusion coefficient (ADC) values in diffusion-weighted imaging (DWI). Methods This retrospective study investigated the pretreatment MRI features for predicting R/R in PCNSL. Only patients who had undergone complete preoperative and postoperative MRI follow-up studies were included. From January 2006 to December 2021, 52 patients from two medical institutions with a diagnosis of PCNSL were included (median follow-up time, 26.3 months). Among these, 24 (46.2%) had developed R/R (median time to relapse, 13 months). Cox proportional hazard regression analyses were performed to determine hazard ratios for all parameters. Results Significant predictors of R/R in PCNSL were female sex, complete response (CR) to first-line chemotherapy, and ADC value/ratio (p < 0.05). Cut-off points of ADC values and ADC ratios for prediction of R/R were 0.68 × 10-3 mm2/s and 0.97, with AUCs of 0.78 and 0.77, respectively (p < 0.05). Multivariate Cox proportional hazards analysis showed that failure of CR to first-line chemotherapy and low ADC values (<0.68 × 10-3 mm2/s) were significant risk factors for R/R, with hazard ratios of 5.22 and 14.45, respectively (p < 0.05). Kaplan-Meier analysis showed that lower ADC values and ratios predicted significantly shorter progression-free survival (p < 0.05). Conclusion Pretreatment ADC values in DWI offer quantitative valuable information for the treatment planning in PCNSL.
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Affiliation(s)
- Hsi-Cheng Chien
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
| | - Lee-Ren Yeh
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Medical Center, Chiali, Tainan, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Chung-Yu Cheng
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Chang Lee
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
| | - Jeon-Hor Chen
- Department of Medical Imaging, E-Da Hospital, Kaohsiung, Taiwan
- Department of Radiological Sciences, University of California, Irvine, Irvine, CA, United States
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Cornell I, Al Busaidi A, Wastling S, Anjari M, Cwynarski K, Fox CP, Martinez-Calle N, Poynton E, Maynard J, Thust SC. Early MRI Predictors of Relapse in Primary Central Nervous System Lymphoma Treated with MATRix Immunochemotherapy. J Pers Med 2023; 13:1182. [PMID: 37511795 PMCID: PMC10381964 DOI: 10.3390/jpm13071182] [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: 04/15/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Primary Central Nervous System Lymphoma (PCNSL) is a highly malignant brain tumour. We investigated dynamic changes in tumour volume and apparent diffusion coefficient (ADC) measurements for predicting outcome following treatment with MATRix chemotherapy in PCNSL. Patients treated with MATRix (n = 38) underwent T1 contrast-enhanced (T1CE) and diffusion-weighted imaging (DWI) before treatment, after two cycles and after four cycles of chemotherapy. Response was assessed using the International PCNSL Collaborative Group (IPCG) imaging criteria. ADC histogram parameters and T1CE tumour volumes were compared among response groups, using one-way ANOVA testing. Logistic regression was performed to examine those imaging parameters predictive of response. Response after two cycles of chemotherapy differed from response after four cycles; of the six patients with progressive disease (PD) after four cycles of treatment, two (33%) had demonstrated a partial response (PR) or complete response (CR) after two cycles. ADCmean at baseline, T1CE at baseline and T1CE percentage volume change differed between response groups (0.005 < p < 0.038) and were predictive of MATRix treatment response (area under the curve: 0.672-0.854). Baseline ADC and T1CE metrics are potential biomarkers for risk stratification of PCNSL patients early during remission induction therapy with MATRix. Standard interim response assessment (after two cycles) according to IPCG imaging criteria does not reliably predict early disease progression in the context of a conventional treatment approach.
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Affiliation(s)
- Isabel Cornell
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
| | - Ayisha Al Busaidi
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
- Neuroradiology Department, Kings College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Stephen Wastling
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Mustafa Anjari
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
- Radiology Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK
| | - Kate Cwynarski
- Haematology Department, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - Christopher P Fox
- School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | | | - Edward Poynton
- Haematology Department, University College London Hospitals NHS Foundation Trust, London NW1 2BU, UK
| | - John Maynard
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London WC1N 3BG, UK
| | - Steffi C Thust
- UCL Institute of Neurology, Department of Brain Rehabilitation and Repair, Queen Square, London WC1N 3BG, UK
- Precision Imaging Beacon, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
- Neuroradiology Department, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
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Gao J, Xu S, Ju H, Pan Y, Zhang Y. The potential application of MR-derived ADCmin values from 68Ga-DOTATATE and 18F-FDG dual tracer PET/MR as replacements for FDG PET in assessment of grade and stage of pancreatic neuroendocrine tumors. EJNMMI Res 2023; 13:10. [PMID: 36752942 PMCID: PMC9908795 DOI: 10.1186/s13550-023-00960-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND To evaluate the utility of 68Ga-DOTATATE and 18F-FDG PET/MR for prediction of grade and stage of pancreatic neuroendocrine tumors (PNETs), and to examine the correlation between parameters obtained from FDG PET and diffusion-weighted imaging (DWI) MR parameters. METHODS A retrospective study using 68Ga-DOTATATE and 18F-FDG PET/MR imaging was performed between April 2020 and May 2022 on 46 individuals with histologically confirmed PNETs. Metabolic tumor volume (MTV), maximum standardized uptake value (FSUVmax), and tumor lesion glycolysis (TLG) for FDG; somatostatin receptor density (SRD), maximum standardized uptake value (GSUVmax), and total lesion somatostatin receptor density (TLSRD) for DOTATATE; and minimum and mean apparent diffusion coefficient (ADCmin and ADCmean) values for MRI, respectively. We performed Spearman's correlation analysis to examine the links between these variables and primary tumor stage and grading. RESULTS Higher PNET grading was associated with higher FSUVmax, MTV, and TLG values (P < 0.05). TLG, SRD, ADCmin, and ADCmean values were correlated with N staging, while SRD, MTV, ADCmin, TLG, and ADCmean were associated with M staging. Notably, ADCmin was a negative correlation between FSUVmax (r = - 0.52; P < 0.001), MTV (r = - 0.50; P < 0.001), and TLG (r = - 0.56; P < 0.001). CONCLUSIONS This study highlights significant correlative relationships between FDG PET-derived parameters and ADCmin. ADCmin may offer utility as a tool for PNET staging and grading in lieu of FDG PET. 68Ga-DOTATATE PET/MR alone may be a sufficient alternative to dual tracer PET/MR when conducting grading and staging of primary PNETs.
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Affiliation(s)
- Jing Gao
- grid.16821.3c0000 0004 0368 8293Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025 China
| | - Si Xu
- grid.16821.3c0000 0004 0368 8293Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025 China
| | - Huijun Ju
- grid.16821.3c0000 0004 0368 8293Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025 China
| | - Yu Pan
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025, China.
| | - Yifan Zhang
- Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai, 200025, China.
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Gonçalves FG, Tierradentro-Garcia LO, Kim JDU, Zandifar A, Ghosh A, Viaene AN, Khrichenko D, Andronikou S, Vossough A. The role of apparent diffusion coefficient histogram metrics for differentiating pediatric medulloblastoma histological variants and molecular groups. Pediatr Radiol 2022; 52:2595-2609. [PMID: 35798974 DOI: 10.1007/s00247-022-05411-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/05/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Medulloblastoma, a high-grade embryonal tumor, is the most common primary brain malignancy in the pediatric population. Molecular medulloblastoma groups have documented clinically and biologically relevant characteristics. Several authors have attempted to differentiate medulloblastoma molecular groups and histology variants using diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) maps. However, literature on the use of ADC histogram analysis in medulloblastomas is still scarce. OBJECTIVE This study presents data from a sizable group of pediatric patients with medulloblastoma from a single institution to determine the performance of ADC histogram metrics for differentiating medulloblastoma variants and groups based on both histological and molecular features. MATERIALS AND METHODS In this retrospective study, we evaluated the distribution of absolute and normalized ADC values of medulloblastomas. Tumors were manually segmented and diffusivity metrics calculated on a pixel-by-pixel basis. We calculated a variety of first-order histogram metrics from the ADC maps, including entropy, minimum, 10th percentile, 90th percentile, maximum, mean, median, skewness and kurtosis, to differentiate molecular and histological variants. ADC values of the tumors were also normalized to the bilateral cerebellar cortex and thalami. We used the Kruskal-Wallis and Mann-Whitney U tests to evaluate differences between the groups. We carried out receiver operating characteristic (ROC) curve analysis to evaluate the areas under the curves and to determine the cut-off values for differentiating tumor groups. RESULTS We found 65 children with confirmed histopathological diagnosis of medulloblastoma. Mean age was 8.3 ± 5.8 years, and 60% (n = 39) were male. One child was excluded because histopathological variant could not be determined. In terms of medulloblastoma variants, tumors were classified as classic (n = 47), desmoplastic/nodular (n = 9), large/cell anaplastic (n = 6) or as having extensive nodularity (n = 2). Seven other children were excluded from the study because of incomplete imaging or equivocal molecular diagnosis. Regarding medulloblastoma molecular groups, there were: wingless (WNT) group (n = 7), sonic hedgehog (SHH) group (n = 14) and non-WNT/non-SHH (n = 36). Our results showed significant differences among the molecular groups in terms of the median (P = 0.002), mean (P = 0.003) and 90th percentile (P = 0.002) ADC histogram metrics. No significant differences among the various medulloblastoma histological variants were found. CONCLUSION ADC histogram analysis can be implemented as a complementary tool in the preoperative evaluation of medulloblastoma in children. This technique can provide valuable information for differentiating among medulloblastoma molecular groups. ADC histogram metrics can help predict medulloblastoma molecular classification preoperatively.
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Affiliation(s)
- Fabrício Guimarães Gonçalves
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Luis Octavio Tierradentro-Garcia
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Jorge Du Ub Kim
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Alireza Zandifar
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Adarsh Ghosh
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Angela N Viaene
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dmitry Khrichenko
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Savvas Andronikou
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Arastoo Vossough
- Department of Radiology, Division of Neuroradiology, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.,Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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10
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Thormann M, Surov A, Pech M, March C, Hass P, Damm R, Omari J. Local ablation of hepatocellular carcinoma by interstitial brachytherapy: prediction of outcome by diffusion-weighted imaging. Acta Radiol 2022; 64:1331-1340. [PMID: 36262039 DOI: 10.1177/02841851221129714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interstitial brachytherapy (iBT) has become a viable treatment option in the therapy of early and intermediate stage hepatocellular carcinoma (HCC). Prognostic imaging tools to predict patient outcome are missing. PURPOSE To assess the predictive value of baseline diffusion-weighted imaging in HCC before iBT with regard to local tumor control and overall survival (OS). MATERIAL AND METHODS We retrospectively identified 107 patients who underwent iBT for HCC from 2011 to 2018 from our database. Apparent diffusion coefficient (ADC) values for each treated lesion were analyzed in region of interest measurements. Additionally, explorative combined ratios adjusting total measured lesion area and mean measured lesion area per patient by ADC values were calculated. Measurements underwent a univariate and multivariate Cox regression analysis. The log rank test was then used to verify prognostic cutoff levels for median survival time. RESULTS A total of 189 lesions in 81 patients were measured. Median survival of patients was 46.0 months. Neither ADC parameter was indicative of local tumor control. Lesion size >5 cm was associated with lower local tumor control (hazard ratio [HR]=4.292, 95% confidence interval [CI]=1.285-14.331; P = 0.018). Average measured lesion area divided by ADCmin (ADCarea mean, min) was identified to independently predict OS (HR=1.994, 95% CI=1.172-3.392; P = 0.011). A cutoff based on the variable's median (0.29 × 10-4 AU) identified patients with poor outcome (OS 36 vs. 61 months) for lower ADCarea mean, min values as verified by the log-rank test (P = 0.040). CONCLUSION Pre-treatment ADCarea mean, min may serve as an independent predictor of OS in patients with HCC undergoing iBT.
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Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Christine March
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Clinic for Radiation Oncology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
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11
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Gihr G, Horvath-Rizea D, Kohlhof-Meinecke P, Ganslandt O, Henkes H, Härtig W, Donitza A, Skalej M, Schob S. Diffusion Weighted Imaging in Gliomas: A Histogram-Based Approach for Tumor Characterization. Cancers (Basel) 2022; 14:cancers14143393. [PMID: 35884457 PMCID: PMC9321540 DOI: 10.3390/cancers14143393] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Glioma represent approximately one-third of all brain tumors. Although they differ clinically, histologically and genetically, they often are not distinguishable by morphological magnetic resonance imaging (MRI) diagnostics. We therefore investigated in this retrospective study whether diffusion weighted imaging (DWI) using a radiomic approach could provide complementary information with respect to tumor differentiation and cell proliferation, as well as the underlying genetic and epigenetic tumor profile. We identified several histogram features that could facilitate presurgical tumor grading and potentially enable one to draw conclusions about tumor characteristics on a cellular and subcellular scale. Abstract (1) Background: Astrocytic gliomas present overlapping appearances in conventional MRI. Supplementary techniques are necessary to improve preoperative diagnostics. Quantitative DWI via the computation of apparent diffusion coefficient (ADC) histograms has proven valuable for tumor characterization and prognosis in this regard. Thus, this study aimed to investigate (I) the potential of ADC histogram analysis (HA) for distinguishing low-grade gliomas (LGG) and high-grade gliomas (HGG) and (II) whether those parameters are associated with Ki-67 immunolabelling, the isocitrate-dehydrogenase-1 (IDH1) mutation profile and the methylguanine-DNA-methyl-transferase (MGMT) promoter methylation profile; (2) Methods: The ADC-histograms of 82 gliomas were computed. Statistical analysis was performed to elucidate associations between histogram features and WHO grade, Ki-67 immunolabelling, IDH1 and MGMT profile; (3) Results: Minimum, lower percentiles (10th and 25th), median, modus and entropy of the ADC histogram were significantly lower in HGG. Significant differences between IDH1-mutated and IDH1-wildtype gliomas were revealed for maximum, lower percentiles, modus, standard deviation (SD), entropy and skewness. No differences were found concerning the MGMT status. Significant correlations with Ki-67 immunolabelling were demonstrated for minimum, maximum, lower percentiles, median, modus, SD and skewness; (4) Conclusions: ADC HA facilitates non-invasive prediction of the WHO grade, tumor-proliferation rate and clinically significant mutations in case of astrocytic gliomas.
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Affiliation(s)
- Georg Gihr
- Katharinenhospital Stuttgart, Clinic for Neuroradiology, 70174 Stuttgart, Germany; (D.H.-R.); (H.H.)
- Correspondence: (G.G.); (S.S.); Tel.: +49-711-2785-4454 (G.G.); +49-345-557-2342 (S.S.)
| | - Diana Horvath-Rizea
- Katharinenhospital Stuttgart, Clinic for Neuroradiology, 70174 Stuttgart, Germany; (D.H.-R.); (H.H.)
| | | | - Oliver Ganslandt
- Katharinenhospital Stuttgart, Clinic for Neurosurgery, 70174 Stuttgart, Germany;
| | - Hans Henkes
- Katharinenhospital Stuttgart, Clinic for Neuroradiology, 70174 Stuttgart, Germany; (D.H.-R.); (H.H.)
| | - Wolfgang Härtig
- Paul Flechsig Institute for Brain Research, University of Leipzig, 04103 Leipzig, Germany;
| | - Aneta Donitza
- Department for Neuroradiology, Clinic and Policlinic for Radiology, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (A.D.); (M.S.)
| | - Martin Skalej
- Department for Neuroradiology, Clinic and Policlinic for Radiology, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (A.D.); (M.S.)
| | - Stefan Schob
- Department for Neuroradiology, Clinic and Policlinic for Radiology, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (A.D.); (M.S.)
- Correspondence: (G.G.); (S.S.); Tel.: +49-711-2785-4454 (G.G.); +49-345-557-2342 (S.S.)
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12
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Brainstem lesions: MRI review of standard morphological sequences. Acta Neurol Belg 2022; 122:597-613. [PMID: 35428930 DOI: 10.1007/s13760-022-01943-y] [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: 07/29/2021] [Accepted: 03/23/2022] [Indexed: 11/01/2022]
Abstract
MRI signal changes in the brainstem are observed in a multitude of disorders including vascular diseases, neoplastic lesions, degenerative diseases, inflammatory disorders, metabolic diseases, infections, and trauma. In some diseases, brainstem involvement is typical and sometimes isolated, while in other diseases, brainstem lesions are only observed occasionally in the presence of other typical extra-brainstem abnormalities. In this review, we will discuss the MRI characteristics of brainstem lesions observed in different disorders associated with frequent and less frequent brainstem involvement. Identification of the origin of the brainstem lesion depends on the exact localisation of the lesion(s) inside the brainstem, the presence and the characteristics of associated lesions seen outside the brainstem, the signal changes on different MRI sequences, the evolution over time of the radiological abnormalities, the history and clinical state of the patient, and other radiological and non-radiological examinations.
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13
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Role of intra-tumoral vasculature imaging features on susceptibility weighted imaging in differentiating primary central nervous system lymphoma from glioblastoma: a multiparametric comparison with pathological validation. Neuroradiology 2022; 64:1801-1818. [DOI: 10.1007/s00234-022-02946-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/04/2022] [Indexed: 10/18/2022]
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14
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Calandrelli R, Pilato F, Massimi L, Gessi M, Panfili M, Colosimo C. Characterization of high-grade pineal region lesions: the usefulness of apparent diffusion coefficient volumetric values. Acta Radiol 2022; 63:222-231. [PMID: 33497274 DOI: 10.1177/0284185120986912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND High-grade pineal region tumors are rare and heterogeneous types of primary central nervous system neoplasms; radiological differential diagnosis is challenging but it is important because it has a therapeutic relevance. PURPOSE To discriminate among high-grade pineal region tumors by combining apparent diffusion coefficient (ADC) volumetric values and qualitative features in order to predict their histology. MATERIAL AND METHODS Twenty-two patients with high-grade pineal region tumors were assessed by qualitative and quantitative analysis. Margins, T2-weighted signal intensity, contrast enhancement, hemorrhage, calcifications, different volumetric ADC fractions (ADCmean, ADCmax, ADCmin) were evaluated and were compared to the histopathologic findings (cell count and proliferation index). RESULTS Our qualitative imaging data showed that only margins were different among different tumors and each tumor type showed peculiar age onset. ADCmean was found the best quantitative value to discriminate high-grade tumors of the pineal region. ADCmean correlated with proliferation index but not with cell count. ADCmean values were lower in tumors with higher proliferation rate and a significant difference in ADCmean values were found between germinomas and pineoblastomas, between germinomas and papillary tumors and between papillary tumors and pineoblastomas. Moreover, the cut-off value of 0.865 × 10-3 mm2/s for ADCmean (ADC mean threshold value) could differentiate germinoma from pineoblastomas with the best combination of sensitivity and specificity. CONCLUSION The ADCmean value measured on the whole tumor, reflecting tumor proliferative activity, may be a practical and non-invasive marker for predicting tumor histology in high-grade pineal region lesions and might be useful in preoperative assessment.
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Affiliation(s)
- Rosalinda Calandrelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
| | - Fabio Pilato
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Neurologia - Polo scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Area Neuroscienze, Rome, Italy
| | - Luca Massimi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Neurochirurgia Infantile - Polo scienze dell’invecchiamento, neurologiche, ortopediche e della testa-collo, Area Neuroscienze, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto di Neurochirurgia, Rome, Italy
| | - Marco Gessi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Anatomia Patologica- UOS Neuropatologia, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto di Anatomia Patologica, Rome, Italy
| | - Marco Panfili
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
| | - Cesare Colosimo
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma-UOC Radiologia e Neuroradiologia, Polo Diagnostica per immagini, radioterapia, oncologia ed ematologia, Area diagnostica per immagini, Rome, Italy
- Università Cattolica del Sacro Cuore, Istituto di Radiologia, Rome, Italy
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15
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Rai S, Raeesa F, Kamath M, Rai S, Pai M, Prabhu S. Multiparametric differentiation of intracranial central nervous system lymphoma and high-grade glioma using diffusion-, perfusion-, susceptibility-weighted magnetic resonance imaging, and spectroscopy. WEST AFRICAN JOURNAL OF RADIOLOGY 2022. [DOI: 10.4103/wajr.wajr_16_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Lin Y, Pan YH, Li MK, Zong XD, Pan XM, Tan SY, Guo YW. Clinical presentation of gastric Burkitt lymphoma presenting with paraplegia and acute pancreatitis: A case report. World J Gastroenterol 2021; 27:7844-7854. [PMID: 34963746 PMCID: PMC8661376 DOI: 10.3748/wjg.v27.i45.7844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/11/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of gastric Burkitt lymphoma (BL), presenting as paraplegia and acute pancreatitis, is extremely low. BL is a great masquerader that presents in varied forms and in atypical locations, and it is prone to misdiagnosis and missed diagnosis. The prognosis of BL remains poor because of the difficulty in early diagnosis and the limited advances in chemotherapy.
CASE SUMMARY A 53-year-old man was referred to our hospital from the local county hospital due to abdominal pain for two weeks and weakness in the lower extremities for one day. Magnetic resonance imaging of the abdomen and lumbar spine showed a swollen pancreas and gallbladder, with peripancreatic exudation and liquid collection, indicating acute pancreatitis and acute cholecystitis. Additionally, we observed abnormally thickened lesions of the gastric wall, multiple enlarged retroperitoneal lymph nodes and a well-demarcated, posterolateral extradural mass lesion between T9 and T12, with extension through the spinal foramen and definite bony destruction, suggesting metastasis in gastric malignancy. Subsequent whole-body positron emission tomography/computed tomography examination showed multifocal malignant lesions in the stomach, pancreas, gallbladder, bone, bilateral supraclavicular fossa, anterior mediastinum, bilateral axillary and retroperitoneal lymph nodes. Gastroduodenal endoscopy revealed primary BL with massive involvement of the gastric body and duodenum. The patient refused chemotherapeutic treatment and died one week later due to upper gastrointestinal hemorrhage. Afterward, we reviewed the characteristics of 11 patients with BL involving the stomach, pancreas or spinal cord.
CONCLUSION Clinicians should be aware that BL can be the potential cause of acute pancreatitis or a rapidly progressive spinal tumor with accompanying paraplegia. For gastric BL, gastroscopy biopsies and pathology are necessary for a definite diagnosis.
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Affiliation(s)
- Ying Lin
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Yu-Hang Pan
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Ming-Kai Li
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Xiao-Dan Zong
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Xue-Mei Pan
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Shu-Yan Tan
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
| | - Yun-Wei Guo
- Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
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The relationship between the apparent diffusion coefficient and the Ki-67 proliferation index in intracranial solitary fibrous tumor/hemangiopericytoma. Neurosurg Rev 2021; 45:1625-1633. [PMID: 34761325 DOI: 10.1007/s10143-021-01687-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
This study evaluated the value of the apparent diffusion coefficient (ADC) in distinguishing grade II and III intracranial solitary fibrous tumors/hemangiopericytomas and explored the correlation between ADC and Ki-67. The preoperative MRIs of 37 patients treated for solitary fibrous tumor/hemangiopericytoma (grade II, n = 15 and grade III, n = 22) in our hospital from 2011 to October 2020 were retrospectively analyzed. We compared the difference between the minimum, average, maximum, and relative ADCs based on tumor grade and examined the correlation between ADC and Ki-67. Receiver operating characteristic curve analysis was used to analyze the diagnostic efficiency of the ADC. There were significant differences in the average, minimum, and relative ADCs between grade II and III patients. The optimal cutoff value for the relative ADC value to differentiate grade II and III tumors was 0.998, which yielded an area under the curve of 0.879. The Ki-67 proliferation indexes of grade II and III tumors were significantly different, and the average (r = - 0.427), minimum (r = - 0.356), and relative (r = - 0.529) ADCs were significantly negatively correlated with the Ki-67 proliferation index. ADC can be used to differentiate grade II and III intracranial solitary fibrous tumors/hemangiopericytomas. Our results can be used to formulate a personalized surgical treatment plan before surgery.
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18
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Clinical applications of diffusion-weighted sequence in brain imaging: beyond stroke. Neuroradiology 2021; 64:15-30. [PMID: 34596716 PMCID: PMC8484843 DOI: 10.1007/s00234-021-02819-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/10/2021] [Indexed: 11/20/2022]
Abstract
Diffusion-weighted imaging (DWI) is a well-established MRI sequence for diagnosing early stroke and provides therapeutic implications. However, DWI yields pertinent information in various other brain pathologies and helps establish a specific diagnosis and management of other central nervous system disorders. Some of these conditions can present with acute changes in neurological status and mimic stroke. This review will focus briefly on diffusion imaging techniques, followed by a more comprehensive description of the utility of DWI in common neurological entities beyond stroke.
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19
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Nakamura M, Iwasa H, Kojima K. Central Nervous System Involvement in Mantle Cell Lymphoma Presenting Magnetic Resonance Imaging Features of Mild Encephalitis/Encephalopathy with a Reversible Splenial Lesion. Intern Med 2021; 60:1597-1600. [PMID: 33281168 PMCID: PMC8188036 DOI: 10.2169/internalmedicine.6386-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mild encephalitis/encephalopathy with reversible splenial lesion (MERS) has not been described in lymphoma patients. A 65-year-old man with refractory mantle cell lymphoma (MCL) presented typical MRI features of MERS. The patient's cerebrospinal fluid contained an increased number of reactive T-cells; a small number of MCL cells were detected by immunoglobulin heavy chain-polymerase chain reaction (IGH-PCR). His symptoms and the splenial lesion resolved in response to ibrutinib treatment, although the patient eventually died of progressive MCL with overt leptomeningeal disease. We suggest that central nervous system involvement in MCL can present clinicoradiological features of MERS and that ibrutinib could be a choice of treatment.
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Affiliation(s)
- Makoto Nakamura
- Department of Hematology, Kochi Medical School, Kochi University, Japan
| | - Hitomi Iwasa
- Department of Radiology, Kochi Medical School, Kochi University, Japan
| | - Kensuke Kojima
- Department of Hematology, Kochi Medical School, Kochi University, Japan
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20
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Gihr G, Horvath-Rizea D, Hekeler E, Ganslandt O, Henkes H, Hoffmann KT, Scherlach C, Schob S. Diffusion weighted imaging in high-grade gliomas: A histogram-based analysis of apparent diffusion coefficient profile. PLoS One 2021; 16:e0249878. [PMID: 33857203 PMCID: PMC8049265 DOI: 10.1371/journal.pone.0249878] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 03/26/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose Glioblastoma and anaplastic astrocytoma represent the most commonly encountered high-grade-glioma (HGG) in adults. Although both neoplasms are very distinct entities in context of epidemiology, clinical course and prognosis, their appearance in conventional magnetic resonance imaging (MRI) is very similar. In search for additional information aiding the distinction of potentially confusable neoplasms, histogram analysis of apparent diffusion coefficient (ADC) maps recently proved to be auxiliary in a number of entities. Therefore, our present exploratory retrospective study investigated whether ADC histogram profile parameters differ significantly between anaplastic astrocytoma and glioblastoma, reflect the proliferation index Ki-67, or are associated with the prognostic relevant MGMT (methylguanine-DNA methyl-transferase) promotor methylation status. Methods Pre-surgical ADC volumes of 56 HGG patients were analyzed by histogram-profiling. Association between extracted histogram parameters and neuropathology including WHO-grade, Ki-67 expression and MGMT promotor methylation status was investigated due to comparative and correlative statistics. Results Grade IV gliomas were more heterogeneous than grade III tumors. More specifically, ADCmin and the lowest percentile ADCp10 were significantly lower, whereas ADCmax, ADC standard deviation and Skewness were significantly higher in the glioblastoma group. ADCmin, ADCmax, ADC standard deviation, Kurtosis and Entropy of ADC histogram were significantly correlated with Ki-67 expression. No significant difference could be revealed by comparison of ADC histogram parameters between MGMT promotor methylated and unmethylated HGG. Conclusions ADC histogram parameters differ significantly between glioblastoma and anaplastic astrocytoma and show distinct associations with the proliferative activity in both HGG. Our results suggest ADC histogram profiling as promising biomarker for differentiation of both, however, further studies with prospective multicenter design are wanted to confirm and further elaborate this hypothesis.
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Affiliation(s)
- Georg Gihr
- Clinic for Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany
- * E-mail:
| | | | - Elena Hekeler
- Department for Pathology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Oliver Ganslandt
- Clinic for Neurosurgery, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Clinic for Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Karl-Titus Hoffmann
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Cordula Scherlach
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Schob
- Department for Radiology, University Hospital Halle (Saale), Halle (Saale), Germany
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21
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Li J, Zhou Y, Wang X, Yu Y, Zhou X, Luan K. Histogram Analysis of Diffusion-Weighted Magnetic Resonance Imaging as a Biomarker to Predict Lymph Node Metastasis in T3 Stage Rectal Carcinoma. Cancer Manag Res 2021; 13:2983-2993. [PMID: 33833581 PMCID: PMC8021267 DOI: 10.2147/cmar.s298907] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 03/03/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose This study investigated the predictive value of apparent diffusion coefficient (ADC) histogram parameters of the primary tumor for regional lymph node metastasis (LNM) in pathological T3 stage rectal cancer. Patients and Methods We retrospectively studied 175 patients with T3 stage rectal cancer who underwent preoperative MRI, including diffusion-weighted imaging, between January 2015 and October 2017. Based on pathological analysis of surgical specimens, 113 patients were classified into the LN− group and 62 in the LN+ group. We analyzed clinical data, radiological characteristics and histogram parameters derived from ADC maps. Then, receiver operating characteristic curve (ROC) analyses were generated to determine the best diagnostic performance. Results The mean (p=0.002, cutoff=1.08×10–3 s/mm2), coefficient of variation (CV) (p=0.040, cutoff=0.249) of the ADC map, carbohydrate antigen 199, and N stage with magnetic resonance (mrN stage) were independent factors for LNM. Combining these factors yielded the best diagnostic performance, with the area under the ROC curve of 0.838, 72.9% sensitivity, 79.1% specificity, 65.2% positive predictive value, and 84.5% negative predictive value. Conclusion With the mean >1.08×10–3 s/mm2 and CV <0.249, the ADC improved the diagnostic performance of LNM in T3 stage rectal cancer, which could assist surgeons with neoadjuvant chemoradiotherapy.
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Affiliation(s)
- Jin Li
- College of Intelligent Systems Science and Engineering, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Yang Zhou
- College of Intelligent Systems Science and Engineering, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, People's Republic of China.,Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Xinxin Wang
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Yanyan Yu
- Department of Radiology, Harbin Medical University Cancer Hospital, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Xueyan Zhou
- School of Technology, Harbin University, Harbin, 150001, Heilongjiang Province, People's Republic of China
| | - Kuan Luan
- College of Intelligent Systems Science and Engineering, Harbin Engineering University, Harbin, 150001, Heilongjiang Province, People's Republic of China
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22
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Bozdağ M, Er A, Ekmekçi S. Association of apparent diffusion coefficient with Ki-67 proliferation index, progesterone-receptor status and various histopathological parameters, and its utility in predicting the high grade in meningiomas. Acta Radiol 2021; 62:401-413. [PMID: 32397733 DOI: 10.1177/0284185120922142] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Accurate preoperative determination of the histological grade and cellular proliferative potential of meningioma by non-invasive imaging is of paramount importance. PURPOSE To evaluate the utility of apparent diffusion coefficient (ADC) in determining the histological grade of meningioma, and to investigate the correlation of ADC with Ki-67 proliferation index (PI), progesterone receptor (PR) status, and a number of other histopathological parameters. MATERIAL AND METHODS Histopathologically confirmed 94 meningioma patients (72 low-grade, 22 high-grade) who had undergone preoperative diffusion-weighted imaging were retrospectively evaluated. ADC values were obtained by manually drawing the regions of interest (ROIs) within the solid components of the tumor. The relationship between ADC and Ki-67 values, PR status, and multiple histopathological parameters were investigated, and the ADC values of high-grade and low-grade meningiomas were compared. Independent sample t-test, Mann-Whitney U test, receiver operating characteristic, Pearson correlation, and multiple logistic regression analysis were used for statistical assessment. RESULTS All ADC and rADC values were significantly lower in high-grade meningiomas than in low-grade meningiomas (all P < 0.05). ADC values showed significantly negative correlations with Ki-67 and mitotic index (P < 0.001 for each). Numerous ADC parameters were significantly lower in meningiomas demonstrating hypercellularity and necrosis features (P < 0.05). ADC values did not show a significant correlation with PR score (all P > 0.05). CONCLUSION ADC can be utilized as a reliable imaging biomarker for predicting the proliferative potential and histological grade in meningiomas.
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Affiliation(s)
- Mustafa Bozdağ
- Department of Radiology, Tepecik Training and Research Hospital, Konak, Izmir, Turkey
| | - Ali Er
- Department of Radiology, Tepecik Training and Research Hospital, Konak, Izmir, Turkey
| | - Sümeyye Ekmekçi
- Department of Pathology, Tepecik Training and Research Hospital, Konak, Izmir, Turkey
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The Correlation Between Apparent Diffusion Coefficient (ADC) and Relative Cerebral Blood Volume (rCBV) with Ki-67 Expression in Central Nervous System Lymphoma. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2020. [DOI: 10.5812/ijcm.107834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: Central nervous system (CNS) lymphoma presents as the dense infiltration of tumor cells in the perivascular space and blood-brain barrier disruption, on histopathological examination. The Ki-67 expression has been significantly correlated with tumor proliferation and is considered to be a prognostic factor. Objectives: This study aimed at analyzing the correlations among the apparent diffusion coefficient (ADC), the relative cerebral blood volume (rCBV), and the Ki-67 proliferation index in CNS lymphoma. Methods: From August 2019 to March 2020, 26 patients (14 men and 12 women) who underwent biopsy or surgery and were histologically confirmed as CNS lymphoma were included in this retrospective study. Diffusion and perfusion acquisitions were performed in 26 and 10 examinations, respectively. The Ki-67 proliferation index was available for all cases. Results: The mean tADC, rADC, and rCBV values were 0.61 ± 0.12 × 10-3 mm2/s, 0.73 ± 0.14, and 1.1 ± 0.32, respectively. Negative correlations were identified between both tADC and rADC and the Ki-67 proliferation index (r = -0.656, P < 0.01 and r = -0.540, P < 0.01, respectively). No significant correlations were found between rCBV values and the Ki-67 proliferation index, between rCBV and rADC, or between rCBV and tADC. Conclusions: tADC and rADC values can be used as noninvasive indicators to predict cell proliferation in CNS lymphoma.
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Khan B, Chong I, Ostrom Q, Ahmed S, Dandachi D, Kotrotsou A, Colen R, Morón F. Diffusion-weighted MR imaging histogram analysis in HIV positive and negative patients with primary central nervous system lymphoma as a predictor of outcome and tumor proliferation. Oncotarget 2020; 11:4093-4103. [PMID: 33227089 PMCID: PMC7665236 DOI: 10.18632/oncotarget.27800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/17/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Ki-67 expression, a marker of tumor proliferation, is considered a prognostic factor in primary CNS lymphoma (PCNSL). Apparent diffusion coefficient (ADC) parameters have also been proposed as imaging biomarkers for tumor progression and proliferative activity in various malignancies. The aim of this study is to investigate the correlation between ADC parameters, Ki-67 expression, overall survival (OS) and progression free survival (PFS) in PCNSL. MATERIALS AND METHODS Patients diagnosed with PCNSL at MD Anderson Cancer Center between Mar 2000 and Jul 2016 and at Ben Taub Hospital between Jan 2012 and Dec 2016 were retrospectively studied. Co-registered ADC maps and post-contrast images underwent whole tumor segmentation. Normalized ADC parameters (nADC) were calculated as the ratio to normal white matter. Percentiles of nADC were calculated and were correlated with Ki-67 using Pearson's correlation coefficient and clinical outcomes (OS and PFS) using Cox proportional hazards models. RESULTS Selection criteria yielded 90 patients, 23 patients living with HIV (PLWH) and 67 immunocompetent patients. Above median values for nADCmean, nADC15, nADC75 and nADC95 were associated with improved OS in all patients (p < 0.05). Above median values for nADCmin, nADCmean, nADC1, nADC5 and kurtosis were associated with improved PFS in all patients (p < 0.05). In patients with available Ki-67 expression data (n = 22), nADCmean, nADC15 and nADC75 inversely correlated with Ki-67 expression (p < 0.05). For PLWH, there was no correlation between ADC parameters and Ki-67 expression or clinical outcomes. CONCLUSIONS ADC histogram analysis can predict tumor proliferation and survival in immunocompetent patients with PCNSL, but with limited utility in PLWH.
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Affiliation(s)
- Bilal Khan
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Insun Chong
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Quinn Ostrom
- Department of Medicine, Section of Epidemiology and Population Sciences, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Sara Ahmed
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Dima Dandachi
- Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, MO, USA
| | - Aikaterini Kotrotsou
- Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA.,Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas at MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka Colen
- Department of Radiology, Neuroradiology Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Fanny Morón
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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Dynamic contrast-enhanced magnetic resonance imaging biomarkers predict chemotherapeutic responses and survival in primary central-nervous-system lymphoma. Eur Radiol 2020; 31:1863-1871. [PMID: 32997181 DOI: 10.1007/s00330-020-07296-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/03/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the utility of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in predicting the response of chemotherapy and clinical outcomes in primary central-nervous-system lymphoma (PCNSL) patients. METHODS DCE-MRI in 56 patients enrolled in a prospective study was performed at baseline and 30 days after treatment from 2016 to 2019. Multivariate logistic regression analyses were performed to assess risk factors for tumor responses. The predictive values of related parameters derived from DCE were analyzed via receiver operating characteristic (ROC) curve analysis. To evaluate prognostic factors, the Kaplan-Meier survival analysis with log-rank tests and Cox regression tests were analyzed. RESULTS Ktrans and Ve were higher in the non-response group than in the response group (p < 0.05). The Ktrans and the percentage of Ktrans decreased after 30 days of treatment were independent predictors of chemotherapy responses (p = 0.034 and p = 0.019). ROC analysis indicated that the cut-off point of Ktrans for predicting chemotherapeutic responses was 0.353 min-1 (AUC, 0.941; 95% CI, 0.87-1; p < 0.001) and percentage of Ktrans decreased after 30 days of treatment was 15.2% (AUC, 0.858; 95% CI, 0.742-0.970; p < 0.001). The greater decrease in Ktrans correlated with a longer progression-free survival (PFS) (χ2 = 13.203, p < 0.001). The higher Ktrans was an independent predictor for shorter PFS (hazard ratio, 10.182; 95% CI, 2.510-41.300; p = 0.001). CONCLUSIONS Ktrans and Ktrans change measured by DCE-MRI were reliable biomarkers for predicting chemotherapy responses in PCNSL patients. KEY POINTS • Baseline Ktrans and greater decrease in Ktrans can predict chemotherapeutic efficacy. • DCE-MRI provides quantitative parameters reflecting the tumor microenvironment. • Targeted treatment therapy can be given with more evidence in the future.
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Zhang HW, Lyu GW, He WJ, Lei Y, Lin F, Feng YN, Wang MZ. Differential diagnosis of central lymphoma and high-grade glioma: dynamic contrast-enhanced histogram. Acta Radiol 2020; 61:1221-1227. [PMID: 31902220 DOI: 10.1177/0284185119896519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In clinical diagnosis, some central nervous system lymphomas (CNSL) are difficult to distinguish from high-grade gliomas (HGG). PURPOSE To evaluate the diagnostic efficacy of the histogram analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in the identification of CNSL and HGG. MATERIAL AND METHODS In all, 43 patients diagnosed with HGG (n = 28) and CNSL (n = 15) by histopathology underwent DCE-MRI scanning. Differences in histogram parameters based on DCE-MRI between HGG and CNSL were analyzed by Mann-Whitney U test. In addition, receiver operating characteristic (ROC) analysis was performed. Short-term follow-up of patients was performed using Kaplan-Meier analysis to explore the survival rates of HGG and CNSL. RESULTS For the ROC curve analysis, we demonstrate that the 10th percentile of Ktrans (area under the curve [AUC] = 0.912, sensitivity = 86.7%, specificity = 92.9%), Kep (AUC = 0.940, sensitivity = 93.3%, specificity = 79.6%), Ve (AUC = 0.907, sensitivity = 86.7%, specificity = 89.3%), and AUC (AUC = 0.904, sensitivity = 86.7%, specificity = 92.9%) were significantly different between the CNSL and HGG groups (P < 0.001), with high diagnostic efficiency. Table 2 shows that the histogram features based on AUC maps (10th, 25th, median, 75th, 90th, and mean) were always significantly higher in the CNSL group than in the HGG group (P < 0.001). There was no significant difference in Vp or in the 75th, 90th and mean of Ktrans, Kep, and Ve between the CNSL and HGG groups (P > 0.05). CONCLUSION A histogram analysis of DCE-MRI identified significant differences between HGG and CNSL, and this will help in the clinical differential diagnosis of these conditions.
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Affiliation(s)
- Han-wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Gui-wen Lyu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Wen-jie He
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Yu-ning Feng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People’s Hospital, Shenzhen, PR China
| | - Meng-zhu Wang
- Department of MR Scientific Marketing, Siemens Healthineers, Guangzhou, Guangdong Province, PR China
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He YX, Qu CX, He YY, Shao J, Gao Q. Conventional MR and DW imaging findings of cerebellar primary CNS lymphoma: comparison with high-grade glioma. Sci Rep 2020; 10:10007. [PMID: 32561819 PMCID: PMC7305207 DOI: 10.1038/s41598-020-67080-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Primary central nervous system lymphomas (PCNSLs) and high-grade gliomas (HGGs) arising in the cerebellum is extremely low, making the differential diagnosis difficult or even impossible. The purpose of this study was to define the MR features of cerebellar PCNSL in immunocompetent patients, and to determine whether a combination of conventional MR and DW imaging can assist in the differentiation of PCNSLs and HGGs. Twelve PCNSLs and 15 HGGs confirmed by pathological analysis were retrospectively identified. The apparent diffusion coefficient (ADC) and conventional MRI parameters were compared for differences between PCNSL and HGG groups using the independent sample t test or chi-square test. Both ADCmin and ADCtotal values were lower in the PCNSL group than those in the HGG group (ADCmin: 0.53 × 10−3 vs. 0.83 × 10−3 mm2/sec, P < 0.001; ADCtotal: 0.66 × 10−3 vs. 0.98 × 10−3 mm2/sec, P = 0.001). As for conventional MR features, there were significant difference in the tumor size, enhancement patterns, the presence of cystic changes, edema degree and streak-like edema (all P < 0.01); but there were no significant difference in lesion type, the presence of bleeding, and involvement of brain surface between two groups (P = 0.554, 0.657 and 0.157, respectively). The results revealed that several conventional MR features, including enhancement patterns, branch-like enhancement and streak-like edema may be useful for the differentiation of PCNSL and HGG in cerebellum and, when combined with ADC values, further improve the discriminating ability.
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Affiliation(s)
- Ye-Xin He
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, 030012, China.
| | - Chong-Xiao Qu
- Department of Pathology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, 030012, China
| | - Yuan-Yan He
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, China
| | - Jia Shao
- Department of Medical Imaging, Shanxi Medical University, Taiyuan, 030001, China
| | - Qiang Gao
- Department of Radiology, Shanxi Provincial People's Hospital, Affiliated People's Hospital of Shanxi Medical University, Taiyuan, 030012, China
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Xing Z, Kang N, Lin Y, Zhou X, Xiao Z, Cao D. Performance of diffusion and perfusion MRI in evaluating primary central nervous system lymphomas of different locations. BMC Med Imaging 2020; 20:62. [PMID: 32517711 PMCID: PMC7285432 DOI: 10.1186/s12880-020-00462-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Diffusion and perfusion MRI can invasively define physical properties and angiogenic features of tumors, and guide the individual treatment. The purpose of this study was to investigate whether the diffusion and perfusion MRI parameters of primary central nervous system lymphomas (PCNSLs) are related to the tumor locations. Methods We retrospectively reviewed the diffusion, perfusion, and conventional MRI of 68 patients with PCNSLs at different locations (group 1: cortical gray matter, group 2: white matter, group 3: deep gray matter). Relative maximum cerebral blood volume (rCBVmax) from perfusion MRI, minimum apparent diffusion coefficients (ADCmin) from DWI of each group were calculated and compared by one-way ANOVA test. In addition, we compared the mean apparent diffusion coefficients (ADCmean) in three different regions of control group. Results The rCBVmax of PCNSLs yielded the lowest value in the white matter group, and the highest value in the cortical gray matter group (P < 0.001). However, the ADCmin of each subgroup was not statistically different. The ADCmean of each subgroup in control group was not statistically different. Conclusion Our study confirms that rCBVmax of PCNSLs are related to the tumor location, and provide simple but effective information for guiding the clinical practice of PCNSLs.
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Affiliation(s)
- Zhen Xing
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Nannan Kang
- Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, 361004, Fujian, China
| | - Yu Lin
- Department of Radiology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, 361004, Fujian, China
| | - Xiaofang Zhou
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China
| | - Zebin Xiao
- Department of Biomedical Sciences, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Dairong Cao
- Department of Radiology, First Affiliated Hospital of Fujian Medical University, 20 Cha-Zhong Road, Fuzhou, 350005, Fujian, China.
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Wang Y, Bai G, Guo L, Chen W. Associations Between Apparent Diffusion Coefficient Value With Pathological Type, Histologic Grade, and Presence of Lymph Node Metastases of Esophageal Carcinoma. Technol Cancer Res Treat 2020; 18:1533033819892254. [PMID: 31782340 PMCID: PMC6886268 DOI: 10.1177/1533033819892254] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To investigate the application value of apparent diffusion coefficient value in the pathological type, histologic grade, and presence of lymph node metastases of esophageal carcinoma. Materials and Methods: Eighty-six patients with pathologically confirmed esophageal carcinoma were divided into different groups according to pathological type, histological grade, and lymph node status. All patients underwent conventional magnetic resonance imaging and diffusion-weighted imaging scan, and apparent diffusion coefficient values of tumors were measured. Independent sample t test and 1-way variance were used to compare the difference of apparent diffusion coefficient value in different pathological types, histologic grades, and lymph node status. Correlation between the apparent diffusion coefficient value and the histologic grade was evaluated using Spearman rank correlation test. Receiver operating characteristic curve of apparent diffusion coefficient value was generated to evaluate the differential diagnostic efficiency of poorly and well/moderately differentiated esophageal carcinoma. Results: No significant difference was observed in apparent diffusion coefficient value between esophageal squamous cell carcinoma and adenocarcinoma and in patients between those with and without lymph node metastases (P > .05). The differences of apparent diffusion coefficient value were statistically significant between different histologic grades of esophageal carcinoma (P < .05). The apparent diffusion coefficient value was positively correlated with histologic grade (rs = 0.802). The apparent diffusion coefficient value ≤1.25 × 10−3 mm2/s as the cutoff value for diagnosis of poorly differentiated esophageal carcinoma with the sensitivity of 84.3%, and the specificity was 94.3%. Conclusions: The performance of apparent diffusion coefficient value was contributing to predict the histologic grade of esophageal carcinoma, which might increase lesions characterization before choosing the best therapeutic alternative. However, they do not correlate with pathological type and the presence of lymph node metastases of esophageal carcinoma.
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Affiliation(s)
- Yating Wang
- Department of Medical Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Genji Bai
- Department of Medical Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Lili Guo
- Department of Medical Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
| | - Wei Chen
- Department of Medical Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huai'an, Jiangsu, China
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Correlation analysis of apparent diffusion coefficient value and P53 and Ki-67 expression in esophageal squamous cell carcinoma. Magn Reson Imaging 2020; 68:183-189. [DOI: 10.1016/j.mri.2020.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/21/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
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Gihr GA, Horvath-Rizea D, Hekeler E, Ganslandt O, Henkes H, Hoffmann KT, Scherlach C, Schob S. Histogram Analysis of Diffusion Weighted Imaging in Low-Grade Gliomas: in vivo Characterization of Tumor Architecture and Corresponding Neuropathology. Front Oncol 2020; 10:206. [PMID: 32158691 PMCID: PMC7051987 DOI: 10.3389/fonc.2020.00206] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/06/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Low-grade gliomas (LGG) in adults are usually slow growing and frequently asymptomatic brain tumors, originating from glial cells of the central nervous system (CNS). Although regarded formally as “benign” neoplasms, they harbor the potential of malignant transformation associated with high morbidity and mortality. Their complex and unpredictable tumor biology requires a reliable and conclusive presurgical magnetic resonance imaging (MRI). A promising and emerging MRI approach in this context is histogram based apparent diffusion coefficient (ADC) profiling, which recently proofed to be capable of providing prognostic relevant information in different tumor entities. Therefore, our study investigated whether histogram profiling of ADC distinguishes grade I from grade II glioma, reflects the proliferation index Ki-67, as well as the IDH (isocitrate dehydrogenase) mutation and MGMT (methylguanine-DNA methyl-transferase) promotor methylation status. Material and Methods: Pre-treatment ADC volumes of 26 LGG patients were used for histogram-profiling. WHO-grade, Ki-67 expression, IDH mutation, and MGMT promotor methylation status were evaluated. Comparative and correlative statistics investigating the association between histogram-profiling and neuropathology were performed. Results: Almost the entire ADC profile (p25, p75, p90, mean, median) was significantly lower in grade II vs. grade I gliomas. Entropy, as second order histogram parameter of ADC volumes, was significantly higher in grade II gliomas compared with grade I gliomas. Mean, maximum value (ADCmax) and the percentiles p10, p75, and p90 of ADC histogram were significantly correlated with Ki-67 expression. Furthermore, minimum ADC value (ADCmin) was significantly associated with MGMT promotor methylation status as well as ADC entropy with IDH-1 mutation status. Conclusions: ADC histogram-profiling is a valuable radiomic approach, which helps differentiating tumor grade, estimating growth kinetics and probably prognostic relevant genetic as well as epigenetic alterations in LGG.
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Affiliation(s)
| | | | - Elena Hekeler
- Department for Pathology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Oliver Ganslandt
- Katharinenhospital Stuttgart, Clinic for Neurosurgery, Stuttgart, Germany
| | - Hans Henkes
- Katharinenhospital Stuttgart, Clinic for Neuroradiology, Stuttgart, Germany
| | - Karl-Titus Hoffmann
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Cordula Scherlach
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
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Whole Tumor Histogram Analysis Using DW MRI in Primary Central Nervous System Lymphoma Correlates with Tumor Biomarkers and Outcome. Cancers (Basel) 2019; 11:cancers11101506. [PMID: 31597366 PMCID: PMC6827036 DOI: 10.3390/cancers11101506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022] Open
Abstract
The ability to non-invasively predict outcomes and monitor treatment response in primary central nervous system lymphoma (PCNSL) is important as treatment regimens are constantly being trialed. The aim of this study was to assess the validity of using apparent diffusion coefficient (ADC) histogram values to predict Ki-67 expression, a tumor proliferation marker, and patient outcomes in PCNSL in both immunocompetent patients and patients living with HIV (PLWH). Qualitative PCNSL magnetic resonance imaging (MRI) characteristics from 93 patients (23 PLWH and 70 immunocompetent) were analyzed, and whole tumor segmentation was performed on the ADC maps. Quantitative histogram analyses of the segmentations were calculated. These measures were compared to PCNSL Ki-67 expression. Progression-free survival (PFS) and overall survival (OS) were analyzed via comparison to the International Primary Central Nervous System Lymphoma Collaboration Group Response Criteria. Associations between ADC measures and clinical outcomes were assessed using univariate and multivariate Cox proportional hazards models. Normalized ADC (nADC)Min, nADCMean, nADC1, nADC5, and nADC15 values were significantly associated with a poorer OS. nADCMax, nADCMean, nADC5, nADC15, nADC75, nADC95, nADC99 inversely correlated with Ki-67 expression. OS was also significantly associated with lesion hemorrhage. PFS was not significantly associated with ADC values but with lesion hemorrhage. ADC histogram values and related parameters can predict the degree of tumor proliferation and patient outcomes for primary central nervous system lymphoma patients and in both immunocompetent patients and patients living with HIV.
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Lee J, Kim CK, Park SY. Histogram analysis of apparent diffusion coefficients for predicting pelvic lymph node metastasis in patients with uterine cervical cancer. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:283-292. [DOI: 10.1007/s10334-019-00777-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/29/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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Fiester PJ, Soule E, Natter PE, Haymes D, Rao D. Necrotic Primary Central Nervous System Lymphoma in an Immunocompetent Patient: A Case Report and Literature Review. Cureus 2019; 11:e4910. [PMID: 31423387 PMCID: PMC6692120 DOI: 10.7759/cureus.4910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary lymphoma that arises de novo from the central nervous system (CNS) is most commonly a non-Hodgkin's B-cell lymphoma and by definition lacks the presence of disease outside the CNS. It demonstrates a characteristic imaging appearance on computed tomography (CT) and magnetic resonance imaging (MRI) exams related to its inherent hypercellularity. On CT, primary CNS lymphoma (PCNSL) demonstrates a hyperdense appearance; on MRI, it commonly demonstrates restricted water diffusion on diffusion-weighted sequences and homogeneous enhancement on post-contrast sequences. We present a case of primary CNS lymphoma in an immunocompetent patient with progressive necrosis and loss of restricted diffusion on diffusion-weighted imaging (DWI) with an atypical enhancement pattern. We further provide a review of the literature regarding the CT and MRI appearance of primary CNS lymphoma and discuss the role of immune status in determining the imaging characteristics of this disease process.
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Affiliation(s)
- Peter J Fiester
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | | | - Dalys Haymes
- Neuroradiology, University of Florida Health, Jacksonville, USA
| | - Dinesh Rao
- Neuroradiology, University of Florida Health, Jacksonville, USA
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He M, Tang Z, Qiang J, Xiao Z, Zhang Z. Differentiation between sinonasal natural killer/T-cell lymphomas and diffuse large B-cell lymphomas by RESOLVE DWI combined with conventional MRI. Magn Reson Imaging 2019; 62:10-17. [PMID: 31212002 DOI: 10.1016/j.mri.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/12/2019] [Accepted: 06/14/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the feasibility of using RESOLVE DWI combined with conventional magnetic resonance imaging (MRI) to discriminate between sinonasal NKTLs and DLBCLs and to investigate the correlation between ADC value and Ki-67 expression in the two subtypes of NHLs. MATERIALS AND METHODS Sixty patients with NKTLs and twenty-six patients with DLBCLs in the sinonasal region who were confirmed by histopathology underwent high-resolution DWI and conventional MRI. The apparent diffusion coefficients (ADCs) and conventional MRI features associated with NKTLs and DLBCLs were compared using multivariate logistic regression. Receiver operating characteristic (ROC) curve analysis was performed, and the area under the curve (AUC) values for conventional MRI and MRI in combination with DWI were compared to determine the diagnostic performances of the approaches in the differentiation of NKTLs and DLBCLs. Spearman's rank correlations were used to analyze the correlation between ADC value with the higher AUC and Ki-67 expression. RESULTS For conventional MRI, localization in the nasal cavity and poor or moderate enhancement indicated an NKTL, whereas localization in the paranasal sinus and intense enhancement indicated a DLBCL, with sensitivity, specificity and area under the curve(AUC)value of 88.5%, 85.0% and 0.883, respectively. A combination with a cut-off ADC value of 0.646 × 10-3 mm2/s yielded sensitivity, specificity and AUC values of 100.0%, 80.0% and 0.951, respectively. A significant difference between the AUCs for conventional MRI and MRI in combination with DWI (p = 0.02) was identified. Ki-67 expression of NKTLs was significantly lower than that of DLBCLs (p < 0.001). Besides, there was an inversely poor correlation between them in the overall sample (r = -0.395, p < 0.001). However, the ADC value was not significantly correlated with Ki-67 LI in neither NKTLs nor DLBCLs (both p > 0.05). CONCLUSIONS Location and enhancement degree were the most valuable conventional MRI features for differentiating between NKTLs and DLBCLs. A combination of DWI and MRI could significantly improve the differential performance. ADC values may be used to noninvasively evaluate the proliferation level of sinonasal NHLs.
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Affiliation(s)
- Mengge He
- The Shanghai Institution of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China; Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zuohua Tang
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China.
| | - Jinwei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai 201508, China.
| | - Zebin Xiao
- Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai 200031, China
| | - Zhongshuai Zhang
- Scientific Marketing, Diagnostic Imaging, Siemens Healthcare, Shanghai 201318, China
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Kalisz K, Alessandrino F, Beck R, Smith D, Kikano E, Ramaiya NH, Tirumani SH. An update on Burkitt lymphoma: a review of pathogenesis and multimodality imaging assessment of disease presentation, treatment response, and recurrence. Insights Imaging 2019; 10:56. [PMID: 31115699 PMCID: PMC6529494 DOI: 10.1186/s13244-019-0733-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/13/2019] [Indexed: 12/12/2022] Open
Abstract
Burkitt lymphoma (BL) is a highly aggressive, rapidly growing B cell non-Hodgkin lymphoma, which manifests in several subtypes including sporadic, endemic, and immunodeficiency-associated forms. Pathologically, BL is classically characterized by translocations of chromosomes 8 and 14 resulting in upregulation of the c-myc protein transcription factor with upregulation of cell proliferation. BL affects nearly every organ system, most commonly the abdomen and pelvis in the sporadic form. Imaging using a multimodality approach plays a crucial role in the management of BL from diagnosis, staging, and evaluation of treatment response to therapy-related complications with ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography playing roles. In this article, we review the pathobiology and classification of BL, illustrate a multimodality imaging approach in evaluating common and uncommon sites of involvement within the trunk and head and neck, and review common therapies and treatment-related complications.
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Affiliation(s)
- Kevin Kalisz
- Department of Radiology, Duke University, Durham, NC, USA
| | - Francesco Alessandrino
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA. .,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Rose Beck
- Department of Pathology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Daniel Smith
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Elias Kikano
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Nikhil H Ramaiya
- Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, UH Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Meyer HJ, Wienke A, Surov A. Correlations Between Imaging Biomarkers and Proliferation Index Ki-67 in Lymphomas: A Systematic Review and Meta-Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e266-e272. [PMID: 31000497 DOI: 10.1016/j.clml.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/20/2019] [Accepted: 03/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few studies investigated relationships between positron emission tomography (PET) as well as diffusion-weighted imaging (DWI) with proliferating index Ki-67 in lymphomas. The aim of the present analysis was to review the published results and perform a meta-analysis to provide data on the associations between standardized uptake values (SUV) derived from PET as well as apparent diffusion coefficient (ADC) derived from DWI with Ki-67 index in lymphomas. MATERIALS AND METHODS The MEDLINE library was screened for relationships between PET and DWI with Ki-67 in lymphoma up to October 2018. Overall, 22 studies with 788 patients were identified. The following data were extracted from the literature: authors, year of publication, number of patients, and correlation coefficients. Associations between SUV and Ki-67 were analyzed using Spearman correlation coefficient. RESULTS Fifteen studies comprising 574 patients were suitable for the analysis between maximum SUV (SUVmax) derived from fluorodeoxyglucose (FDG) PET and Ki-67. The pooled correlation coefficient was r = 0.49 (95% confidence interval [CI], 0.36-0.61). Four studies were included in the analysis between SUVmax derived from fluorothymidine (FLT) PET and Ki-67 index involving 84 patients. The pooled correlation coefficient was r = 0.46 (95% CI, 0.19-0.73). Four studies comprising 130 patients were suitable for the analysis between ADC values derived from DWI and Ki-67. The pooled correlation coefficient was r = -0.25 (95% CI, -0.53 to 0.04). CONCLUSION SUVmax derived from FDG and FLT PET correlated moderately and approximately equally with Ki-67 index. On the contrary, ADC values only correlated weakly inversely and might not reliably predict Ki-67 index in lymphomas.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany.
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
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Meyer HJ, Schob S, Münch B, Frydrychowicz C, Garnov N, Quäschling U, Hoffmann KT, Surov A. Histogram Analysis of T1-Weighted, T2-Weighted, and Postcontrast T1-Weighted Images in Primary CNS Lymphoma: Correlations with Histopathological Findings-a Preliminary Study. Mol Imaging Biol 2019; 20:318-323. [PMID: 28865050 DOI: 10.1007/s11307-017-1115-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Previously, some reports mentioned that magnetic resonance imaging (MRI) can predict histopathological features in primary CNS lymphoma (PCNSL). The reported data analyzed diffusion-weighted imaging findings. The aim of this study was to investigate possible associations between histopathological findings, such as tumor cellularity, nucleic areas and proliferation index Ki-67, and signal intensity on T1-weighted and T2-weighted images in PCNSL. PROCEDURES For this study, 18 patients with PCNSL were retrospectively investigated by histogram analysis on precontrast and postcontrast T1-weighted and fluid-attenuated inversion recovery (FLAIR) images. For every patient, histopathology parameters, nucleic count, total nucleic area, and average nucleic area, as well as Ki-67 index, were estimated. RESULTS Correlation analysis identified several statistically significant associations. Skewness derived from precontrast T1-weighted images correlated with Ki-67 index (p = - 0.55, P = 0.028). Furthermore, entropy derived from precontrast T1-weighted images correlated with average nucleic area (p = 0.53, P = 0.04). Several parameters from postcontrast T1-weighted images correlated with nucleic count: maximum signal intensity (p = 0.59, P = 0.017), P75 (p = 0.56, P = 0.02), and P90 (p = 0.52, P = 0.04) as well as SD (p = 0.58, P = 0.02). Maximum signal intensity derived from FLAIR sequence correlated with nucleic count (p = 0.50, P = 0.03). CONCLUSION Histogram-derived parameters of conventional MRI sequences can reflect different histopathological features in PSNCL.
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Affiliation(s)
- Hans-Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, University Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Stefan Schob
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Benno Münch
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, University Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | | | - Nikita Garnov
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, University Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ulf Quäschling
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, University Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Ravanelli M, Grammatica A, Tononcelli E, Morello R, Leali M, Battocchio S, Agazzi GM, Buglione di Monale E Bastia M, Maroldi R, Nicolai P, Farina D. Correlation between Human Papillomavirus Status and Quantitative MR Imaging Parameters including Diffusion-Weighted Imaging and Texture Features in Oropharyngeal Carcinoma. AJNR Am J Neuroradiol 2018; 39:1878-1883. [PMID: 30213805 DOI: 10.3174/ajnr.a5792] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of Oropharyngeal Squampus Cell Carcinoma (OPSCC) cases is increasing especially in the Western countries due to the spreading of human papilloma virus (HPV) infection. Radiological investigations, MRI in particular, are used in the daily clinical practice to stage OPSCC. The aim of this study was to investigate the association of quantitative MR imaging features including diffusion-weighted imaging and human papillomavirus status in oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS We retrospectively analyzed 59 patients with untreated histologically proved T2-T4 oropharyngeal squamous cell carcinoma. Human papillomavirus status was determined by viral DNA detection on tissue samples. MR imaging protocol included T2-weighted, contrast-enhanced T1-weighted (volumetric interpolated brain examination), and DWI sequences. Parametric maps of apparent diffusion coefficient were obtained from DWI sequences. Texture analysis was performed on T2 and volumetric-interpolated brain examination sequences and on ADC maps. Differences in quantitative MR imaging features between tumors positive and negative for human papillomavirus and among subgroups of patients stratified by smoking status were tested using the nonparametric Mann-Whitney U test; the false discovery rate was controlled using the Benjamini-Hochberg correction; and a predictive model for human papillomavirus status was built using multivariable logistic regression. RESULTS Twenty-eight patients had human papillomavirus-positive oropharyngeal squamous cell carcinoma, while 31 patients had human papillomavirus-negative oropharyngeal squamous cell carcinoma. Tumors positive for human papillomavirus had a significantly lower mean ADC compared with those negative for it (median, 850.87 versus median, 1033.68; P < .001). Texture features had a lower discriminatory power for human papillomavirus status. Skewness on volumetric interpolated brain examination sequences was significantly higher in the subgroup of patients positive for human papillomavirus and smokers (P = .003). A predictive model based on smoking status and mean ADC yielded a sensitivity of 83.3% and specificity 92.6% in classifying human papillomavirus status. CONCLUSIONS ADC is significantly lower in oropharyngeal squamous cell carcinoma positive for human papillomavirus compared with oropharyngeal squamous cell carcinoma negative for it. ADC and smoking status allowed noninvasive prediction of human papillomavirus status with a good accuracy. These results should be validated and further investigated on larger prospective studies.
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Affiliation(s)
- M Ravanelli
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - A Grammatica
- Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - E Tononcelli
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - R Morello
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.).,Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - M Leali
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | | | - G M Agazzi
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | | | - R Maroldi
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
| | - P Nicolai
- Otolaryngology-Head and Neck Surgery (A.G., R.M., P.N.)
| | - D Farina
- From the Departments of Radiology (M.R., E.T., M.L., G.M.A., R.M., D.F.)
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Huttinger AL, Wheeler DG, Gnyawali S, Dornbos D, Layzer JM, Venetos N, Talentino S, Musgrave NJ, Jones C, Bratton C, Joseph ME, Sen C, Sullenger BA, Nimjee SM. Ferric Chloride-induced Canine Carotid Artery Thrombosis: A Large Animal Model of Vascular Injury. J Vis Exp 2018. [PMID: 30247470 DOI: 10.3791/57981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Occlusive arterial thrombosis leading to cerebral ischemic stroke and myocardial infarction contributes to ~13 million deaths every year globally. Here, we have translated a vascular injury model from a small animal into a large animal (canine), with slight modifications that can be used for pre-clinical screening of prophylactic and thrombolytic agents. In addition to the surgical methods, the modified protocol describes the step-by-step methods to assess carotid artery canalization by angiography, detailed instructions to process both the brain and carotid artery for histological analysis to verify carotid canalization and cerebral hemorrhage, and specific parameters to complete an assessment of downstream thromboembolic events by utilizing magnetic resonance imaging (MRI). In addition, specific procedural changes from the previously well-established small animal model necessary to translate into a large animal (canine) vascular injury are discussed.
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Affiliation(s)
| | | | | | - David Dornbos
- Department of Neurological Surgery, Ohio State University
| | | | | | | | | | - Cheyenne Jones
- Department of Neurological Surgery, Ohio State University
| | | | | | - Chandan Sen
- Department of Surgery, Ohio State University
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Diffusion profiling of tumor volumes using a histogram approach can predict proliferation and further microarchitectural features in medulloblastoma. Childs Nerv Syst 2018; 34:1651-1656. [PMID: 29855678 DOI: 10.1007/s00381-018-3846-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/17/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Medulloblastomas are the most common central nervous system tumors in childhood. Treatment and prognosis strongly depend on histology and transcriptomic profiling. However, the proliferative potential also has prognostical value. Our study aimed to investigate correlations between histogram profiling of diffusion-weighted images and further microarchitectural features. MATERIAL AND METHODS Seven patients (age median 14.6 years, minimum 2 years, maximum 20 years; 5 male, 2 female) were included in this retrospective study. Using a Matlab-based analysis tool, histogram analysis of whole apparent diffusion coefficient (ADC) volumes was performed. RESULTS ADC entropy revealed a strong inverse correlation with the expression of the proliferation marker Ki67 (r = - 0.962, p = 0.009) and with total nuclear area (r = - 0.888, p = 0.044). Furthermore, ADC percentiles, most of all ADCp90, showed significant correlations with Ki67 expression (r = 0.902, p = 0.036). DISCUSSION AND CONCLUSION Diffusion histogram profiling of medulloblastomas provides valuable in vivo information which potentially can be used for risk stratification and prognostication. First of all, entropy revealed to be the most promising imaging biomarker. However, further studies are warranted.
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Meyer HJ, Pazaitis N, Surov A. ADC histogram analysis of muscle lymphoma-correlation with histopathology in a rare entity. Br J Radiol 2018; 91:20180291. [PMID: 29927638 DOI: 10.1259/bjr.20180291] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE: Diffusion-weighted imaging is able to reflect histopathology architecture. A novel imaging approach, namely histogram analysis, is used to further characterize lesion on MRI. To correlate histogram parameters derived from apparent diffusion coefficient (ADC) maps with histopathology parameters in muscle lymphoma. METHODS: Eight patients (mean age 64.8 years, range 45-72 years) with histopathologically confirmed muscle lymphoma were retrospectively identified. Cell count, total nucleic and average nucleic areas were estimated using ImageJ. Additionally, Ki67-index was calculated. Diffusion-weightedimaging was obtained on a 1.5 T scanner by using the b-values of 0 and 1000 s mm-2. Histogram analysis was performed as a whole lesion measurement by using a custom-made Matlab-based application. RESULTS: All ADC parameters showed a good to excellent interreader variability. Cell count correlated well with ADCmean (ρ = -0.76, p = 0.03) and ADCp75 (ρ =-0.79, p = 0.02). Kurtosis and entropy correlated with average nucleic area (ρ = -0.81, p = 0.02, ρ =0.88, p = 0.007, respectively). None of the analyzed ADC parameters correlated with total nucleic area and with Ki67-index. CONCLUSION: ADC histogram analysis parameters can reflect cellularity in muscle lymphoma. ADVANCES IN KNOWLEDGE: Histogram parameters derived from ADC maps can reflect several different cellularity parameters in muscle lymphoma.
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Affiliation(s)
- Hans-Jonas Meyer
- 1 Department of Diagnostic and Interventional Radiology, University of Leipzig , Leipzig , Germany
| | - Nikolaos Pazaitis
- 2 Department of Pathology, Martin-Luther-University Halle-Wittenberg , Halle , Germany
| | - Alexey Surov
- 1 Department of Diagnostic and Interventional Radiology, University of Leipzig , Leipzig , Germany
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Gihr GA, Horvath-Rizea D, Kohlhof-Meinecke P, Ganslandt O, Henkes H, Richter C, Hoffmann KT, Surov A, Schob S. Histogram Profiling of Postcontrast T1-Weighted MRI Gives Valuable Insights into Tumor Biology and Enables Prediction of Growth Kinetics and Prognosis in Meningiomas. Transl Oncol 2018; 11:957-961. [PMID: 29909365 PMCID: PMC6008484 DOI: 10.1016/j.tranon.2018.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/24/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: Meningiomas are the most frequently diagnosed intracranial masses, oftentimes requiring surgery. Especially procedure-related morbidity can be substantial, particularly in elderly patients. Hence, reliable imaging modalities enabling pretherapeutic prediction of tumor grade, growth kinetic, realistic prognosis, and—as a consequence—necessity of surgery are of great value. In this context, a promising diagnostic approach is advanced analysis of magnetic resonance imaging data. Therefore, our study investigated whether histogram profiling of routinely acquired postcontrast T1-weighted images is capable of separating low-grade from high-grade lesions and whether histogram parameters reflect Ki-67 expression in meningiomas. MATERIAL AND METHODS: Pretreatment T1-weighted postcontrast volumes of 44 meningioma patients were used for signal intensity histogram profiling. WHO grade, tumor volume, and Ki-67 expression were evaluated. Comparative and correlative statistics investigating the association between histogram profile parameters and neuropathology were performed. RESULTS: None of the investigated histogram parameters revealed significant differences between low-grade and high-grade meningiomas. However, significant correlations were identified between Ki-67 and the histogram parameters skewness and entropy as well as between entropy and tumor volume. CONCLUSIONS: Contrary to previously reported findings, pretherapeutic postcontrast T1-weighted images can be used to predict growth kinetics in meningiomas if whole tumor histogram analysis is employed. However, no differences between distinct WHO grades were identifiable in out cohort. As a consequence, histogram analysis of postcontrast T1-weighted images is a promising approach to obtain quantitative in vivo biomarkers reflecting the proliferative potential in meningiomas.
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Affiliation(s)
| | | | | | - Oliver Ganslandt
- Katharinenhospital Stuttgart, Neurosurgical Clinic, Stuttgart, Germany
| | - Hans Henkes
- Katharinenhospital Stuttgart, Clinic for Neuroradiology, Stuttgart, Germany
| | - Cindy Richter
- University Hospital Leipzig, Department for Neuroradiology, Leipzig, Germany
| | - Karl-Titus Hoffmann
- University Hospital Leipzig, Department for Neuroradiology, Leipzig, Germany
| | - Alexey Surov
- University Hospital Leipzig, Clinic for Diagnostic and Interventional Radiology, Leipzig, Germany
| | - Stefan Schob
- University Hospital Leipzig, Department for Neuroradiology, Leipzig, Germany
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Surov A, Hamerla G, Meyer HJ, Winter K, Schob S, Fiedler E. Whole lesion histogram analysis of meningiomas derived from ADC values. Correlation with several cellularity parameters, proliferation index KI 67, nucleic content, and membrane permeability. Magn Reson Imaging 2018; 51:158-162. [PMID: 29782920 DOI: 10.1016/j.mri.2018.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/19/2022]
Abstract
PURPOSE To analyze several histopathological features and their possible correlations with whole lesion histogram analysis derived from ADC maps in meningioma. MATERIALS AND METHODS The retrospective study involved 36 patients with primary meningiomas. For every tumor, the following histogram analysis parameters of apparent diffusion coefficient (ADC) were calculated: ADCmean, ADCmax, ADCmin, ADCmedian, ADCmode, ADC percentiles: P10, P25, P75, P90, as well kurtosis, skewness, and entropy. All measures were performed by two radiologists. Proliferation index KI 67, minimal, maximal and mean cell count, total nucleic area, and expression of water channel aquaporin 4 (AQP4) were estimated. Spearman's correlation coefficient was used to analyze associations between investigated parameters. RESULTS A perfect interobserver agreement for all ADC values (0.84-0.97) was identified. All ADC values correlated inversely with tumor cellularity with the strongest correlation between P10, P25 and mean cell count (-0.558). KI 67 correlated inversely with all ADC values except ADCmin. ADC parameters did not correlate with total nucleic area. All ADC values correlated statistically significant with expression of AQP4. CONCLUSIONS ADC histogram analysis is a valid method with an excellent interobserver agreement. Cellularity parameters and proliferation potential are associated with different ADC values. Membrane permeability may play a greater role for water diffusion than cell count and proliferation activity.
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany; Department of Radiology, Martin-Luther-university Halle-Wittenberg, Germany.
| | - Gordian Hamerla
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany
| | - Karsten Winter
- Institute of Neuroanatomy, University of Leipzig, Germany; Institute of Biometry, University of Leipzig, Germany
| | - Stefan Schob
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Germany
| | - Eckhard Fiedler
- Department of Dermatology, Martin-Luther-university Halle-Wittenberg, Germany
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Horvath-Rizea D, Surov A, Hoffmann KT, Garnov N, Vörkel C, Kohlhof-Meinecke P, Ganslandt O, Bäzner H, Gihr GA, Kalman M, Henkes E, Henkes H, Schob S. The value of whole lesion ADC histogram profiling to differentiate between morphologically indistinguishable ring enhancing lesions-comparison of glioblastomas and brain abscesses. Oncotarget 2018; 9:18148-18159. [PMID: 29719596 PMCID: PMC5915063 DOI: 10.18632/oncotarget.24454] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 01/30/2018] [Indexed: 12/17/2022] Open
Abstract
Background Morphologically similar appearing ring enhancing lesions in the brain parenchyma can be caused by a number of distinct pathologies, however, they consistently represent life-threatening conditions. The two most frequently encountered diseases manifesting as such are glioblastoma multiforme (GBM) and brain abscess (BA), each requiring disparate therapeutical approaches. As a result of their morphological resemblance, essential treatment might be significantly delayed or even ommited, in case results of conventional imaging remain inconclusive. Therefore, our study aimed to investigate, whether ADC histogram profiling reliably can distinguish between both entities, thus enhancing the differential diagnostic process and preventing treatment failure in this highly critical context. Methods 103 patients (51 BA, 52 GBM) with histopathologically confirmed diagnosis were enrolled. Pretreatment diffusion weighted imaging (DWI) was obtained in a 1.5T system using b values of 0, 500, and 1000 s/mm2. Whole lesion ADC volumes were analyzed using a histogram-based approach. Statistical analysis was performed using SPSS version 23. Results All investigated parameters were statistically different in comparison of both groups. Most importantly, ADCp10 was able to differentiate reliably between BA and GBM with excellent accuracy (0.948) using a cutpoint value of 70 × 10−5 mm2 × s−1. Conclusions ADC whole lesion histogram profiling provides a valuable tool to differentiate between morphologically indistinguishable mass lesions. Among the investigated parameters, the 10th percentile of the ADC volume distinguished best between GBM and BA.
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Affiliation(s)
| | - Alexey Surov
- Clinic for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | - Karl-Titus Hoffmann
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Cathrin Vörkel
- Clinic for Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, Germany
| | | | - Oliver Ganslandt
- Clinic for Neurosurgery, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Hansjörg Bäzner
- Clinic for Neurology, Katherinenhospital Stuttgart, Stuttgart, Germany
| | | | - Marcell Kalman
- Clinic for Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Elina Henkes
- Clinic for Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Hans Henkes
- Clinic for Neuroradiology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
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Whole Tumor Histogram-profiling of Diffusion-Weighted Magnetic Resonance Images Reflects Tumorbiological Features of Primary Central Nervous System Lymphoma. Transl Oncol 2018. [PMID: 29522972 PMCID: PMC5884194 DOI: 10.1016/j.tranon.2018.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
PURPOSE: Diffusion weighted imaging (DWI) quantifies motion of hydrogen nuclei in biological tissues and hereby has been used to assess the underlying tissue microarchitecture. Histogram-profiling of DWI provides more detailed information on diffusion characteristics of a lesion than the standardly calculated values of the apparent diffusion coefficient (ADC)—minimum, mean and maximum. Hence, the aim of our study was to investigate, which parameters of histogram-profiling of DWI in primary central nervous system lymphoma can be used to specifically predict features like cellular density, chromatin content and proliferative activity. PROCEDURES: Pre-treatment ADC maps of 21 PCNSL patients (8 female, 13 male, 28–89 years) from a 1.5T system were used for Matlab-based histogram profiling. Results of histopathology (H&E staining) and immunohistochemistry (Ki-67 expression) were quantified. Correlations between histogram-profiling parameters and neuropathologic examination were calculated using SPSS 23.0. RESULTS: The lower percentiles (p10 and p25) showed significant correlations with structural parameters of the neuropathologic examination (cellular density, chromatin content). The highest percentile, p90, correlated significantly with Ki-67 expression, resembling proliferative activity. Kurtosis of the ADC histogram correlated significantly with cellular density. CONCLUSIONS: Histogram-profiling of DWI in PCNSL provides a comprehensible set of parameters, which reflect distinct tumor-architectural and tumor-biological features, and hence, are promising biomarkers for treatment response and prognosis.
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Gihr GA, Horvath-Rizea D, Garnov N, Kohlhof-Meinecke P, Ganslandt O, Henkes H, Meyer HJ, Hoffmann KT, Surov A, Schob S. Diffusion Profiling via a Histogram Approach Distinguishes Low-grade from High-grade Meningiomas, Can Reflect the Respective Proliferative Potential and Progesterone Receptor Status. Mol Imaging Biol 2018; 20:632-640. [DOI: 10.1007/s11307-018-1166-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Surov A, Meyer HJ, Wienke A. Associations between apparent diffusion coefficient (ADC) and KI 67 in different tumors: a meta-analysis. Part 2: ADC min. Oncotarget 2018; 9:8675-8680. [PMID: 29492226 PMCID: PMC5823566 DOI: 10.18632/oncotarget.24006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022] Open
Abstract
The purpose of this part of the meta-analysis was to summarize data regarding associations between minimum apparent diffusion coefficient (ADCmin) and KI 67 in different tumors. MEDLINE library was screened for associations between ADCmin and KI 67 in different tumors up to April 2017. Overall, 23 studies with 944 patients were identified. Associations between ADC and KI 67 were analyzed by Spearman's correlation coefficient. The pooled correlation coefficient between ADCmin and KI 67 for all included tumors was ρ = -0.47. In detail, the correlation coefficients for separate tumors were as follows: cerebral lymphoma: ρ = -0.61 (95% CI = [-0.82; -0.41]); cervical cancer: ρ = -0.56 (95% CI = [-0.68;-0.43]); pituitary adenoma: ρ = -0.55 (95% CI = [-1.31; 0.22]); glioma: ρ = -0.40 (95% CI = [-0.55; -0.24]); breast cancer: ρ = -0.37 (95% CI = [-0.74; -0.01]); meningioma, ρ = -0.15 (95% CI = [-0.38; 0.07]).
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Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Meyer HJ, Leifels L, Schob S, Garnov N, Surov A. Histogram analysis parameters identify multiple associations between DWI and DCE MRI in head and neck squamous cell carcinoma. Magn Reson Imaging 2018; 45:72-77. [DOI: 10.1016/j.mri.2017.09.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/24/2017] [Accepted: 09/24/2017] [Indexed: 01/21/2023]
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Application of DWIBS in malignant lymphoma: correlation between ADC values and Ki-67 index. Eur Radiol 2017; 28:1701-1708. [PMID: 29143105 DOI: 10.1007/s00330-017-5135-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES We investigated the correlation between the apparent diffusion coefficient (ADC) and Ki-67 index using diffusion-weighted whole-body imaging with background body signal suppression (DWIBS), and their utility in evaluating malignant lymphoma cell proliferation. MATERIALS AND METHODS Seventy-four patients with malignant lymphoma underwent DWIBS within 1 week before pathological confirmation. The ADC value was measured at the site of the pathological examination, and specimens were also stained with Ki-67. The ADC values and Ki-67 indices in aggressive non-Hodgkin's lymphoma (NHL), indolent NHL, and Hodgkin's lymphoma (HL) were compared using Spearman's rank correlation coefficient and the Kruskal-Wallis test. RESULTS The Ki-67 indices and ADC values were inversely correlated (r = -0.289, p = 0.0125); the differences in the Ki-67 index between aggressive NHL, indolent NHL, and HL were significant (p < 0.001); this was confirmed by the Nemenyi test except for indolent NHL vs. HL. The ADC values were significantly different between the types of lymphoma (p = 0.013); the Nemenyi test showed a significant difference only between aggressive NHL and HL. CONCLUSIONS The Ki-67 indices and ADC values are inversely correlated in patients with lymphoma, combining DWIBS and ADC values can evaluate the proliferation level of malignant lymphoma cells noninvasively. KEY POINTS • By using DWIBS, malignant lymphoma cell proliferation can be assessed noninvasively. • The ADC value and Ki-67 index are significantly and inversely correlated. • The ADC values were lower in aggressive NHL than in HL. • The ADC values of aggressive and indolent NHL were not significantly different.
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