1
|
Özdemir İ, Etyemez S, Barker PB. High-field downfield MR spectroscopic imaging in the human brain. Magn Reson Med 2024; 92:890-899. [PMID: 38469953 PMCID: PMC11209804 DOI: 10.1002/mrm.30075] [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: 09/15/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE To investigate the feasibility of downfield MR spectroscopic imaging (DF-MRSI) in the human brain at 7T. METHODS A 7T DF-MRSI pulse sequence was implemented based on the previously described methodology at 3T, with 3D phase-encoding,1 3 ‾ 3 1 ‾ $$ 1\overline{3}3\overline{1} $$ spectral-spatial excitation, and frequency selective refocusing. Data were pre-processed followed by analysis using the "LCModel" software package, and metabolite maps created from the LCModel results. Total scan time, including brain MRI and a water-reference MRSI, was 24 min. The sequence was tested in 10 normal volunteers. Estimated metabolite levels and uncertainty values (Cramer Rao lower bounds, CRLBs) for nine downfield peaks were compared between seven different brain regions, anterior cingulate cortex (ACC), centrum semiovale (CSO), corpus callosum (CC), cerebellar vermis (CV), dorsolateral prefrontal cortex (DLPFC), posterior cingulate cortex (PCC), and thalamus (Thal). RESULTS DF peaks were relatively uniformly distributed throughout the brain, with only a small number of peaks showing any significant regional variations. Most DF peaks had average CRLB<25% in most brain regions. Average SNR values were higher for the brain regions ACC and DLPFC (˜7 ± 0.95, mean ± SD) while in a range of 3.4-6.0 for other brain regions. Average linewidth (FWHM) values were greater than 35 Hz in the ACC, CV, and Thal, and 22 Hz in CC, CSO, DLPFC, and PCC. CONCLUSION High-field DF-MRSI is able to spatially map exchangeable protons in the human brain at high resolution and with near whole-brain coverage in acceptable scan times, and in the future may be used to study metabolism of brain tumors or other neuropathological disorders.
Collapse
Affiliation(s)
- İpek Özdemir
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Semra Etyemez
- Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, NY
- Department of Psychiatry, Weill Cornell Medicine, New York, NY
| | - Peter B. Barker
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kennedy Krieger Institute, Baltimore, MD, United States
| |
Collapse
|
2
|
Deng HZ, Zhang HW, Huang B, Deng JH, Luo SP, Li WH, Lei Y, Liu XL, Lin F. Advances in diffuse glioma assessment: preoperative and postoperative applications of chemical exchange saturation transfer. Front Neurosci 2024; 18:1424316. [PMID: 39148521 PMCID: PMC11325484 DOI: 10.3389/fnins.2024.1424316] [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: 04/27/2024] [Accepted: 07/16/2024] [Indexed: 08/17/2024] Open
Abstract
Chemical Exchange Saturation Transfer (CEST) is a technique that uses specific off-resonance saturation pulses to pre-saturate targeted substances. This process influences the signal intensity of free water, thereby indirectly providing information about the pre-saturated substance. Among the clinical applications of CEST, Amide Proton Transfer (APT) is currently the most well-established. APT can be utilized for the preoperative grading of gliomas. Tumors with higher APTw signals generally indicate a higher likelihood of malignancy. In predicting preoperative molecular typing, APTw values are typically lower in tumors with favorable molecular phenotypes, such as isocitrate dehydrogenase (IDH) mutations, compared to IDH wild-type tumors. For differential diagnosis, the average APTw values of meningiomas are significantly lower than those of high-grade gliomas. Various APTw measurement indices assist in distinguishing central nervous system lesions with similar imaging features, such as progressive multifocal leukoencephalopathy, central nervous system lymphoma, solitary brain metastases, and glioblastoma. Regarding prognosis, APT effectively differentiates between tumor recurrence and treatment effects, and also possesses predictive capabilities for overall survival (OS) and progression-free survival (PFS).
Collapse
Affiliation(s)
- Hua-Zhen Deng
- Shantou University Medical College, Shantou City, China
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Han-Wen Zhang
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Biao Huang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Jin-Huan Deng
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Si-Ping Luo
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei-Hua Li
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Lei
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiao-Lei Liu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Fan Lin
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| |
Collapse
|
3
|
Kim H, Park S, Hu R, Hoang KB, Sun PZ. 3D CEST MRI with an unevenly segmented RF irradiation scheme: A feasibility study in brain tumor imaging. Magn Reson Med 2023; 90:2400-2410. [PMID: 37526017 PMCID: PMC10586718 DOI: 10.1002/mrm.29810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/17/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To integrate 3D CEST EPI with an unevenly segmented RF irradiation module and preliminarily demonstrate it in the clinical setting. METHODS A CEST MRI with unevenly segmented RF saturation was implemented, including a long primary RF saturation to induce the steady-state CEST effect, maintained with repetitive short secondary RF irradiation between readouts. This configuration reduces relaxation-induced blur artifacts during acquisition, allowing fast 3D spatial coverage. Numerical simulations were performed to select parameters such as flip angle (FA), short RF saturation duration (Ts2), and the number of readout segments. The sequence was validated experimentally with data from a phantom, healthy volunteers, and a brain tumor patient. RESULTS Based on the numerical simulation and l-carnosine gel phantom experiment, FA, Ts2, and the number of segments were set to 20°, 0.3 s, and the range from 4 to 8, respectively. The proposed method minimized signal modulation in the human brain images in the kz direction during the acquisition and provided the blur artifacts-free CEST contrast over the whole volume. Additionally, the CEST contrast in the tumor tissue region is higher than in the contralateral normal tissue region. CONCLUSIONS It is feasible to implement a highly accelerated 3D EPI CEST imaging with unevenly segmented RF irradiation.
Collapse
Affiliation(s)
- Hahnsung Kim
- Emory National Primate Research Center, Emory University, Atlanta GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | - Suhyung Park
- Department of Computer Engineering, Chonnam National University, South Korea
- Department of ICT Convergence System Engineering, Chonnam National University, South Korea
| | - Ranliang Hu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | - Kimberly B Hoang
- Department of Neurosurgery, Emory University School of Medicine, Atlanta GA
| | - Phillip Zhe Sun
- Emory National Primate Research Center, Emory University, Atlanta GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| |
Collapse
|
4
|
Wu Y, Wood TC, Derks SHAE, Pruis IJ, van der Voort S, van Zanten SEMV, Smits M, Warnert EAH. Reproducibility of APT-weighted CEST-MRI at 3T in healthy brain and tumor across sessions and scanners. Sci Rep 2023; 13:18115. [PMID: 37872418 PMCID: PMC10593824 DOI: 10.1038/s41598-023-44891-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Amide proton transfer (APT)-weighted chemical exchange saturation transfer (CEST) imaging is a recent MRI technique making its way into clinical application. In this work, we investigated whether APT-weighted CEST imaging can provide reproducible measurements across scan sessions and scanners. Within-session, between-session and between scanner reproducibility was calculated for 19 healthy volunteers and 7 patients with a brain tumor on two 3T MRI scanners. The APT-weighted CEST effect was evaluated by calculating the Lorentzian Difference (LD), magnetization transfer ratio asymmetry (MTRasym), and relaxation-compensated inverse magnetization transfer ratio (MTRREX) averaged in whole brain white matter (WM), enhancing tumor and necrosis. Within subject coefficient of variation (COV) calculations, Bland-Altman plots and mixed effect modeling were performed to assess the repeatability and reproducibility of averaged values. The group median COVs of LD APT were 0.56% (N = 19), 0.84% (N = 6), 0.80% (N = 9) in WM within-session, between-session and between-scanner respectively. The between-session COV of LD APT in enhancing tumor (N = 6) and necrotic core (N = 3) were 4.57% and 5.67%, respectively. There were no significant differences in within session, between session and between scanner comparisons of the APT effect. The COVs of LD and MTRREX were consistently lower than MTRasym in all experiments, both in healthy tissues and tumor. The repeatability and reproducibility of APT-weighted CEST was clinically acceptable across scan sessions and scanners. Although MTRasym is simple to acquire and compute and sufficient to provide robust measurement, it is beneficial to include LD and MTRREX to obtain higher reproducibility for detecting minor signal difference in different tissue types.
Collapse
Affiliation(s)
- Yulun Wu
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Tobias C Wood
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sophie H A E Derks
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Medical Oncology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ilanah J Pruis
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Sebastian van der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Sophie E M Veldhuijzen van Zanten
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
- Medical Delta, Delft, The Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| |
Collapse
|
5
|
Chauvie S, Mazzoni LN, O’Doherty J. A Review on the Use of Imaging Biomarkers in Oncology Clinical Trials: Quality Assurance Strategies for Technical Validation. Tomography 2023; 9:1876-1902. [PMID: 37888741 PMCID: PMC10610870 DOI: 10.3390/tomography9050149] [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: 08/16/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Imaging biomarkers (IBs) have been proposed in medical literature that exploit images in a quantitative way, going beyond the visual assessment by an imaging physician. These IBs can be used in the diagnosis, prognosis, and response assessment of several pathologies and are very often used for patient management pathways. In this respect, IBs to be used in clinical practice and clinical trials have a requirement to be precise, accurate, and reproducible. Due to limitations in imaging technology, an error can be associated with their value when considering the entire imaging chain, from data acquisition to data reconstruction and subsequent analysis. From this point of view, the use of IBs in clinical trials requires a broadening of the concept of quality assurance and this can be a challenge for the responsible medical physics experts (MPEs). Within this manuscript, we describe the concept of an IB, examine some examples of IBs currently employed in clinical practice/clinical trials and analyze the procedure that should be carried out to achieve better accuracy and reproducibility in their use. We anticipate that this narrative review, written by the components of the EFOMP working group on "the role of the MPEs in clinical trials"-imaging sub-group, can represent a valid reference material for MPEs approaching the subject.
Collapse
Affiliation(s)
- Stephane Chauvie
- Medical Physics Division, Santa Croce e Carle Hospital, 12100 Cuneo, Italy;
| | | | - Jim O’Doherty
- Siemens Medical Solutions, Malvern, PA 19355, USA;
- Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, SC 20455, USA
- Radiography & Diagnostic Imaging, University College Dublin, D04 C7X2 Dublin, Ireland
| |
Collapse
|
6
|
3D Amide Proton Transfer-Weighted Imaging for Grading Glioma and Correlating IDH Mutation Status: Added Value to 3D Pseudocontinuous Arterial Spin Labelling Perfusion. Mol Imaging Biol 2023; 25:343-352. [PMID: 35962302 DOI: 10.1007/s11307-022-01762-w] [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: 03/03/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The goal of this study was to evaluate the diagnostic performance of 3D amide proton transfer-weighted (3D-APTW) imaging and 3D pseudocontinuous arterial spin labelling (3D-pCASL) alone and in combination in grading gliomas (low-grade glioma (LGG) vs. high-grade glioma (HGG)) and correlating isocitrate dehydrogenase (IDH) mutation status. PROCEDURES Preoperatively, 81 patients with pathologically confirmed gliomas underwent 3.0-T magnetic resonance imaging (MRI) examinations. The APTW, relative APTW (rAPTW), cerebral blood flow (CBF), and relative CBF (rCBF) values were calculated to evaluate the solid components of the tumours. The MRI parameters were compared in the classification of gliomas by independent- and paired-samples t tests. A receiver operating characteristic (ROC) curve was constructed, and the area under the ROC curve (AUC) was calculated to assess the diagnostic performance of each parameter and the combination of the rAPTW and rCBF values. RESULTS Patients with HGG showed significantly higher APTW, rAPTW, CBF, and rCBF values than those with LGG (all p < 0.001). In the ROC curve analysis, the AUC of rAPTW was the highest at 0.90. By adding the rAPTW signal to the rCBF values, the diagnostic ability of the combined parameters improved from 0.90 to 0.96. The rAPTW value yielded the highest AUC (0.92) in correlating the IDH mutation status, and the diagnostic ability improved to 0.96 by adding it to the rCBF value. CONCLUSION 3D-APTW imaging combined with 3D-pCASL imaging may be used to aid assessment of grading glioma and IDH mutation status.
Collapse
|
7
|
Zhou J, Zaiss M, Knutsson L, Sun PZ, Ahn SS, Aime S, Bachert P, Blakeley JO, Cai K, Chappell MA, Chen M, Gochberg DF, Goerke S, Heo HY, Jiang S, Jin T, Kim SG, Laterra J, Paech D, Pagel MD, Park JE, Reddy R, Sakata A, Sartoretti-Schefer S, Sherry AD, Smith SA, Stanisz GJ, Sundgren PC, Togao O, Vandsburger M, Wen Z, Wu Y, Zhang Y, Zhu W, Zu Z, van Zijl PCM. Review and consensus recommendations on clinical APT-weighted imaging approaches at 3T: Application to brain tumors. Magn Reson Med 2022; 88:546-574. [PMID: 35452155 PMCID: PMC9321891 DOI: 10.1002/mrm.29241] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
Abstract
Amide proton transfer-weighted (APTw) MR imaging shows promise as a biomarker of brain tumor status. Currently used APTw MRI pulse sequences and protocols vary substantially among different institutes, and there are no agreed-on standards in the imaging community. Therefore, the results acquired from different research centers are difficult to compare, which hampers uniform clinical application and interpretation. This paper reviews current clinical APTw imaging approaches and provides a rationale for optimized APTw brain tumor imaging at 3 T, including specific recommendations for pulse sequences, acquisition protocols, and data processing methods. We expect that these consensus recommendations will become the first broadly accepted guidelines for APTw imaging of brain tumors on 3 T MRI systems from different vendors. This will allow more medical centers to use the same or comparable APTw MRI techniques for the detection, characterization, and monitoring of brain tumors, enabling multi-center trials in larger patient cohorts and, ultimately, routine clinical use.
Collapse
Affiliation(s)
- Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moritz Zaiss
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Institute of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Linda Knutsson
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Medical Radiation Physics, Lund University, Lund, Sweden.,F.M. Kirby Research Center for Functional Brain Imaging, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| | - Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Silvio Aime
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Peter Bachert
- Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kejia Cai
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael A Chappell
- Mental Health and Clinical Neurosciences and Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daniel F Gochberg
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physics, Vanderbilt University, Nashville, Tennessee, USA
| | - Steffen Goerke
- Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tao Jin
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science and Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - John Laterra
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.,Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Mark D Pagel
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ravinder Reddy
- Center for Advance Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - A Dean Sherry
- Advanced Imaging Research Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Chemistry and Biochemistry, University of Texas at Dallas, Richardson, Texas, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Greg J Stanisz
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Pia C Sundgren
- Department of Diagnostic Radiology/Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Bioimaging Center, Lund University, Lund, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Osamu Togao
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yin Wu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter C M van Zijl
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Molecular Imaging of Brain Tumors and Drug Delivery Using CEST MRI: Promises and Challenges. Pharmaceutics 2022; 14:pharmaceutics14020451. [PMID: 35214183 PMCID: PMC8880023 DOI: 10.3390/pharmaceutics14020451] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 12/10/2022] Open
Abstract
Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) detects molecules in their natural forms in a sensitive and non-invasive manner. This makes it a robust approach to assess brain tumors and related molecular alterations using endogenous molecules, such as proteins/peptides, and drugs approved for clinical use. In this review, we will discuss the promises of CEST MRI in the identification of tumors, tumor grading, detecting molecular alterations related to isocitrate dehydrogenase (IDH) and O-6-methylguanine-DNA methyltransferase (MGMT), assessment of treatment effects, and using multiple contrasts of CEST to develop theranostic approaches for cancer treatments. Promising applications include (i) using the CEST contrast of amide protons of proteins/peptides to detect brain tumors, such as glioblastoma multiforme (GBM) and low-grade gliomas; (ii) using multiple CEST contrasts for tumor stratification, and (iii) evaluation of the efficacy of drug delivery without the need of metallic or radioactive labels. These promising applications have raised enthusiasm, however, the use of CEST MRI is not trivial. CEST contrast depends on the pulse sequences, saturation parameters, methods used to analyze the CEST spectrum (i.e., Z-spectrum), and, importantly, how to interpret changes in CEST contrast and related molecular alterations in the brain. Emerging pulse sequence designs and data analysis approaches, including those assisted with deep learning, have enhanced the capability of CEST MRI in detecting molecules in brain tumors. CEST has become a specific marker for tumor grading and has the potential for prognosis and theranostics in brain tumors. With increasing understanding of the technical aspects and associated molecular alterations detected by CEST MRI, this young field is expected to have wide clinical applications in the near future.
Collapse
|
9
|
Wu Y, Wood TC, Arzanforoosh F, Hernandez-Tamames JA, Barker GJ, Smits M, Warnert EAH. 3D APT and NOE CEST-MRI of healthy volunteers and patients with non-enhancing glioma at 3 T. MAGMA (NEW YORK, N.Y.) 2022; 35:63-73. [PMID: 34994858 PMCID: PMC8901510 DOI: 10.1007/s10334-021-00996-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
Objective Clinical application of chemical exchange saturation transfer (CEST) can be performed with investigation of amide proton transfer (APT) and nuclear Overhauser enhancement (NOE) effects. Here, we investigated APT- and NOE-weighted imaging based on advanced CEST metrics to map tumor heterogeneity of non-enhancing glioma at 3 T. Materials and methods APT- and NOE-weighted maps based on Lorentzian difference (LD) and inverse magnetization transfer ratio (MTRREX) were acquired with a 3D snapshot CEST acquisition at 3 T. Saturation power was investigated first by varying B1 (0.5–2 µT) in 5 healthy volunteers then by applying B1 of 0.5 and 1.5 µT in 10 patients with non-enhancing glioma. Tissue contrast (TC) and contrast-to-noise ratios (CNR) were calculated between glioma and normal appearing white matter (NAWM) and grey matter, in APT- and NOE-weighted images. Volume percentages of the tumor showing hypo/hyperintensity (VPhypo/hyper,CEST) in APT/NOE-weighted images were calculated for each patient. Results LD APT resulting from using a B1 of 1.5 µT was found to provide significant positive TCtumor,NAWM and MTRREX NOE (B1 of 1.5 µT) provided significant negative TCtumor,NAWM in tissue differentiation. MTRREX-based NOE imaging under 1.5 µT provided significantly larger VPhypo,CEST than MTRREX APT under 1.5 µT. Conclusion This work showed that with a rapid CEST acquisition using a B1 saturation power of 1.5 µT and covering the whole tumor, analysis of both LD APT and MTRREX NOE allows for observing tumor heterogeneity, which will be beneficial in future studies using CEST-MRI to improve imaging diagnostics for non-enhancing glioma.
Collapse
Affiliation(s)
- Yulun Wu
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| | - Tobias C Wood
- Centre for Neuroimaging Science, King's College London, London, UK
| | - Fatemeh Arzanforoosh
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Juan A Hernandez-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Gareth J Barker
- Centre for Neuroimaging Science, King's College London, London, UK
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.,Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther A H Warnert
- Department of Radiology and Nuclear Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Brain Tumor Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
| |
Collapse
|
10
|
Wei RL, Wei XT. Advanced Diagnosis of Glioma by Using Emerging Magnetic Resonance Sequences. Front Oncol 2021; 11:694498. [PMID: 34422648 PMCID: PMC8374052 DOI: 10.3389/fonc.2021.694498] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/19/2021] [Indexed: 12/15/2022] Open
Abstract
Glioma, the most common primary brain tumor in adults, can be difficult to discern radiologically from other brain lesions, which affects surgical planning and follow-up treatment. Recent advances in MRI demonstrate that preoperative diagnosis of glioma has stepped into molecular and algorithm-assisted levels. Specifically, the histology-based glioma classification is composed of multiple different molecular subtypes with distinct behavior, prognosis, and response to therapy, and now each aspect can be assessed by corresponding emerging MR sequences like amide proton transfer-weighted MRI, inflow-based vascular-space-occupancy MRI, and radiomics algorithm. As a result of this novel progress, the clinical practice of glioma has been updated. Accurate diagnosis of glioma at the molecular level can be achieved ahead of the operation to formulate a thorough plan including surgery radical level, shortened length of stay, flexible follow-up plan, timely therapy response feedback, and eventually benefit patients individually.
Collapse
Affiliation(s)
- Ruo-Lun Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin-Ting Wei
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
11
|
Correction: Assessment of Amide proton transfer weighted (APTw) MRI for pre-surgical prediction of final diagnosis in gliomas. PLoS One 2021; 16:e0250189. [PMID: 33831103 PMCID: PMC8031083 DOI: 10.1371/journal.pone.0250189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|