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Calvo-Imirizaldu M, Aramendía-Vidaurreta V, Sánchez-Albardíaz C, Vidorreta M, García de Eulate R, Domínguez Echávarri PD, Pfeuffer J, Bejarano Herruzo B, Gonzalez-Quarante LH, Martinez-Simon A, Fernández-Seara MA. Clinical utility of intraoperative arterial spin labeling for resection control in brain tumor surgery at 3 T. NMR IN BIOMEDICINE 2023:e4938. [PMID: 36967637 DOI: 10.1002/nbm.4938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/28/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Resection control in brain tumor surgery can be achieved in real time with intraoperative MRI (iMRI). Arterial spin labeling (ASL), a technique that measures cerebral blood flow (CBF) non-invasively without the use of intravenous contrast agents, can be performed intraoperatively, providing morpho-physiological information. This study aimed to evaluate the feasibility, image quality and potential to depict residual tumor of a pseudo-continuous ASL (PCASL) sequence at 3 T. Seventeen patients with brain tumors, primary (16) or metastatic (1), undergoing resection surgery with iMRI monitoring, were prospectively recruited (nine men, age 56 ± 16.6 years). A PCASL sequence with long labeling duration (3000 ms) and postlabeling delay (2000 ms) was added to the conventional protocol, which consisted of pre- and postcontrast 3D T1 -weighted (T1w) images, optional 3D-FLAIR, and diffusion. Three observers independently assessed the image quality (four-point scale) of PCASL-derived CBF maps. In those with diagnostic quality (Scores 2-4) they evaluated the presence of residual tumor using the conventional sequences first, and the CBF maps afterwards (three-point scale). Inter-observer agreement for image quality and the presence of residual tumor was assessed using Fleiss kappa statistics. The intraoperative CBF ratio of the surgical margins (i.e., perilesional CBF values normalized to contralateral gray matter CBF) was compared with preoperative CBF ratio within the tumor (Wilcoxon's test). Diagnostic ASL image quality was observed in 94.1% of patients (interobserver Fleiss κ = 0.76). PCASL showed additional foci suggestive of high-grade residual component in three patients, and a hyperperfused area extending outside the enhancing component in one patient. Interobserver agreement was almost perfect in the evaluation of residual tumor with the conventional sequences (Fleiss κ = 0.92) and substantial for PCASL (Fleiss κ = 0.80). No significant differences were found between pre and intraoperative CBF ratios (p = 0.578) in patients with residual tumor (n = 7). iMRI-PCASL perfusion is feasible at 3 T and is useful for the intraoperative assessment of residual tumor, providing in some cases additional information to the conventional sequences.
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Affiliation(s)
| | - Verónica Aramendía-Vidaurreta
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | | | | | | | - Pablo D Domínguez Echávarri
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Josef Pfeuffer
- Application Development, Siemens Healthcare, Erlangen, Germany
| | | | | | - Antonio Martinez-Simon
- Anesthesia and Intensive Care Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - María A Fernández-Seara
- Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
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Negroni D, Bono R, Soligo E, Longo V, Cossandi C, Carriero A, Stecco A. T1-Weighted Contrast Enhancement, Apparent Diffusion Coefficient, and Cerebral-Blood-Volume Changes after Glioblastoma Resection: MRI within 48 Hours vs. beyond 48 Hours. Tomography 2023; 9:342-351. [PMID: 36828379 PMCID: PMC9967426 DOI: 10.3390/tomography9010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of the study is to identify the advantages, if any, of post-operative MRIs performed at 48 h compared to MRIs performed after 48 h in glioblastoma surgery. MATERIALS AND METHODS To assess the presence of a residual tumor, the T1-weighted Contrast Enhancement (CE), Apparent Diffusion Coefficient (ADC), and Cerebral Blood Volume (rCBV) in the proximity of the surgical cavity were considered. The rCBV ratio was calculated by comparing the rCBV with the contralateral normal white matter. After the blind image examinations by the two radiologists, the patients were divided into two groups according to time window after surgery: ≤48 h (group 1) and >48 h (group 2). RESULTS A total of 145 patients were enrolled; at the 6-month follow-up MRI, disease recurrence was 89.9% (125/139), with a mean patient survival of 8.5 months (SD 7.8). The mean ADC and rCBV ratio values presented statistical differences between the two groups (p < 0.05). Of these 40 patients in whom an ADC value was not obtained, the rCBV values could not be calculated in 52.5% (21/40) due to artifacts (p < 0.05). CONCLUSION The study showed differences in CE, rCBV, and ADC values between the groups of patients undergoing MRIs before and after 48 h. An MRI performed within 48 h may increase the ability of detecting GBM by the perfusion technique with the calculation of the rCBV ratio.
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Affiliation(s)
- Davide Negroni
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
- Correspondence:
| | - Romina Bono
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Eleonora Soligo
- Radiology Department, San Andrea Hospital of Vercelli, 13100 Vercelli, Italy
| | - Vittorio Longo
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Christian Cossandi
- Neurosurgery Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Alessandro Carriero
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Alessandro Stecco
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
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A Multi-Disciplinary Approach to Diagnosis and Treatment of Radionecrosis in Malignant Gliomas and Cerebral Metastases. Cancers (Basel) 2022; 14:cancers14246264. [PMID: 36551750 PMCID: PMC9777318 DOI: 10.3390/cancers14246264] [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: 10/16/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation necrosis represents a potentially devastating complication after radiation therapy in brain tumors. The establishment of the diagnosis and especially the differentiation from progression and pseudoprogression with its therapeutic implications requires interdisciplinary consent and monitoring. Herein, we want to provide an overview of the diagnostic modalities, therapeutic possibilities and an outlook on future developments to tackle this challenging topic. The aim of this report is to provide an overview of the current morphological, functional, metabolic and evolving imaging tools described in the literature in order to (I) identify the best criteria to distinguish radionecrosis from tumor recurrence after the radio-oncological treatment of malignant gliomas and cerebral metastases, (II) analyze the therapeutic possibilities and (III) give an outlook on future developments to tackle this challenging topic. Additionally, we provide the experience of a tertiary tumor center with this important issue in neuro-oncology and provide an institutional pathway dealing with this problem.
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Huhndorf M, Eimer C, Becher T, Ahmeti H, Jansen O, Synowitz M, Helle M, Ulmer S, Lindner T. Effect of General Anesthesia on Cerebral Blood Flow Measured by Arterial Spin Labeling: A Retrospective Study. J Magn Reson Imaging 2022. [DOI: 10.1002/jmri.28507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Monika Huhndorf
- Department of Radiology and Neuroradiology University Hospital Schleswig‐Holstein Kiel Germany
| | - Christine Eimer
- Department of Anaesthesiology and Intensive Care Medicine University Schleswig‐Holstein Kiel Germany
| | - Tobias Becher
- Department of Anaesthesiology and Intensive Care Medicine University Schleswig‐Holstein Kiel Germany
| | - Hajrullah Ahmeti
- Department for Neurosurgery University Hospital Schleswig‐Holstein Kiel Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology University Hospital Schleswig‐Holstein Kiel Germany
| | - Michael Synowitz
- Department for Neurosurgery University Hospital Schleswig‐Holstein Kiel Germany
| | - Michael Helle
- Tomographic Imaging Department Philips Research Laboratories Hamburg Germany
| | - Stephan Ulmer
- Department of Radiology and Nuclear Medicine Kantonsspital Winterthur Winterthur Switzerland
| | - Thomas Lindner
- Department of Radiology and Neuroradiology University Hospital Schleswig‐Holstein Kiel Germany
- Department of Diagnostic and Interventional Neuroradiology University Hospital Hamburg‐Eppendorf Hamburg Germany
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Lee D, Kim ES, Lee Y, Lee SM, Yoon DY, Ju YS, Chang IB. Changes in computed tomography perfusion parameters and maximum contrast enhancement in patients having hydrocephalus with a ventriculoperitoneal shunt: a pilot study. Acta Radiol 2022; 63:1398-1405. [PMID: 34781783 DOI: 10.1177/02841851211038807] [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: 12/30/2022]
Abstract
BACKGROUND Acute hydrocephalus may decrease cerebral perfusion by increasing intracranial pressure. Computed tomography perfusion (CTP) has become a significant adjunct in evaluating regional and global cerebral blood flow (CBF). PURPOSE To investigate the changes in cerebral perfusion parameters and maximum contrast enhancement (MCE) in patients with hydrocephalus with ventriculoperitoneal shunt (VPS). MATERIAL AND METHODS We performed brain CTP in 45 patients, including those with subarachnoid hemorrhage (SAH)-induced hydrocephalus with VPS (n = 14, G1), hydrocephalus (not related to SAH) with VPS (n = 11, G2), SAH-induced hydrocephalus without VPS (n = 10, G3), and hydrocephalus (not related to SAH) without VPS (n = 10, G4). We measured the cerebral perfusion in the frontal white matter (FWM), centrum semiovale, basal ganglia (BG), and eight cortical lesions of interest and compared the differences in CTP parameters among the groups. RESULTS Between the four groups, cerebral blood volume and MCE in the left FWM and CBF in the right FWM increased significantly in G1 and G2 who underwent VP shunt compared to G3 and G4, whereas perfusion significantly reduced in G3 and G4 who did not undergo VP shunt compared to G1 and G2. MCE in the left BG significantly increased in G2 and decreased in G3 and G4. SAH-induced hydrocephalus showed a lower perfusion than hydrocephalus (not related to SAH) in FWM. CONCLUSIONS Perfusion changes in patients with hydrocephalus after VP shunt were seen in the FWM and BG, which appears to be the result of the hydrocephalus reducing brain perfusion in the deep part of the brain. We concluded that SAH slows brain perfusion recovery.
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Affiliation(s)
- Dongjun Lee
- Department of Radiology, 158781Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Eun Soo Kim
- Department of Radiology, 158781Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Yul Lee
- Department of Radiology, 158781Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sang Min Lee
- Department of Radiology, 158781Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Dae Young Yoon
- Department of Radiology, Kangdong Sacred Heart Hospital, 568730Hallym University College of Medicine, Gangdong-gu, Republic of Korea
| | - Young-Su Ju
- Department of Occupational & Environmental Medicine, National Medical Center, Seoul, Republic of Korea
| | - In-Bok Chang
- Department of Neurosurgery, 158781Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
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Aphasic status epilepticus after glioma resection: two case reports. Acta Neurochir (Wien) 2021; 163:3109-3113. [PMID: 34477975 DOI: 10.1007/s00701-021-04984-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/21/2021] [Indexed: 10/20/2022]
Abstract
Aphasic status epilepticus (ASE) is a subtype of focal nonconvulsive status epilepticus, in which language disturbance is the only objective clinical manifestation. We present two cases of patients who experienced delayed onset of temporal aphasia after the removal of glioma at the language-dominant hemisphere. In both cases, arterial spin labeling was useful for diagnosis and antiepileptic drug was effective. ASE should be considered a cause of persistent aphasia after glioma resection at or near the language area.
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Measurements of Functional Network Connectivity Using Resting State Arterial Spin Labeling During Neurosurgery. World Neurosurg 2021; 157:152-158. [PMID: 34673240 DOI: 10.1016/j.wneu.2021.10.107] [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: 08/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/21/2022]
Abstract
In neurosurgery, an exact delineation of functional areas is of great interest to spare important regions to ensure the best possible outcome for the patient (i.e., maximum removal while maintaining the highest possible quality of life). Preoperative imaging is routinely performed, including the visualization of not only structural but also functional information. During surgery, however, brain shift can occur, leading to an offset between the previously defined and the real position. Real-time imaging during the procedure is therefore desired to obtain this information while performing surgery. In this study 15 patients suffering from glioblastoma multiforme were included. These patients underwent structural and perfusion imaging using arterial spin labeling during the procedure. The latter has been used for gathering information about tumor residual perfusion. However, special postprocessing of this data allows for additional mapping of resting state networks and is intended to be used to gather deeper insights to aid the surgeon in planning the procedure. The data of each patient could be successfully postprocessed and used to map different resting state networks alongside the default mode network. On the basis of this study, it is feasible to use the information obtained from perfusion imaging to visualize not only vascular signal but also functional activation of resting state networks without acquiring any additional data besides the already available information. This may help guide the neurosurgeon in real time to adjust the surgical plan.
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陈 世, 王 丽, 王 莉, 郑 长, 杨 开. [Consistency analysis between 3D arterial spin labeling and dynamic susceptibility contrast perfusion magnetic resonance imaging in perfusion imaging of brain tumor]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1283-1286. [PMID: 34549723 PMCID: PMC8527226 DOI: 10.12122/j.issn.1673-4254.2021.08.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyze the consistency between cerebral blood flow (CBF) of 3D arterial spin labeling (3D ASL) and dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC-PWI) in the measurement of brain tumors. METHODS Nineteen patients with pathologically confirmed brain tumors were enrolled in this study.The brain tumors included glioma (n=9), meningioma (n=5), hemangioblastoma (n=2), cerebral metastasis (n=2) and cavernous hemangioma (n=1).Both ASL and DSC MRI were performed in all the 19 patients (57 regions of interest), and CBF was quantitatively determined. RESULTS A significant consistency was found between CBF measured by 3D ASL and the relative CBF (rCBF) determined by DSC (P=0.005). CONCLUSION 3D ASL and DSC PWI are consistent in evaluating blood flow in brain tumors and can accurately evaluate brain tumors perfusion.
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Affiliation(s)
- 世林 陈
- />海南省肿瘤医院放射科, 海南 海口 570300Department of Radiology, Hainan Cancer Hospital, Haikou 570300, China
| | - 丽英 王
- />海南省肿瘤医院放射科, 海南 海口 570300Department of Radiology, Hainan Cancer Hospital, Haikou 570300, China
| | - 莉 王
- />海南省肿瘤医院放射科, 海南 海口 570300Department of Radiology, Hainan Cancer Hospital, Haikou 570300, China
| | - 长宝 郑
- />海南省肿瘤医院放射科, 海南 海口 570300Department of Radiology, Hainan Cancer Hospital, Haikou 570300, China
| | - 开志 杨
- />海南省肿瘤医院放射科, 海南 海口 570300Department of Radiology, Hainan Cancer Hospital, Haikou 570300, China
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Pellerin A, Khalifé M, Sanson M, Rozenblum-Beddok L, Bertaux M, Soret M, Galanaud D, Dormont D, Kas A, Pyatigorskaya N. Simultaneously acquired PET and ASL imaging biomarkers may be helpful in differentiating progression from pseudo-progression in treated gliomas. Eur Radiol 2021; 31:7395-7405. [PMID: 33787971 DOI: 10.1007/s00330-021-07732-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/21/2020] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this work was investigating the methods based on coupling cerebral perfusion (ASL) and amino acid metabolism ([18F]DOPA-PET) measurements to evaluate the diagnostic performance of PET/MRI in glioma follow-up. METHODS Images were acquired using a 3-T PET/MR system, on a prospective cohort of patients addressed for possible glioma progression. Data were preprocessed with statistical parametric mapping (SPM), including registration on T1-weighted images, spatial and intensity normalization, and tumor segmentation. As index tests, tumor isocontour maps of [18F]DOPA-PET and ASL T-maps were created and metabolic/perfusion abnormalities were evaluated with the asymmetry index z-score. SPM map analysis of significant size clusters and semi-quantitative PET and ASL map evaluation were performed and compared to the gold standard diagnosis. Lastly, ASL and PET topography of significant clusters was compared to that of the initial tumor. RESULTS Fifty-eight patients with unilateral treated glioma were included (34 progressions and 24 pseudo-progressions). The tumor isocontour maps and T-maps showed the highest specificity (100%) and sensitivity (94.1%) for ASL and [18F]DOPA analysis, respectively. The sensitivity of qualitative SPM maps and semi-quantitative rCBF and rSUV analyses were the highest for glioblastoma. CONCLUSION Tumor isocontour T-maps and combined analysis of CBF and [18F]DOPA-PET uptake allow achieving high diagnostic performance in differentiating between progression and pseudo-progression in treated gliomas. The sensitivity is particularly high for glioblastomas. KEY POINTS • Applied separately, MRI and PET imaging modalities may be insufficient to characterize the brain glioma post-therapeutic profile. • Combined ASL and [18F]DOPA-PET map analysis allows differentiating between tumor progression and pseudo-progression.
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Affiliation(s)
- Arnaud Pellerin
- Service de Neuroradiologie Diagnostique et Interventionnelle, Centre Hospitalier Universitaire de Nantes, Hôpital Nord Laennec, Rez-de-chaussée Bas Aile Est, Boulevard Jacques-Monod, Saint-Herblain, 44093, Nantes Cedex 1, France.
- Service de Neuroradiologie Diagnostique et Fonctionnelle, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
| | - Maya Khalifé
- Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle épinière (ICM), CNRS UMR 7225 - Inserm U1127 - Sorbonne Université - UMR S1127, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Arterys, 34 av. des Champs-Elysées, 75008, Paris, France
| | - Marc Sanson
- Service de Neurologie, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Laura Rozenblum-Beddok
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Marc Bertaux
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Marine Soret
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Damien Galanaud
- Service de Neuroradiologie Diagnostique et Fonctionnelle, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle épinière (ICM), CNRS UMR 7225 - Inserm U1127 - Sorbonne Université - UMR S1127, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Didier Dormont
- Service de Neuroradiologie Diagnostique et Fonctionnelle, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
| | - Aurélie Kas
- Service de Médecine Nucléaire, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Université Paris 6 UPMC, LIB Inserm U1146, 91-105 Boulevard de l'Hôpital, 75013, Paris, France
| | - Nadya Pyatigorskaya
- Service de Neuroradiologie Diagnostique et Fonctionnelle, Groupe Hospitalier Pitié-Salpêtrière C. Foix, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
- Centre de NeuroImagerie de Recherche (CENIR), Institut du Cerveau et de la Moelle épinière (ICM), CNRS UMR 7225 - Inserm U1127 - Sorbonne Université - UMR S1127, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France
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Pseudo-continuous arterial spin labelling shows high diagnostic performance in the detection of postoperative residual lesion in hyper-vascularised adult brain tumours. Eur Radiol 2020; 30:2809-2820. [PMID: 31965259 DOI: 10.1007/s00330-019-06474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/26/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Our aim was to evaluate the contribution of pseudo-continuous arterial spin labelling (pCASL) in the detection of a postoperative residual lesion in adult brain tumours. METHODS Seventy-five patients were prospectively included. Following the results of preoperative DSC-PWI assessment, intra-axial lesions, including high-grade gliomas (n = 43) and certain metastases (n = 14), were classified as hyper-vascular (HV+ group, n = 57); other lesions, including low-grade gliomas and certain metastases, were classified as non-hyper-vascular (HV- group, n = 18). To confirm the absence/presence of a residual lesion or disease progression, postoperative MRI including pCASL sequence and follow-up-MRI were performed within 72 h and 1-6 months after the resection, respectively. Two raters evaluated the images. Mean and maximal ASL cerebral blood flow (CBF) values were measured in the perioperative region and normalised to the contralateral tissue. The pCASL-CBF maps and post-contrast T1WI were visually assessed for residual lesion. Quantitative data were analysed with unpaired Student t and Mann-Whitney U tests and the visual diagnostic performance with the McNemar test. RESULTS In the HV+ group, the mean normalised CBF was 1.97 ± 0.59 and 0.97 ± 0.29 (p < 0.0001, AUC = 0.964, cut-off = 1.27) for patients with or without residual tumours, respectively. The mean normalised CBF was not discriminative for assessing residual tumours in the HV- group (p = 0.454). Visual CBF evaluation allowed 92.98% patients belonging to the HV+ group to be correctly classified (sensitivity 93.02%, specificity 92.86%, p < 0.001). Visual evaluation was correlated with contrast enhancement evaluation and with the mean normalised CBF values (r = 0.505, p < 0.0001 and 0.838, p < 0.0001, respectively). CONCLUSION Qualitative and quantitative ASL evaluation shows high diagnostic performance in postoperative assessment of hyper-perfused tumours. In this case, postoperative pCASL may be useful, especially if contrast injection cannot be performed or when contrast enhancement is doubtful. KEY POINTS • Evaluation of postoperative residual lesion in the case of brain tumours is an imaging challenge. • This prospective monocentric study showed that increased normalised cerebral blood flow assessed by pseudo-continuous arterial spin labelling (pCASL) correlates well with the presence of a residual tumour in the case of hyper-vascular tumour diagnosed on preoperative MRI. • Qualitative and quantitative pCASL is an informative sequence for hyper-vascular residual tumour, especially if acquired more than 48 h after brain tumour surgery, when contrast enhancement can give ambiguous results due to blood-brain barrier disruption.
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Alsaedi A, Doniselli F, Jäger HR, Panovska-Griffiths J, Rojas-Garcia A, Golay X, Bisdas S. The value of arterial spin labelling in adults glioma grading: systematic review and meta-analysis. Oncotarget 2019; 10:1589-1601. [PMID: 30899427 PMCID: PMC6422184 DOI: 10.18632/oncotarget.26674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/01/2019] [Indexed: 12/20/2022] Open
Abstract
This study aimed to evaluate the diagnostic performance of arterial spin labelling (ASL) in grading of adult gliomas. Eighteen studies matched the inclusion criteria and were included after systematic searches through EMBASE and MEDLINE databases. The quality of the included studies was assessed utilizing Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The quantitative values were extracted and a meta-analysis was subsequently based on a random-effect model with forest plot and joint sensitivity and specificity modelling. Hierarchical summary receiver operating characteristic (HROC) curve analysis was also conducted. The absolute tumour blood flow (TBF) values can differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) and grade II from grade IV tumours. However, it lacked the capacity to differentiate grade II from grade III tumours and grade III from grade IV tumours. In contrast, the relative TBF (rTBF) is effective in differentiating HGG from LGG and in glioma grading. The maximum rTBF (rTBFmax) demonstrated the best results in glioma grading. These results were also reflected in the sensitivity/specificity analysis in which the rTBFmax showed the highest discrimination performance in glioma grading. The estimated effect size for the rTBF was approximately similar between HGGs and LGGs, and grade II and grade III tumours, (-1.46 (-2.00, -0.91), p-value < 0.001), (-1.39 (-1.89, -0.89), p-value < 0.001), respectively; while it exhibited smaller effect size between grade III and grade IV (-1.05 (-1.82, -0.27)), p < 0.05). Sensitivity and specificity analysis replicate these results as well. This meta-analysis suggests that ASL is useful for glioma grading, especially when considering the rTBFmax parameter.
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Affiliation(s)
- Amirah Alsaedi
- Department of Radiology Technology, Taibah University, Medina, KSA.,Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK
| | - Fabio Doniselli
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.,PhD Course in Clinical Research, Università degli Studi di Milano, Milan, Italy
| | - Hans Rolf Jäger
- Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | | | | | - Xavier Golay
- Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK
| | - Sotirios Bisdas
- Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
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