1
|
Gill SK, Rose HEL, Wilson M, Rodriguez Gutierrez D, Worthington L, Davies NP, MacPherson L, Hargrave DR, Saunders DE, Clark CA, Payne GS, Leach MO, Howe FA, Auer DP, Jaspan T, Morgan PS, Grundy RG, Avula S, Pizer B, Arvanitis TN, Peet AC. Characterisation of paediatric brain tumours by their MRS metabolite profiles. NMR IN BIOMEDICINE 2024; 37:e5101. [PMID: 38303627 DOI: 10.1002/nbm.5101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 02/03/2024]
Abstract
1H-magnetic resonance spectroscopy (MRS) has the potential to improve the noninvasive diagnostic accuracy for paediatric brain tumours. However, studies analysing large, comprehensive, multicentre datasets are lacking, hindering translation to widespread clinical practice. Single-voxel MRS (point-resolved single-voxel spectroscopy sequence, 1.5 T: echo time [TE] 23-37 ms/135-144 ms, repetition time [TR] 1500 ms; 3 T: TE 37-41 ms/135-144 ms, TR 2000 ms) was performed from 2003 to 2012 during routine magnetic resonance imaging for a suspected brain tumour on 340 children from five hospitals with 464 spectra being available for analysis and 281 meeting quality control. Mean spectra were generated for 13 tumour types. Mann-Whitney U-tests and Kruskal-Wallis tests were used to compare mean metabolite concentrations. Receiver operator characteristic curves were used to determine the potential for individual metabolites to discriminate between specific tumour types. Principal component analysis followed by linear discriminant analysis was used to construct a classifier to discriminate the three main central nervous system tumour types in paediatrics. Mean concentrations of metabolites were shown to differ significantly between tumour types. Large variability existed across each tumour type, but individual metabolites were able to aid discrimination between some tumour types of importance. Complete metabolite profiles were found to be strongly characteristic of tumour type and, when combined with the machine learning methods, demonstrated a diagnostic accuracy of 93% for distinguishing between the three main tumour groups (medulloblastoma, pilocytic astrocytoma and ependymoma). The accuracy of this approach was similar even when data of marginal quality were included, greatly reducing the proportion of MRS excluded for poor quality. Children's brain tumours are strongly characterised by MRS metabolite profiles readily acquired during routine clinical practice, and this information can be used to support noninvasive diagnosis. This study provides both key evidence and an important resource for the future use of MRS in the diagnosis of children's brain tumours.
Collapse
Affiliation(s)
- Simrandip K Gill
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Heather E L Rose
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Martin Wilson
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Lara Worthington
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nigel P Davies
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Department of Imaging and Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Darren R Hargrave
- Paediatric Oncology Unit, Great Ormond Street Hospital For Sick Children, London, UK
| | - Dawn E Saunders
- Paediatric Oncology Unit, Great Ormond Street Hospital For Sick Children, London, UK
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Geoffrey S Payne
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin O Leach
- CRUK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Franklyn A Howe
- Neurosciences Research Section, Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Dorothee P Auer
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Radiological Sciences, Department of Clinical Neuroscience, University of Nottingham, Nottingham, UK
- Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
- Neuroradiology, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
| | - Paul S Morgan
- Medical Physics, Nottingham University Hospital, Queen's Medical Centre, Nottingham, UK
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Richard G Grundy
- The Children's Brain Tumour Research Centre, University of Nottingham, Nottingham, UK
| | - Shivaram Avula
- Department of Radiology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Barry Pizer
- Department of Paediatric Oncology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Theodoros N Arvanitis
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Department of Electronic, Electrical and Systems Engineering, University of Birmingham, Birmingham, UK
| | - Andrew C Peet
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
2
|
Aseel A, McCarthy P, Mohammed A. Brain magnetic resonance spectroscopy to differentiate recurrent neoplasm from radiation necrosis: A systematic review and meta-analysis. J Neuroimaging 2023; 33:189-201. [PMID: 36631883 DOI: 10.1111/jon.13080] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Postradiation treatment necrosis is one of the most serious late sequelae and appears within 6 months. The magnetic resonance spectroscopy imaging (MRSI) has been used for the detection of brain tumors. The study aimed to determine the radiological accuracy and efficacy in distinguishing recurrent brain tumor from radiation-induced necrosis by identifying pseudoprogression. METHODS The research was performed in accordance with the preferred reporting items for systematic review and meta-analysis guidelines. International electronic databases including 15 English sources were investigated. A total of 4281 papers with 2159 citations from 15 databases from 2011 to 2021 met the search strategies of magnetic resonance (MR) spectroscopy in recurrent brain tumors and postradiation necrosis. RESULTS Nine studies were enrolled in the meta-analysis with a total of 354 patients (203 male and 151 female) whose average age ranged from 4 to 74 years. Anbarloui et al., Elias et al., Nemattalla et al., Smith et al., Zeng et al., and Weybright et al. showed strong evidence of heterogeneity regarding choline/N-acetylaspartate (Cho/NAA) ratio in the evaluation of the nine studies. Elias et al., Nemattalla et al., Bobek-Billewicz et al., and Smith et al. showed a high heterogeneity in Cho/creatine (Cr) ratio. Elias et al., Nemattalla et al., Smith et al., and Weybright et al. revealed high heterogeneity in NAA/Cr ratio estimates. CONCLUSION MR spectroscopy is effective in distinguishing recurrent brain tumors from necrosis. Our meta-analysis revealed that Cho/NAA, Cho/Cr, and NAA/Cr ratios were significantly better predictor of detected recurrent tumor. Therefore, the MRSI is an informative tool in the distinction of tumor recurrence versus necrosis.
Collapse
Affiliation(s)
- Almusaedi Aseel
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland
| | - Peter McCarthy
- School of Medicine, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland
| | | |
Collapse
|
3
|
Sidibe I, Tensaouti F, Gilhodes J, Cabarrou B, Filleron T, Desmoulin F, Ken S, Noël G, Truc G, Sunyach MP, Charissoux M, Magné N, Lotterie JA, Roques M, Péran P, Cohen-Jonathan Moyal E, Laprie A. Pseudoprogression in GBM versus true progression in patients with glioblastoma: A multiapproach analysis. Radiother Oncol 2023; 181:109486. [PMID: 36706959 DOI: 10.1016/j.radonc.2023.109486] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE To investigate the feasibility of using a multiapproach analysis combining clinical data, diffusion- and perfusion-weighted imaging, and 3D magnetic resonance spectroscopic imaging to distinguish true tumor progression (TP) from pseudoprogression (PSP) in patients with glioblastoma. MATERIALS AND METHODS Progression was suspected within 6 months of radiotherapy in 46 of the 180 patients included in the Phase-III SpectroGlio trial (NCT01507506). Choline/creatine (Cho/Cr), choline/N-acetyl aspartate (Cho/NAA) and lactate/N-acetyl aspartate (Lac/NAA) ratios were extracted. Apparent diffusion coefficient (ADC) and cerebral blood volume (CBV) maps were calculated. ADC, relative CBV values and tumor volume (TV) were collected at relapse. Differences between TP and PSP were evaluated using Mann-Whitney tests, and p values were adjusted with Bonferroni correction. RESULTS Patients with suspected progression underwent a new MRI scan 1 month after the first one. Of these, 28 were classified as PSP, and 18 as TP. After a median follow-up of 41 months, median overall survival was higher in PSP than in TP (25.2 vs 20.3 months; p = 0.0092). Lac/NAA and Cho/Cr ratios were higher in TP than in PSP (1.2 vs 0.5; p = 0.006; and 3 vs 2.2; p = 0.021). After multivariate regression analysis, TV was the most significant predictor of TP vs PSP, and the only one retained in the model (p = 0.028). CONCLUSION Three spectroscopic ratios could be used to differentiate PSP from TP. TV at relapse was the most predictive factor in the multivariate analysis, and overall survival was higher in PSP than in TP.
Collapse
Affiliation(s)
- Ingrid Sidibe
- Radiation Oncology Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France; Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France
| | - Fatima Tensaouti
- Radiation Oncology Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France; Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France
| | - Julia Gilhodes
- Biostatistics Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France
| | - Bastien Cabarrou
- Biostatistics Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France
| | - Thomas Filleron
- Biostatistics Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France
| | - Franck Desmoulin
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France
| | - Soleakhena Ken
- Radiation Oncology Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France; Radiation Oncology Department, Toulouse Center for Cancer Research & INSERM, Toulouse, France
| | - Georges Noël
- Radiation Oncology Department, ICANS, Strasbourg, France
| | - Gilles Truc
- Radiation Oncology Department, Georges-François Leclerc Center, Dijon, France
| | | | | | - Nicolas Magné
- Radiation Oncology Department, Lucien Neuwirth Loire Cancer Institute, Saint-Priest-en-Jarez, France
| | - Jean-Albert Lotterie
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France
| | - Margaux Roques
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- Radiation Oncology Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France; Radiation Oncology Department, Toulouse Center for Cancer Research & INSERM, Toulouse, France
| | - Anne Laprie
- Radiation Oncology Department, Claudius Regaud Institute/Toulouse University Cancer Institute - Oncopôle, Toulouse, France; Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier & INSERM, Toulouse, France.
| |
Collapse
|
4
|
McCarthy L, Verma G, Hangel G, Neal A, Moffat BA, Stockmann JP, Andronesi OC, Balchandani P, Hadjipanayis CG. Application of 7T MRS to High-Grade Gliomas. AJNR Am J Neuroradiol 2022; 43:1378-1395. [PMID: 35618424 PMCID: PMC9575545 DOI: 10.3174/ajnr.a7502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/11/2022] [Indexed: 01/26/2023]
Abstract
MRS, including single-voxel spectroscopy and MR spectroscopic imaging, captures metabolites in high-grade gliomas. Emerging evidence indicates that 7T MRS may be more sensitive to aberrant metabolic activity than lower-field strength MRS. However, the literature on the use of 7T MRS to visualize high-grade gliomas has not been summarized. We aimed to identify metabolic information provided by 7T MRS, optimal spectroscopic sequences, and areas for improvement in and new applications for 7T MRS. Literature was found on PubMed using "high-grade glioma," "malignant glioma," "glioblastoma," "anaplastic astrocytoma," "7T," "MR spectroscopy," and "MR spectroscopic imaging." 7T MRS offers higher SNR, modestly improved spatial resolution, and better resolution of overlapping resonances. 7T MRS also yields reduced Cramér-Rao lower bound values. These features help to quantify D-2-hydroxyglutarate in isocitrate dehydrogenase 1 and 2 gliomas and to isolate variable glutamate, increased glutamine, and increased glycine with higher sensitivity and specificity. 7T MRS may better characterize tumor infiltration and treatment effect in high-grade gliomas, though further study is necessary. 7T MRS will benefit from increased sample size; reductions in field inhomogeneity, specific absorption rate, and acquisition time; and advanced editing techniques. These findings suggest that 7T MRS may advance understanding of high-grade glioma metabolism, with reduced Cramér-Rao lower bound values and better measurement of smaller metabolite signals. Nevertheless, 7T is not widely used clinically, and technical improvements are necessary. 7T MRS isolates metabolites that may be valuable therapeutic targets in high-grade gliomas, potentially resulting in wider ranging neuro-oncologic applications.
Collapse
Affiliation(s)
- L McCarthy
- From the Department of Neurosurgery (L.M., C.G.H.), Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| | - G Verma
- BioMedical Engineering and Imaging Institute (G.V., P.B.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - G Hangel
- Department of Neurosurgery (G.H.)
- High-field MR Center (G.H.), Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - A Neal
- Department of Medicine (A.N.), Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
- Department of Neurology (A.N.), Royal Melbourne Hospital, Melbourne, Australia
| | - B A Moffat
- The Melbourne Brain Centre Imaging Unit (B.A.M.), Department of Radiology, The University of Melbourne, Melbourne, Australia
| | - J P Stockmann
- A. A. Martinos Center for Biomedical Imaging (J.P.S., O.C.A.), Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (J.P.S., O.C.A.), Boston, Massachusetts
| | - O C Andronesi
- A. A. Martinos Center for Biomedical Imaging (J.P.S., O.C.A.), Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (J.P.S., O.C.A.), Boston, Massachusetts
| | - P Balchandani
- BioMedical Engineering and Imaging Institute (G.V., P.B.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C G Hadjipanayis
- From the Department of Neurosurgery (L.M., C.G.H.), Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York
| |
Collapse
|
5
|
Multiparametric Characterization of Intracranial Gliomas Using Dynamic [18F]FET-PET and Magnetic Resonance Spectroscopy. Diagnostics (Basel) 2022; 12:diagnostics12102331. [PMID: 36292019 PMCID: PMC9601276 DOI: 10.3390/diagnostics12102331] [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: 08/15/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 11/18/2022] Open
Abstract
Both static and dynamic O-(2-[18F]fluoroethyl)-l-tyrosine-(FET)-PET and 1H magnetic resonance spectroscopy (MRS) are useful tools for grading and prognostication in gliomas. However, little is known about the potential of multimodal imaging comprising both procedures. We therefore acquired NAA/Cr and Cho/Cr ratios in multi-voxel MRS as well as FET-PET parameters in 67 glioma patients and determined multiparametric parameter combinations. Using receiver operating characteristics, differentiation between low-grade and high-grade glioma was possible by static FET-PET (area under the curve (AUC) 0.86, p = 0.001), time-to-peak (TTP; AUC 0.79, p = 0.049), and using the Cho/Cr ratio (AUC 0.72, p = 0.039), while the multimodal analysis led to improved discrimination with an AUC of 0.97 (p = 0.001). In order to distinguish glioblastoma from non-glioblastoma, MRS (NAA/Cr ratio, AUC 0.66, p = 0.031), and dynamic FET-PET (AUC 0.88, p = 0.001) were superior to static FET imaging. The multimodal analysis increased the accuracy with an AUC of 0.97 (p < 0.001). In the survival analysis, PET parameters, but not spectroscopy, were significantly correlated with overall survival (OS, static PET p = 0.014, TTP p = 0.012), still, the multiparametric analysis, including MRS, was also useful for the prediction of OS (p = 0.002). In conclusion, FET-PET and MRS provide complementary information to better characterize gliomas before therapy, which is particularly interesting with respect to the increasing use of hybrid PET/MRI for brain tumors.
Collapse
|
6
|
Chawla S, Bukhari S, Afridi OM, Wang S, Yadav SK, Akbari H, Verma G, Nath K, Haris M, Bagley S, Davatzikos C, Loevner LA, Mohan S. Metabolic and physiologic magnetic resonance imaging in distinguishing true progression from pseudoprogression in patients with glioblastoma. NMR IN BIOMEDICINE 2022; 35:e4719. [PMID: 35233862 PMCID: PMC9203929 DOI: 10.1002/nbm.4719] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 05/15/2023]
Abstract
Pseudoprogression (PsP) refers to treatment-related clinico-radiologic changes mimicking true progression (TP) that occurs in patients with glioblastoma (GBM), predominantly within the first 6 months after the completion of surgery and concurrent chemoradiation therapy (CCRT) with temozolomide. Accurate differentiation of TP from PsP is essential for making informed decisions on appropriate therapeutic intervention as well as for prognostication of these patients. Conventional neuroimaging findings are often equivocal in distinguishing between TP and PsP and present a considerable diagnostic dilemma to oncologists and radiologists. These challenges have emphasized the need for developing alternative imaging techniques that may aid in the accurate diagnosis of TP and PsP. In this review, we encapsulate the current state of knowledge in the clinical applications of commonly used metabolic and physiologic magnetic resonance (MR) imaging techniques such as diffusion and perfusion imaging and proton spectroscopy in distinguishing TP from PsP. We also showcase the potential of promising imaging techniques, such as amide proton transfer and amino acid-based positron emission tomography, in providing useful information about the treatment response. Additionally, we highlight the role of "radiomics", which is an emerging field of radiology that has the potential to change the way in which advanced MR techniques are utilized in assessing treatment response in GBM patients. Finally, we present our institutional experiences and discuss future perspectives on the role of multiparametric MR imaging in identifying PsP in GBM patients treated with "standard-of-care" CCRT as well as novel/targeted therapies.
Collapse
Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sultan Bukhari
- Rowan School of Osteopathic Medicine at Rowan University, Voorhees, New Jersey, USA
| | - Omar M. Afridi
- Rowan School of Osteopathic Medicine at Rowan University, Voorhees, New Jersey, USA
| | - Sumei Wang
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Santosh K. Yadav
- Laboratory of Functional and Molecular Imaging, Sidra Medicine, Doha, Qatar
| | - Hamed Akbari
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gaurav Verma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kavindra Nath
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohammad Haris
- Laboratory of Functional and Molecular Imaging, Sidra Medicine, Doha, Qatar
| | - Stephen Bagley
- Department of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie A. Loevner
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Galijasevic M, Steiger R, Mangesius S, Mangesius J, Kerschbaumer J, Freyschlag CF, Gruber N, Janjic T, Gizewski ER, Grams AE. Magnetic Resonance Spectroscopy in Diagnosis and Follow-Up of Gliomas: State-of-the-Art. Cancers (Basel) 2022; 14:3197. [PMID: 35804969 PMCID: PMC9264890 DOI: 10.3390/cancers14133197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/16/2022] [Accepted: 06/27/2022] [Indexed: 02/06/2023] Open
Abstract
Preoperative grade prediction is important in diagnostics of glioma. Even more important can be follow-up after chemotherapy and radiotherapy of high grade gliomas. In this review we provide an overview of MR-spectroscopy (MRS), technical aspects, and different clinical scenarios in the diagnostics and follow-up of gliomas in pediatric and adult populations. Furthermore, we provide a recap of the current research utility and possible future strategies regarding proton- and phosphorous-MRS in glioma research.
Collapse
Affiliation(s)
- Malik Galijasevic
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (R.S.); (T.J.); (E.R.G.); (A.E.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (R.S.); (T.J.); (E.R.G.); (A.E.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (R.S.); (T.J.); (E.R.G.); (A.E.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julian Mangesius
- Department of Radiation Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (J.K.); (C.F.F.)
| | | | - Nadja Gruber
- VASCage-Research Centre on Vascular Ageing and Stroke, 6020 Innsbruck, Austria;
- Department of Applied Mathematics, University of Innsbruck, 6020 Innsbruck, Austria
| | - Tanja Janjic
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (R.S.); (T.J.); (E.R.G.); (A.E.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (R.S.); (T.J.); (E.R.G.); (A.E.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Astrid Ellen Grams
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (M.G.); (R.S.); (T.J.); (E.R.G.); (A.E.G.)
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
8
|
Sidibe I, Tensaouti F, Roques M, Cohen-Jonathan-Moyal E, Laprie A. Pseudoprogression in Glioblastoma: Role of Metabolic and Functional MRI-Systematic Review. Biomedicines 2022; 10:biomedicines10020285. [PMID: 35203493 PMCID: PMC8869397 DOI: 10.3390/biomedicines10020285] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 12/16/2022] Open
Abstract
Background: Glioblastoma is the most frequent malignant primitive brain tumor in adults. The treatment includes surgery, radiotherapy, and chemotherapy. During follow-up, combined chemoradiotherapy can induce treatment-related changes mimicking tumor progression on medical imaging, such as pseudoprogression (PsP). Differentiating PsP from true progression (TP) remains a challenge for radiologists and oncologists, who need to promptly start a second-line treatment in the case of TP. Advanced magnetic resonance imaging (MRI) techniques such as diffusion-weighted imaging, perfusion MRI, and proton magnetic resonance spectroscopic imaging are more efficient than conventional MRI in differentiating PsP from TP. None of these techniques are fully effective, but current advances in computer science and the advent of artificial intelligence are opening up new possibilities in the imaging field with radiomics (i.e., extraction of a large number of quantitative MRI features describing tumor density, texture, and geometry). These features are used to build predictive models for diagnosis, prognosis, and therapeutic response. Method: Out of 7350 records for MR spectroscopy, GBM, glioma, recurrence, diffusion, perfusion, pseudoprogression, radiomics, and advanced imaging, we screened 574 papers. A total of 228 were eligible, and we analyzed 72 of them, in order to establish the role of each imaging modality and the usefulness and limitations of radiomics analysis.
Collapse
Affiliation(s)
- Ingrid Sidibe
- Radiation Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute Oncopole, 31100 Toulouse, France; (I.S.); (F.T.); (E.C.-J.-M.)
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier INSERM, 31100 Toulouse, France;
| | - Fatima Tensaouti
- Radiation Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute Oncopole, 31100 Toulouse, France; (I.S.); (F.T.); (E.C.-J.-M.)
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier INSERM, 31100 Toulouse, France;
| | - Margaux Roques
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier INSERM, 31100 Toulouse, France;
- Radiology Department, Purpan University Hospital, 31300 Toulouse, France
| | - Elizabeth Cohen-Jonathan-Moyal
- Radiation Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute Oncopole, 31100 Toulouse, France; (I.S.); (F.T.); (E.C.-J.-M.)
- INSERM UMR.1037-Cancer Research Center of Toulouse (CRCT)/University Paul Sabatier Toulouse III, 31100 Toulouse, France
| | - Anne Laprie
- Radiation Oncology Department, Claudius Regaud Institute, Toulouse University Cancer Institute Oncopole, 31100 Toulouse, France; (I.S.); (F.T.); (E.C.-J.-M.)
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier INSERM, 31100 Toulouse, France;
- Correspondence:
| |
Collapse
|
9
|
Zheng L, Zhou ZR, Shi M, Chen H, Yu QQ, Yang Y, Liu L, Zhang L, Guo Y, Zhou X, Li C, Wei Q. Nomograms for predicting progression-free survival and overall survival after surgery and concurrent chemoradiotherapy for glioblastoma: a retrospective cohort study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:571. [PMID: 33987269 DOI: 10.21037/atm-21-673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Glioblastoma (GBM) is the most common malignant brain tumor in adults. The prognosis of GBM patients is poor. Even with active standard treatment, the median overall survival is only 14.6 months. It is therefore critical to ascertain recurrence and search for factors that influence the prognosis of GBM. This study aimed to screen the variables related to the progression-free survival (PFS) and overall survival (OS) of GBM patients undergoing surgery and concurrent chemoradiotherapy, as well as propose a nomogram for individual risk prediction based on preoperative imaging parameters and clinicopathological variables readily available in clinical practice. Methods We retrospectively analyzed 114 consecutive patients with GBM who underwent surgery and concurrent chemoradiotherapy at the Second Affiliated Hospital, Zhejiang University School of Medicine from January 1st, 2015, to June 1st, 2018. Twenty-four preoperative magnetic resonance imaging (MRI) parameters were extracted manually from the Picture Archiving and Communication System (PACS). Clinicopathological factors were extracted from the electronic medical record system (EMRS). Least absolute shrinkage and selection operator (LASSO) regression and Cox regression were used for feature selection and model prediction, respectively. The models were presented using nomograms, which were applied to identify the risk of recurrence and survival according to the score. The performance of the nomograms to predict PFS and OS was tested with C-statistics, calibration plots, and Kaplan-Meier curves. Results The results revealed that sex, Karnofsky performance score (KPS), O6-methylglucamine-DNA methyltransferase (MGMT) protein expression, number of adjuvant chemotherapy cycles with temozolomide (TMZ), and the MRI signature effectively predicted PFS; and sex, KPS, extent of surgery, number of TMZ cycles, and MRI signature effectively predicted OS. The nomogram revealed good discriminative ability (C-statistics: 0.81 for PFS and 0.79 for OS). In the nomogram of PFS, patients with a score greater than 122 were considered to have a high risk of recurrence. In the nomogram of OS, the cutoff score were 115 and 145, and then patients were classified as low, medium, and high risk. Conclusions In conclusion, our nomograms can effectively predict the risk of recurrence and survival of GBM patients and thus can be a good guide for clinical practice.
Collapse
Affiliation(s)
- Lin Zheng
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Radiation Oncology, Taizhou Cancer Hospital, Taizhou, China
| | - Zhi-Rui Zhou
- Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Minghan Shi
- Département de l'éducation aux adultes, Cégep Saint-Jean-sur-Richelieu, Brossard, QC, Canada
| | - Haiyan Chen
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qian-Qian Yu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Yang
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihong Liu
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lili Zhang
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yinglu Guo
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaofeng Zhou
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chao Li
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qichun Wei
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
10
|
Early Detection of Radiation-Induced Injury and Prediction of Cognitive Deficit by MRS Metabolites in Radiotherapy of Low-Grade Glioma. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6616992. [PMID: 34258272 PMCID: PMC8260313 DOI: 10.1155/2021/6616992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/04/2021] [Accepted: 02/21/2021] [Indexed: 12/18/2022]
Abstract
Purpose To compare the sensitivity of MRS metabolites and MoCA and ACE-R cognitive tests in the detection of radiation-induced injury in low grade glioma (LGG) patients in early and early delayed postradiation stages. Methods MRS metabolite ratios of NAA/Cr and Cho/Cr, ACE-R and MoCA cognitive tests, and dosimetric parameters in corpus callosum were analyzed during RT and up to 6-month post-RT for ten LGG patients. Results Compared to pre RT baseline, a significant decline in both NAA/Cr and Cho/Cr in the corpus callosum was seen at the 4th week of RT, 1, 3, and 6-month post-RT. These declines were detected at least 3 months before the detection of declines in cognitive functions by ACE-R and MoCA tools. Moreover, NAA/Cr alterations at 4th week of RT and 1-month post-RT were significantly negatively correlated with the mean dose received by the corpus callosum, as well as the corpus callosum 40 Gy dose volume, i.e., the volume of the corpus callosum receiving a dose greater than 40 Gy. Conclusion MRS-based biomarkers may be more sensitive than the state-of-the-art cognitive tests in the prediction of postradiation cognitive impairments. They would be utilized in treatment planning and dose sparing protocols, with a specific focus on the corpus callosum in the radiation therapy of LGG patients.
Collapse
|
11
|
Le Fèvre C, Constans JM, Chambrelant I, Antoni D, Bund C, Leroy-Freschini B, Schott R, Cebula H, Noël G. Pseudoprogression versus true progression in glioblastoma patients: A multiapproach literature review. Part 2 - Radiological features and metric markers. Crit Rev Oncol Hematol 2021; 159:103230. [PMID: 33515701 DOI: 10.1016/j.critrevonc.2021.103230] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/10/2021] [Accepted: 01/16/2021] [Indexed: 12/28/2022] Open
Abstract
After chemoradiotherapy for glioblastoma, pseudoprogression can occur and must be distinguished from true progression to correctly manage glioblastoma treatment and follow-up. Conventional treatment response assessment is evaluated via conventional MRI (contrast-enhanced T1-weighted and T2/FLAIR), which is unreliable. The emergence of advanced MRI techniques, MR spectroscopy, and PET tracers has improved pseudoprogression diagnostic accuracy. This review presents a literature review of the different imaging techniques and potential imaging biomarkers to differentiate pseudoprogression from true progression.
Collapse
Affiliation(s)
- Clara Le Fèvre
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Jean-Marc Constans
- Department of Radiology, Amiens-Picardie University Hospital, 1 rond-point du Professeur Christian Cabrol, 80054, Amiens Cedex 1, France.
| | - Isabelle Chambrelant
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Delphine Antoni
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Caroline Bund
- Department of Nuclear Medicine, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Benjamin Leroy-Freschini
- Department of Nuclear Medicine, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Roland Schott
- Departement of Medical Oncology, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| | - Hélène Cebula
- Departement of Neurosurgery, Hautepierre University Hospital, 1, avenue Molière, 67200, Strasbourg, France.
| | - Georges Noël
- Department of Radiotherapy, ICANS, Institut Cancérologie Strasbourg Europe, 17 rue Albert Calmette, 67200, Strasbourg Cedex, France.
| |
Collapse
|
12
|
Kamson D, Tsien C. Novel Magnetic Resonance Imaging and Positron Emission Tomography in the RT Planning and Assessment of Response of Malignant Gliomas. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00078-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
13
|
Alemany M, Velasco R, Simó M, Bruna J. Late effects of cancer treatment: consequences for long-term brain cancer survivors. Neurooncol Pract 2020; 8:18-30. [PMID: 33664966 DOI: 10.1093/nop/npaa039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Late adverse effects of cancer treatments represent a significant source of morbidity and also financial hardship among brain tumor patients. These effects can be produced by direct neurologic damage of the tumor and its removal, and/or by complementary treatments such as chemotherapy and radiotherapy, either alone or combined. Notably, young adults are the critical population that faces major consequences because the early onset of the disease may affect their development and socioeconomic status. The spectrum of these late adverse effects is large and involves multiple domains. In this review we classify the main long-term adverse effects into 4 sections: CNS complications, peripheral nervous system complications, secondary neoplasms, and Economic impact. In addition, CNS main complications are divided into nonfocal and focal symptoms. Owing to all the secondary effects mentioned, it is essential for physicians to have a high level of clinical suspicion to prevent and provide early intervention to minimize their impact.
Collapse
Affiliation(s)
- Montse Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO L'Hospitalet (IDIBELL), Barcelona, Spain
| |
Collapse
|
14
|
González Moreno I, Torres del Río S, Vázquez Olmos C. Seguimiento del cáncer de cabeza y cuello tratado. Lo que el radiólogo debe conocer. RADIOLOGIA 2020; 62:13-27. [DOI: 10.1016/j.rx.2019.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 05/27/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022]
|
15
|
|
16
|
Chae WH, Niesel K, Schulz M, Klemm F, Joyce JA, Prümmer M, Brill B, Bergs J, Rödel F, Pilatus U, Sevenich L. Evaluating Magnetic Resonance Spectroscopy as a Tool for Monitoring Therapeutic Response of Whole Brain Radiotherapy in a Mouse Model for Breast-to-Brain Metastasis. Front Oncol 2019; 9:1324. [PMID: 31828043 PMCID: PMC6890861 DOI: 10.3389/fonc.2019.01324] [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: 01/28/2019] [Accepted: 11/13/2019] [Indexed: 01/06/2023] Open
Abstract
Brain metastases are the most common intracranial tumor in adults and are associated with poor patient prognosis and median survival of only a few months. Treatment options for brain metastasis patients remain limited and largely depend on surgical resection, radio- and/or chemotherapy. The development and pre-clinical testing of novel therapeutic strategies require reliable experimental models and diagnostic tools that closely mimic technologies that are used in the clinic and reflect histopathological and biochemical changes that distinguish tumor progression from therapeutic response. In this study, we sought to test the applicability of magnetic resonance (MR) spectroscopy in combination with MR imaging to closely monitor therapeutic efficacy in a breast-to-brain metastasis model. Given the importance of radiotherapy as the standard of care for the majority of brain metastases patients, we chose to monitor the post-irradiation response by magnetic resonance spectroscopy (MRS) in combination with MR imaging (MRI) using a 7 Tesla small animal scanner. Radiation was applied as whole brain radiotherapy (WBRT) using the image-guided Small Animal Radiation Research Platform (SARRP). Here we describe alterations in different metabolites, including creatine and N-acetylaspartate, that are characteristic for brain metastases progression and lactate, which indicates hypoxia, while choline levels remained stable. Radiotherapy resulted in normalization of metabolite levels indicating tumor stasis or regression in response to treatment. Our data indicate that the use of MR spectroscopy in addition to MRI represents a valuable tool to closely monitor not only volumetrical but also metabolic changes during tumor progression and to evaluate therapeutic efficacy of intervention strategies. Adapting the analytical technology in brain metastasis models to those used in clinical settings will increase the translational significance of experimental evaluation and thus contribute to the advancement of pre-clinical assessment of novel therapeutic strategies to improve treatment options for brain metastases patients.
Collapse
Affiliation(s)
- Woon Hyung Chae
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Katja Niesel
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Michael Schulz
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany.,Faculty of Biological Sciences, Goethe-University, Frankfurt, Germany
| | - Florian Klemm
- Department of Oncology and Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | - Johanna A Joyce
- Department of Oncology and Ludwig Institute for Cancer Research, University of Lausanne, Lausanne, Switzerland
| | | | - Boris Brill
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany
| | - Judith Bergs
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Franz Rödel
- Department of Radiotherapy and Oncology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute, Goethe University, Frankfurt am Main, Germany
| | - Ulrich Pilatus
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Lisa Sevenich
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy, Frankfurt, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Frankfurt Cancer Institute, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
17
|
Liu J, Li C, Chen Y, Lv X, Lv Y, Zhou J, Xi S, Dou W, Qian L, Zheng H, Wu Y, Chen Z. Diagnostic performance of multiparametric MRI in the evaluation of treatment response in glioma patients at 3T. J Magn Reson Imaging 2019; 51:1154-1161. [DOI: 10.1002/jmri.26900] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jie Liu
- Paul C. Lauterbur Research Center for Biomedical ImagingShenzhen Institutes of Advanced Technology, Chinese Academy of Sciences Shenzhen Guangdong China
| | - Cong Li
- Department of NeurosurgerySun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| | - Yinsheng Chen
- Department of NeurosurgerySun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| | - Xiaofei Lv
- Department of Medical ImagingSun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| | - Yanchun Lv
- Department of Medical ImagingSun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| | - Jian Zhou
- Department of Medical ImagingSun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| | - Shaoyan Xi
- Department of PathologySun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| | | | | | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical ImagingShenzhen Institutes of Advanced Technology, Chinese Academy of Sciences Shenzhen Guangdong China
| | - Yin Wu
- Paul C. Lauterbur Research Center for Biomedical ImagingShenzhen Institutes of Advanced Technology, Chinese Academy of Sciences Shenzhen Guangdong China
| | - Zhongping Chen
- Department of NeurosurgerySun Yat‐Sen University Cancer Center Guangzhou Guangdong China
| |
Collapse
|
18
|
Arevalo OD, Soto C, Rabiei P, Kamali A, Ballester LY, Esquenazi Y, Zhu JJ, Riascos RF. Assessment of Glioblastoma Response in the Era of Bevacizumab: Longstanding and Emergent Challenges in the Imaging Evaluation of Pseudoresponse. Front Neurol 2019; 10:460. [PMID: 31133966 PMCID: PMC6514158 DOI: 10.3389/fneur.2019.00460] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 04/16/2019] [Indexed: 12/17/2022] Open
Abstract
Glioblastoma is the deadliest primary malignant brain neoplasm, and despite the availability of many treatment options, its prognosis remains somber. Enhancement detected by magnetic resonance imaging (MRI) was considered the best imaging marker of tumor activity in glioblastoma for decades. However, its role as a surrogate marker of tumor viability has changed with the appearance of new treatment regimens and imaging modalities. The antiangiogenic therapy created an inflection point in the imaging assessment of glioblastoma response in clinical trials and clinical practice. Although BEV led to the improvement of enhancement, it did not necessarily mean tumor response. The decrease in the enhancement intensity represents a change in the permeability properties of the blood brain barrier, and presumably, the switch of the tumor growth pattern to an infiltrative non-enhancing phenotype. New imaging techniques for the assessment of cellularity, blood flow hemodynamics, and biochemistry have emerged to overcome this hurdle; nevertheless, designing tools to assess tumor response more accurately, and in so doing, improve the assessment of response to standard of care (SOC) therapies and to novel therapies, remains challenging.
Collapse
Affiliation(s)
- Octavio D Arevalo
- Department of Diagnostic and Interventional Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Carolina Soto
- Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Pejman Rabiei
- Department of Diagnostic and Interventional Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arash Kamali
- Department of Diagnostic and Interventional Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Leomar Y Ballester
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jay-Jiguang Zhu
- Vivian L. Smith Department of Neurosurgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Roy Francisco Riascos
- Department of Diagnostic and Interventional Radiology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| |
Collapse
|
19
|
Narasimhan S, Johnson HB, Nickles TM, Miga MI, Rana N, Attia A, Weis JA. Biophysical model-based parameters to classify tumor recurrence from radiation-induced necrosis for brain metastases. Med Phys 2019; 46:2487-2496. [PMID: 30816555 DOI: 10.1002/mp.13461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/30/2019] [Accepted: 02/20/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Stereotactic radiosurgery (SRS) is used for local control treatment of patients with intracranial metastases. As a result of SRS, some patients develop radiation-induced necrosis. Radiographically, radiation-induced necrosis can appear similar to tumor recurrence in magnetic resonance (MR) T1 -weighted contrast-enhanced imaging, T2 -weighted MR imaging, and Fluid-Attenuated Inversion Recovery (FLAIR) MR imaging. Radiographic ambiguities often necessitate invasive brain biopsies to determine lesion etiology or cause delayed subsequent therapy initiation. We use a biomechanically coupled tumor growth model to estimate patient-specific model parameters and model-derived measures to noninvasively classify etiology of enhancing lesions in this patient population. METHODS In this initial, preliminary retrospective study, we evaluated five patients with tumor recurrence and five with radiation-induced necrosis. Longitudinal patient-specific MR imaging data were used in conjunction with the model to parameterize tumor cell proliferation rate and tumor cell diffusion coefficient, and Dice correlation coefficients were used to quantify degree of correlation between model-estimated mechanical stress fields and edema visualized from MR imaging. RESULTS Results found four statistically relevant parameters which can differentiate tumor recurrence and radiation-induced necrosis. CONCLUSIONS This preliminary investigation suggests potential of this framework to noninvasively determine the etiology of enhancing lesions in patients who previously underwent SRS for intracranial metastases.
Collapse
Affiliation(s)
- Saramati Narasimhan
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN, 37235, USA
| | - Haley B Johnson
- Department of Biomedical Engineering, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Tanner M Nickles
- Department of Biomedical Engineering, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Michael I Miga
- Department of Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, TN, 37235, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Nitesh Rana
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Albert Attia
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jared A Weis
- Department of Biomedical Engineering, Wake Forest School of Medicine, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Comprehensive Cancer Center, Wake Forest Baptist Medical Center, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| |
Collapse
|
20
|
Tamrazi B, Mankad K, Nelson M, D'Arco F. Current concepts and challenges in the radiologic assessment of brain tumors in children: part 2. Pediatr Radiol 2018; 48:1844-1860. [PMID: 30215111 DOI: 10.1007/s00247-018-4232-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/06/2018] [Accepted: 08/08/2018] [Indexed: 12/16/2022]
Abstract
Assessing tumor response is a large part of everyday clinical work in neuroradiology. However in the setting of tumor treatment, distinguishing tumor progression from treatment-related changes is difficult on conventional MRI sequences. This is made even more challenging in children where mainstay advanced imaging techniques that are often used to decipher progression versus treatment-related changes have technical limitations. In this review, we highlight the challenges in pediatric neuro-oncologic tumor assessment with discussion of pseudophenomenon including pseudoresponse and pseudoprogression. Additionally, we discuss the advanced imaging techniques often employed in neuroradiology to distinguish between pseudophenomenon and true progressive disease.
Collapse
Affiliation(s)
- Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #81, Los Angeles, CA, 90027, USA.
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marvin Nelson
- Department of Radiology, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #81, Los Angeles, CA, 90027, USA
| | - Felice D'Arco
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| |
Collapse
|
21
|
FDG PET/MRI Coregistration Helps Predict Response to Gamma Knife Radiosurgery in Patients With Brain Metastases. AJR Am J Roentgenol 2018; 212:425-430. [PMID: 30422717 DOI: 10.2214/ajr.18.20006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether relative standardized uptake value (SUV) measurements at FDG PET/MRI coregistration are predictive of local tumor control in patients with brain metastases treated with stereotactic radiosurgery (SRS). MATERIALS AND METHODS A retrospective review was conducted of the images and clinical characteristics of a cohort of patients with brain metastases from non-CNS neoplasms treated with gamma knife radiosurgery (GKRS) who underwent posttherapy FDG PET because of MRI findings concerning for progression. The PET and contrast-enhanced MR images were fused. Relative SUV measurements were calculated from ROIs placed in the area of highest FDG uptake within the enhancing lesion and in the contralateral normal-appearing white matter. Relative SUV was defined as the ratio of maximum SUV in the tumor to maximum SUV in healthy white matter. Two independent readers evaluated response to GKRS using serial posttherapy MRI performed at least 3 months after GKRS completion. The relation between relative SUV and local tumor progression was evaluated with respect to treatment effect. RESULTS Eighty-five patients (48 [56.5%] women, 37 [43.5%] men; mean age at diagnosis, 60.5 ± 11.3 years) met the inclusion criteria. Thirty-three (38.8%) lesions progressed after SRS. There was a significant association between relative SUV and local tumor control (p = 0.035). Relative SUV provided a diagnostic ROC AUC of 0.67 (95% CI, 0.55-0.79). CONCLUSION Quantitative relative SUV at posttherapy FDG PET serves as a biomarker of response to SRS in patients with brain metastases in cases in which lesion growth is identified at follow-up MRI. This prognostic data may affect management, supporting the need for further therapeutic actions for selected patients.
Collapse
|
22
|
Wang B, Zhang Y, Zhao B, Zhao P, Ge M, Gao M, Ding F, Xu S, Liu Y. Postcontrast T1 Mapping for Differential Diagnosis of Recurrence and Radionecrosis after Gamma Knife Radiosurgery for Brain Metastasis. AJNR Am J Neuroradiol 2018; 39:1025-1031. [PMID: 29724761 DOI: 10.3174/ajnr.a5643] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 03/03/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE The differential diagnosis of radionecrosis and tumor recurrence in brain metastases is challenging. We investigated the diagnostic efficiency of postcontrast T1 mapping in solving this problem. MATERIALS AND METHODS Between March 2016 and June 2017, fifty-six patients with brain metastases who underwent contrast-enhanced cerebral T1 mapping were recruited for this prospective study. The findings revealed new enhancement after gamma knife radiosurgery. The subjects were assigned to radionecrosis and recurrence groups based on follow-up (median, 11.5 months) and histopathologic results. T1 values of lesions 5 (T15min) and 60 (T160min) minutes after administration of contrast agent and their difference (T1differ) were compared between the 2 groups with the 2-tailed Mann-Whitney U test. Receiver operating characteristic curves were used to determine the optimum cutoff values for differential diagnosis. RESULTS There were significant differences between the 2 groups in T15min, T160min, and T1differ values (P = .012, P = .004, and P < .001, respectively). Relative to T15min and T160min, T1differ exhibited greater sensitivity and specificity (P < .001, respectively) in identifying radionecrosis. The optimum T1differ value for differential diagnosis was 71.1 ms (area under the curve = 0.97; 95% CI, 0.93-1.00), with sensitivity and specificity of 81.5% and 96.5%, respectively. CONCLUSIONS Postcontrast T1 mapping is optimal for the differential diagnosis of radionecrosis and tumor recurrence. Among T1 parameters, T1differ is the most powerful parameter for differential diagnosis. Advantages in terms of quantitative analysis and high resolution portend the wide use of postcontrast T1 mapping in the future.
Collapse
Affiliation(s)
- B Wang
- From the School of Medicine (B.W.)
| | - Y Zhang
- Shandong Medical Imaging Research Institute (Y.Z., B.Z.), Shandong University, Jinan, P.R. China
| | - B Zhao
- Shandong Medical Imaging Research Institute (Y.Z., B.Z.), Shandong University, Jinan, P.R. China
| | - P Zhao
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - M Ge
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - M Gao
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - F Ding
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China
| | - S Xu
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China.
| | - Y Liu
- Department of Neurosurgery (P.Z., M.Ge, M.Gao, F.D., S.X., Y.L.), Provincial Hospital Affiliated with Shandong University, Jinan, P.R. China.
| |
Collapse
|
23
|
Nandu H, Wen PY, Huang RY. Imaging in neuro-oncology. Ther Adv Neurol Disord 2018; 11:1756286418759865. [PMID: 29511385 PMCID: PMC5833173 DOI: 10.1177/1756286418759865] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/18/2018] [Indexed: 12/11/2022] Open
Abstract
Imaging plays several key roles in managing brain tumors, including diagnosis, prognosis, and treatment response assessment. Ongoing challenges remain as new therapies emerge and there are urgent needs to find accurate and clinically feasible methods to noninvasively evaluate brain tumors before and after treatment. This review aims to provide an overview of several advanced imaging modalities including magnetic resonance imaging and positron emission tomography (PET), including advances in new PET agents, and summarize several key areas of their applications, including improving the accuracy of diagnosis and addressing the challenging clinical problems such as evaluation of pseudoprogression and anti-angiogenic therapy, and rising challenges of imaging with immunotherapy.
Collapse
Affiliation(s)
- Hari Nandu
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02445, USA
| |
Collapse
|
24
|
Chiang GC, Kovanlikaya I, Choi C, Ramakrishna R, Magge R, Shungu DC. Magnetic Resonance Spectroscopy, Positron Emission Tomography and Radiogenomics-Relevance to Glioma. Front Neurol 2018; 9:33. [PMID: 29459844 PMCID: PMC5807339 DOI: 10.3389/fneur.2018.00033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/15/2018] [Indexed: 12/22/2022] Open
Abstract
Advances in metabolic imaging techniques have allowed for more precise characterization of gliomas, particularly as it relates to tumor recurrence or pseudoprogression. Furthermore, the emerging field of radiogenomics where radiographic features are systemically correlated with molecular markers has the potential to achieve the holy grail of neuro-oncologic neuro-radiology, namely molecular diagnosis without requiring tissue specimens. In this section, we will review the utility of metabolic imaging and discuss the current state of the art related to the radiogenomics of glioblastoma.
Collapse
Affiliation(s)
- Gloria C Chiang
- Department of Neuroradiology, Weill Cornell Medical College, New York, NY, United States
| | - Ilhami Kovanlikaya
- Department of Neuroradiology, Weill Cornell Medical College, New York, NY, United States
| | - Changho Choi
- Radiology, Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medical College, New York, NY, United States
| | - Rajiv Magge
- Department of Neurology, Weill Cornell Medical College, New York, NY, United States
| | - Dikoma C Shungu
- Department of Neuroradiology, Weill Cornell Medical College, New York, NY, United States
| |
Collapse
|
25
|
Margiewicz S, Cordova C, Chi AS, Jain R. State of the Art Treatment and Surveillance Imaging of Glioblastomas. Semin Roentgenol 2017; 53:23-36. [PMID: 29405952 DOI: 10.1053/j.ro.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | - Christine Cordova
- Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Andrew S Chi
- Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine, New York, NY
| | - Rajan Jain
- Department of Radiology, NYU School of Medicine, New York, NY; Department of Neurosurgery, NYU School of Medicine, New York, NY.
| |
Collapse
|
26
|
Pandey R, Caflisch L, Lodi A, Brenner AJ, Tiziani S. Metabolomic signature of brain cancer. Mol Carcinog 2017; 56:2355-2371. [PMID: 28618012 DOI: 10.1002/mc.22694] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 06/01/2017] [Accepted: 06/13/2017] [Indexed: 12/17/2022]
Abstract
Despite advances in surgery and adjuvant therapy, brain tumors represent one of the leading causes of cancer-related mortality and morbidity in both adults and children. Gliomas constitute about 60% of all cerebral tumors, showing varying degrees of malignancy. They are difficult to treat due to dismal prognosis and limited therapeutics. Metabolomics is the untargeted and targeted analyses of endogenous and exogenous small molecules, which charact erizes the phenotype of an individual. This emerging "omics" science provides functional readouts of cellular activity that contribute greatly to the understanding of cancer biology including brain tumor biology. Metabolites are highly informative as a direct signature of biochemical activity; therefore, metabolite profiling has become a promising approach for clinical diagnostics and prognostics. The metabolic alterations are well-recognized as one of the key hallmarks in monitoring disease progression, therapy, and revealing new molecular targets for effective therapeutic intervention. Taking advantage of the latest high-throughput analytical technologies, that is, nuclear magnetic resonance (NMR) spectroscopy and mass spectrometry (MS), metabolomics is now a promising field for precision medicine and drug discovery. In the present report, we review the application of metabolomics and in vivo metabolic profiling in the context of adult gliomas and paediatric brain tumors. Analytical platforms such as high-resolution (HR) NMR, in vivo magnetic resonance spectroscopic imaging and high- and low-resolution MS are discussed. Moreover, the relevance of metabolic studies in the development of new therapeutic strategies for treatment of gliomas are reviewed.
Collapse
Affiliation(s)
- Renu Pandey
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
| | - Laura Caflisch
- Department of Hematology and Medical oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Alessia Lodi
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas
| | - Andrew J Brenner
- Department of Hematology and Medical oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.,Department of Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stefano Tiziani
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, Texas.,Dell Pediatric Research Institute, The University of Texas at Austin, Austin, Texas
| |
Collapse
|
27
|
Cao Y, Tseng CL, Balter JM, Teng F, Parmar HA, Sahgal A. MR-guided radiation therapy: transformative technology and its role in the central nervous system. Neuro Oncol 2017; 19:ii16-ii29. [PMID: 28380637 DOI: 10.1093/neuonc/nox006] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
This review article describes advancement of magnetic resonance imaging technologies in radiation therapy planning, guidance, and adaptation of brain tumors. The potential for MR-guided radiation therapy to improve outcomes and the challenges in its adoption are discussed.
Collapse
Affiliation(s)
- Yue Cao
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James M Balter
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Feifei Teng
- Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
- Department of Radiation Oncology, Shandong Cancer Hospital, Shandong University, Jinan, China
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Brandão LA, Castillo M. Adult Brain Tumors: Clinical Applications of Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2017; 24:781-809. [PMID: 27742117 DOI: 10.1016/j.mric.2016.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.
Collapse
Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Av. Das Américas 700, sala 320, Barra da Tijuca, Rio de Janeiro 30112011, Brazil; Clínica IRM- Ressonância Magnética, Rua Capitão Salomão 44 Humaitá, Rio de Janeiro 22271040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
| |
Collapse
|
29
|
Apparent diffusion coefficient changes predict survival after intra-arterial bevacizumab treatment in recurrent glioblastoma. Neuroradiology 2017; 59:499-505. [PMID: 28343250 DOI: 10.1007/s00234-017-1820-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Superselective intra-arterial cerebral infusion (SIACI) of bevacizumab (BV) has emerged as a novel therapy in the treatment of recurrent glioblastoma (GB). This study assessed the use of apparent diffusion coefficient (ADC) in predicting length of survival after SIACI BV and overall survival in patients with recurrent GB. METHODS Sixty-five patients from a cohort enrolled in a phase I/II trial of SIACI BV for treatment of recurrent GB were retrospectively included in this analysis. MR imaging with a diffusion-weighted (DWI) sequence was performed before and after treatment. ROIs were manually delineated on ADC maps corresponding to the enhancing and non-enhancing portions of the tumor. Cox and logistic regression analyses were performed to determine which ADC values best predicted survival. RESULTS The change in minimum ADC in the enhancing portion of the tumor after SIACI BV therapy was associated with an increased risk of death (hazard ratio = 2.0, 95% confidence interval(CI) [1.04-3.79], p = 0.038), adjusting for age, tumor size, BV dose, and prior IV BV treatments. Similarly, the change in ADC after SIACI BV therapy was associated with greater likelihood of surviving less than 1 year after therapy (odds ratio = 7.0, 95% CI [1.08-45.7], p = 0.04). Having previously received IV BV was associated with increased risk of death (OR 18, 95% CI [1.8-180.0], p = 0.014). CONCLUSION In patients with recurrent GB treated with SIACI BV, the change in ADC value after treatment is predictive of overall survival.
Collapse
|
30
|
Huang RY, Wen PY. Response Assessment in Neuro-Oncology Criteria and Clinical Endpoints. Magn Reson Imaging Clin N Am 2016; 24:705-718. [PMID: 27742111 DOI: 10.1016/j.mric.2016.06.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The Response Assessment in Neuro-Oncology (RANO) Working Group is an international multidisciplinary group whose goal is to improve response criteria and define endpoints for neuro-oncology trials. The RANO criteria for high-grade gliomas attempt to address the issues of pseudoprogression, pseudoresponse, and nonenhancing tumor progression. Incorporation of advanced MR imaging may eventually help improve the ability of these criteria to define enhancing and nonenhancing disease better. The RANO group has also developed criteria for neurologic response and evaluation of patients receiving immunologic therapies. RANO criteria have been developed for brain metastases and are in progress for meningiomas, leptomeningeal disease, spinal tumors, and pediatric tumors.
Collapse
Affiliation(s)
- Raymond Y Huang
- Division of Neuroradiology, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Patrick Y Wen
- Division of Neuro-Oncology, Department of Neurology, Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA
| |
Collapse
|
31
|
Kimura M, da Cruz LCH. Multiparametric MR Imaging in the Assessment of Brain Tumors. Magn Reson Imaging Clin N Am 2016; 24:87-122. [PMID: 26613877 DOI: 10.1016/j.mric.2015.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Functional MR imaging methods make possible the quantification of dynamic physiologic processes that occur in the brain. Moreover, the use of these advanced imaging techniques in the setting of oncologic treatment of the brain is widely accepted and has found worldwide routine clinical use.
Collapse
Affiliation(s)
- Margareth Kimura
- Magnetic Resonance Department of Clínica de Diagnóstico por Imagem (CDPI), Centro Médico Barrashopping, Av. das Américas, 4666, grupo 325, Barra da Tijuca, Rio de Janeiro, RJ, CEP: 22649-900, Brazil.
| | - L Celso Hygino da Cruz
- Magnetic Resonance Department of Clínica de Diagnóstico por Imagem (CDPI), IRM Ressonância Magnética, Av. das Américas, 4666, grupo 325, Barra da Tijuca, Rio de Janeiro, RJ, CEP: 22649-900, Brazil
| |
Collapse
|
32
|
Abstract
Magnetic resonance spectroscopy (MRS) is a noninvasive functional technique to evaluate the biochemical behavior of human tissues. This property has been widely used in assessment and therapy monitoring of brain tumors. MRS studies can be implemented outside the brain, with successful and promising results in the evaluation of prostate and breast cancer, although still with limited reproducibility. As a result of technical improvements, malignancies of the musculoskeletal system and abdominopelvic organs can benefit from the molecular information that MRS provides. The technical challenges and main applications in oncology of (1)H MRS in a clinical setting are the focus of this review.
Collapse
|
33
|
Basic Principles and Clinical Applications of Magnetic Resonance Spectroscopy in Neuroradiology. J Comput Assist Tomogr 2016; 40:1-13. [PMID: 26484954 DOI: 10.1097/rct.0000000000000322] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Magnetic resonance spectroscopy is a powerful tool to assist daily clinical diagnostics. This review is intended to give an overview on basic principles of the technology, discuss some of its technical aspects, and present typical applications in daily clinical routine in neuroradiology.
Collapse
|
34
|
Masch WR, Wang PI, Chenevert TL, Junck L, Tsien C, Heth JA, Sundgren PC. Comparison of Diffusion Tensor Imaging and Magnetic Resonance Perfusion Imaging in Differentiating Recurrent Brain Neoplasm From Radiation Necrosis. Acad Radiol 2016; 23:569-76. [PMID: 26916251 DOI: 10.1016/j.acra.2015.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 09/26/2015] [Accepted: 11/03/2015] [Indexed: 10/22/2022]
Abstract
RATIONALE AND OBJECTIVES To compare differences in diffusion tensor imaging (DTI) and dynamic susceptibility-weighted contrast-enhanced (DSC) magnetic resonance (MR) perfusion imaging characteristics of recurrent neoplasm and radiation necrosis in patients with brain tumors previously treated with radiotherapy with or without surgery and chemotherapy. MATERIALS AND METHODS Patients with a history of brain neoplasm previously treated with radiotherapy with or without chemotherapy and surgery who developed a new enhancing lesion on posttreatment surveillance MRI were enrolled. DSC perfusion MRI and DTI were performed. Region of interest cursors were manually drawn in the contrast-enhancing lesions, in the perilesional white matter edema, and in the contralateral normal-appearing frontal lobe white matter. DTI and DSC perfusion MR indices were compared in recurrent tumor versus radiation necrosis. RESULTS Twenty-two patients with 24 lesions were included. Sixteen (67%) lesions were placed into the recurrent neoplasm group and eight (33%) lesions were placed into the radiation necrosis group using biopsy results as the gold standard in all but three patients. Mean apparent diffusion coefficient values, mean parallel eigenvalues, and mean perpendicular eigenvalues in the contrast-enhancing lesion were significantly lower, and relative cerebral blood volume was significantly higher for the recurrent neoplasm group compared to the radiation necrosis group (P < 0.01, P = 0.03, P < 0.01, and P < 0.01, respectively). CONCLUSIONS The combined assessment of DTI and DSC MR perfusion properties of new contrast-enhancing lesions is helpful in distinguishing recurrent neoplasm from radiation necrosis in patients with a history of brain neoplasm previously treated with radiotherapy with or without surgery and chemotherapy.
Collapse
|
35
|
Abstract
This review covers important topics relating to the imaging evaluation of glioblastoma multiforme after therapy. An overview of the Macdonald and Response Assessment in Neuro-Oncology criteria as well as important questions and limitations regarding their use are provided. Pseudoprogression and pseudoresponse as well as the use of advanced magnetic resonance imaging techniques such as perfusion, diffusion, and spectroscopy in the evaluation of the posttherapeutic brain are also reviewed.
Collapse
|
36
|
Chuang MT, Liu YS, Tsai YS, Chen YC, Wang CK. Differentiating Radiation-Induced Necrosis from Recurrent Brain Tumor Using MR Perfusion and Spectroscopy: A Meta-Analysis. PLoS One 2016; 11:e0141438. [PMID: 26741961 PMCID: PMC4712150 DOI: 10.1371/journal.pone.0141438] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 08/16/2015] [Indexed: 01/03/2023] Open
Abstract
Purpose This meta-analysis examined roles of several metabolites in differentiating recurrent tumor from necrosis in patients with brain tumors using MR perfusion and spectroscopy. Methods Medline, Cochrane, EMBASE, and Google Scholar were searched for studies using perfusion MRI and/or MR spectroscopy published up to March 4, 2015 which differentiated between recurrent tumor vs. necrosis in patients with primary brain tumors or brain metastasis. Only two-armed, prospective or retrospective studies were included. A meta-analysis was performed on the difference in relative cerebral blood volume (rCBV), ratios of choline/creatine (Cho/Cr) and/or choline/N-acetyl aspartate (Cho/NAA) between participants undergoing MRI evaluation. A χ2-based test of homogeneity was performed using Cochran’s Q statistic and I2. Results Of 397 patients in 13 studies who were analyzed, the majority had tumor recurrence. As there was evidence of heterogeneity among 10 of the studies which used rCBV for evaluation (Q statistic = 31.634, I2 = 97.11%, P < 0.0001) a random-effects analysis was applied. The pooled difference in means (2.18, 95%CI = 0.85 to 3.50) indicated that the average rCBV in a contrast-enhancing lesion was significantly higher in tumor recurrence compared with radiation injury (P = 0.001). Based on a fixed-effect model of analysis encompassing the six studies which used Cho/Cr ratios for evaluation (Q statistic = 8.388, I2 = 40.39%, P = 0.137), the pooled difference in means (0.77, 95%CI = 0.57 to 0.98) of the average Cho/Cr ratio was significantly higher in tumor recurrence than in tumor necrosis (P = 0.001). There was significant difference in ratios of Cho to NAA between recurrent tumor and necrosis (1.02, 95%CI = 0.03 to 2.00, P = 0.044). Conclusions MR spectroscopy and MR perfusion using Cho/NAA and Cho/Cr ratios and rCBV may increase the accuracy of differentiating necrosis from recurrent tumor in patients with primary brain tumors or metastases.
Collapse
Affiliation(s)
- Ming-Tsung Chuang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Sheng Liu
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yi-Shan Tsai
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ying-Chen Chen
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chien-Kuo Wang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
- * E-mail:
| |
Collapse
|
37
|
Abstract
Imaging is integral to the management of patients with brain tumors. Conventional structural imaging provides exquisite anatomic detail but remains limited in the evaluation of molecular characteristics of intracranial neoplasms. Quantitative and physiologic biomarkers derived from advanced imaging techniques have been increasingly utilized as problem-solving tools to identify glioma grade and assess response to therapy. This chapter provides a comprehensive overview of the imaging strategies used in the clinical assessment of patients with gliomas and describes how novel imaging biomarkers have the potential to improve patient management.
Collapse
Affiliation(s)
- Whitney B Pope
- Radiological Sciences, Ronald Reagan Medical Center, Los Angeles, CA, USA.
| | - Ibrahim Djoukhadar
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| | - Alan Jackson
- Wolfson Molecular Imaging Centre, University of Manchester, Manchester, UK
| |
Collapse
|
38
|
Park JE, Kim HS, Park KJ, Kim SJ, Kim JH, Smith SA. Pre- and Posttreatment Glioma: Comparison of Amide Proton Transfer Imaging with MR Spectroscopy for Biomarkers of Tumor Proliferation. Radiology 2015; 278:514-23. [PMID: 26491847 DOI: 10.1148/radiol.2015142979] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To correlate and compare diagnostic performance with amide proton transfer (APT) imaging as a tumor proliferation index with that with magnetic resonance (MR) spectroscopy in subgroups of patients with pre- and posttreatment glioma. MATERIALS AND METHODS This retrospective study was approved by the institutional review board. In 40 patients with pretreatment glioma and 25 patients with posttreatment glioma, correlation between APT asymmetry and the choline-to-creatine and choline-to-N-acetylaspartate ratios in corresponding voxels of interest was determined, and the 90% histogram cutoff of APT asymmetry values (APT90) for the entire solid portion of gliomas was calculated for diagnostic performance. Area under the receiver operating characteristic curve (AUC), leave-one-out cross validation, and intraclass correlation coefficients were analyzed. RESULTS The APT asymmetry values showed a moderate correlation (r = 0.49, P < .001) with the choline-to-creatine ratios and a mild correlation with the choline-to-N-acetyl-aspartate ratios (r = 0.32, P = .011) in the corresponding lesions. The APT90 showed comparable diagnostic accuracy for grading of gliomas (AUC, 0.81-0.84 vs 0.86; P = .582-.864) and superior accuracy for differentiation of tumor progression from treatment-related change (AUC, 0.89-0.90 vs 0.60; P = .031-.046) compared with those with MR spectroscopy. The cross-validated area under the curve and accuracy of the APT90 in posttreatment gliomas were 0.89-0.90 and 72%, respectively. The interreader agreement for APT90 was excellent in both pretreatment and posttreatment gliomas (intraclass correlation coefficient, 0.95 and 0.96, respectively). CONCLUSION APT imaging used as a tumor proliferation index showed moderate correlation with MR spectroscopic values and is a superior imaging method to MR spectroscopy, particularly for assessment of posttreatment gliomas.
Collapse
Affiliation(s)
- Ji Eun Park
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., K.J.P., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tenn (S.A.S.)
| | - Ho Sung Kim
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., K.J.P., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tenn (S.A.S.)
| | - Kye Jin Park
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., K.J.P., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tenn (S.A.S.)
| | - Sang Joon Kim
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., K.J.P., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tenn (S.A.S.)
| | - Jeong Hoon Kim
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., K.J.P., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tenn (S.A.S.)
| | - Seth A Smith
- From the Department of Radiology and Research Institute of Radiology (J.E.P., H.S.K., K.J.P., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea; and Department of Radiology and Radiological Sciences, Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, Tenn (S.A.S.)
| |
Collapse
|
39
|
Atallah V, Gariel F, Gillon P, Crombé A, Mazeron JJ. [Radiotherapy for gliomas in adults: What are the stakes of the follow-up?]. Cancer Radiother 2015; 19:603-9. [PMID: 26278986 DOI: 10.1016/j.canrad.2015.05.012] [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: 05/11/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022]
Abstract
Linked to the difference of prognosis, the terms and conditions of the follow-up of low-grade and high-grade gliomas treated by irradiation differ highly. Patients treated for a low-grade glioma have prolonged survival. In this case, monitoring of toxicities linked to the treatment is a major objective. Opportunistic infections and depression are corticosteroids side effects widely underestimated. Radionecrosis search and differentiation with recurrent disease are done by MRI. Perfusion and spectroscopy showing a choline/creatine ratio increase are in favour of disease recurrence. Cognitive status and quality of life must be evaluated during the follow-up. They have to be evaluated by adapted scales. Cognitive rehabilitation improves interestingly the post-treatment cognitive status. Pseudoprogression rates for high-grade gliomas are near 20%. MRI is the benchmark imaging for its diagnosis. Diffusion weight imaging and spectroscopy are actually the most interesting techniques.
Collapse
Affiliation(s)
- V Atallah
- Service de radiothérapie, institut Bergonié, 226, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - F Gariel
- Service de neuro-imagerie diagnostique et thérapeutique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - P Gillon
- Service de radiothérapie, institut Bergonié, 226, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - A Crombé
- Service de neuro-imagerie diagnostique et thérapeutique, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - J-J Mazeron
- Service de radiothérapie oncologique, groupe hospitalier Pitié-Salpêtrière, AP-HP, université Pierre-et-Marie-Curie Paris VI, 47, boulevard de l'Hôpital, 75651 Paris cedex 13, France
| |
Collapse
|
40
|
Yang D. Standardized MRI assessment of high-grade glioma response: a review of the essential elements and pitfalls of the RANO criteria. Neurooncol Pract 2015; 3:59-67. [PMID: 31579522 DOI: 10.1093/nop/npv023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Indexed: 01/01/2023] Open
Abstract
Accurately evaluating response in the treatment of high-grade gliomas presents considerable challenges. This review looks at the advancements made in response criteria while critically outlining remaining weaknesses, and directs our vision toward promising endpoints to come. The 2010 guidelines from the Response Assessment in Neuro-Oncology (RANO) working group have enhanced interpretation of clinical trials involving novel treatments for high-grade glioma. Yet, while the criteria are considered clinically applicable to high-grade glioma trials, as well as reasonably accurate and reproducible, RANO lacks sufficient detail for consistent implementation in certain aspects and leaves some issues from the original Macdonald guidelines unresolved. To provide the most accurate assessment of response to therapeutic intervention currently possible, it is essential that trial oncologists and radiologists not only have a solid understanding of RANO guidelines, but also proper insight into the inherent limitations of the criteria. With the expectation of improved data collection as a standard, the author anticipates that the next high-grade glioma response criteria updates will incorporate advanced MRI methods and quantitative tumor volume measurements, availing a more accurate interpretation of response in the future.
Collapse
Affiliation(s)
- Dewen Yang
- ICON Medical Imaging, 2800 Kelly Road, Warrington, PA 18976
| |
Collapse
|
41
|
Zhang H, Ma L, Wang Q, Zheng X, Wu C, Xu BN. Role of magnetic resonance spectroscopy for the differentiation of recurrent glioma from radiation necrosis: a systematic review and meta-analysis. Eur J Radiol 2015; 83:2181-2189. [PMID: 25452098 DOI: 10.1016/j.ejrad.2014.09.018] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE Differentiating glioma recurrence from radiation necrosis remains a great challenge. We conducted a meta-analysis to evaluate the diagnostic quality of magnetic resonance spectroscopy (MRS) in differentiating glioma recurrence from radiation necrosis. METHODS Studies about evaluation of MRS for the differential diagnosis of glioma recurrence from radiation necrosis were systematically searched in PubMed, Embase and Chinese Biomedical databases up to May 4, 2014. The data were extracted to perform heterogeneity test, threshold effect test and to calculate sensitivity (SEN), specificity (SPE) and areas under summary receiver operating characteristic curve (SROC). RESULTS Eighteen articles comprising a total sample size of 455 patients (447 lesions) with suspected glioma recurrence after radiotherapy, met all inclusion and exclusion criteria, and were included in our meta-analysis. Quantitative synthesis of studies showed that the pooled SEN and SPE for Cho/Cr ratio were 0.83 (95% CI: 0.77, 0.89) and 0.83 (95% CI: 0.74, 0.90). The area under the curve (AUC) under the SROC was 0.9001. The pooled SEN and SPE for Cho/NAA ratio were 0.88 (95% CI: 0.81, 0.93) and 0.86 (95% CI: 0.76, 0.93). The AUC under the SROC was 0.9185. CONCLUSION This meta-analysis shows that MRS alone has moderate diagnostic performance in differentiating glioma recurrence from radiation necrosis using metabolite ratios like Cho/Cr and Cho/NAA ratio. It is strongly recommended that MRS should combine other advanced imaging technologies to improve diagnostic accuracy. This article underlines the importance of implementing multimodal imaging trials and multicentre trials in the future.
Collapse
Affiliation(s)
- Hui Zhang
- Department of Neurosurgery, Air Force General Hospital of the Chinese PLA, 30 Fucheng Road, Haidian District, Beijing 100142, China; Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Li Ma
- Department of Anesthesiology, Beijing Military General Hospital, Beijing 100700, China
| | - Qun Wang
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Xuan Zheng
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Chen Wu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China
| | - Bai-Nan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, 28 Fuxing Road,Haidian District, Beijing 100853, China.
| |
Collapse
|
42
|
Re-defining response and treatment effects for neuro-oncology immunotherapy clinical trials. J Neurooncol 2015; 123:339-46. [DOI: 10.1007/s11060-015-1748-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/16/2015] [Indexed: 01/01/2023]
|
43
|
Huang RY, Neagu MR, Reardon DA, Wen PY. Pitfalls in the neuroimaging of glioblastoma in the era of antiangiogenic and immuno/targeted therapy - detecting illusive disease, defining response. Front Neurol 2015; 6:33. [PMID: 25755649 PMCID: PMC4337341 DOI: 10.3389/fneur.2015.00033] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/09/2015] [Indexed: 02/04/2023] Open
Abstract
Glioblastoma, the most common malignant primary brain tumor in adults is a devastating diagnosis with an average survival of 14–16 months using the current standard of care treatment. The determination of treatment response and clinical decision making is based on the accuracy of radiographic assessment. Notwithstanding, challenges exist in the neuroimaging evaluation of patients undergoing treatment for malignant glioma. Differentiating treatment response from tumor progression is problematic and currently combines long-term follow-up using standard magnetic resonance imaging (MRI), with clinical status and corticosteroid-dependency assessments. In the clinical trial setting, treatment with gene therapy, vaccines, immunotherapy, and targeted biologicals similarly produces MRI changes mimicking disease progression. A neuroimaging method to clearly distinguish between pseudoprogression and tumor progression has unfortunately not been found to date. With the incorporation of antiangiogenic therapies, a further pitfall in imaging interpretation is pseudoresponse. The Macdonald criteria that correlate tumor burden with contrast-enhanced imaging proved insufficient and misleading in the context of rapid blood–brain barrier normalization following antiangiogenic treatment that is not accompanied by expected survival benefit. Even improved criteria, such as the RANO criteria, which incorporate non-enhancing disease, clinical status, and need for corticosteroid use, fall short of definitively distinguishing tumor progression, pseudoresponse, and pseudoprogression. This review focuses on advanced imaging techniques including perfusion MRI, diffusion MRI, MR spectroscopy, and new positron emission tomography imaging tracers. The relevant image analysis algorithms and interpretation methods of these promising techniques are discussed in the context of determining response and progression during treatment of glioblastoma both in the standard of care and in clinical trial context.
Collapse
Affiliation(s)
- Raymond Y Huang
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Martha R Neagu
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - David A Reardon
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| | - Patrick Y Wen
- Center of Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center , Boston, MA , USA
| |
Collapse
|
44
|
Imaging biomarkers in primary brain tumours. Eur J Nucl Med Mol Imaging 2014; 42:597-612. [PMID: 25520293 DOI: 10.1007/s00259-014-2971-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/03/2014] [Indexed: 12/18/2022]
Abstract
We are getting used to referring to instrumentally detectable biological features in medical language as "imaging biomarkers". These two terms combined reflect the evolution of medical imaging during recent decades, and conceptually comprise the principle of noninvasive detection of internal processes that can become targets for supplementary therapeutic strategies. These targets in oncology include those biological pathways that are associated with several tumour features including independence from growth and growth-inhibitory signals, avoidance of apoptosis and immune system control, unlimited potential for replication, self-sufficiency in vascular supply and neoangiogenesis, acquired tissue invasiveness and metastatic diffusion. Concerning brain tumours, there have been major improvements in neurosurgical techniques and radiotherapy planning, and developments of novel target drugs, thus increasing the need for reproducible, noninvasive, quantitative imaging biomarkers. However, in this context, conventional radiological criteria may be inappropriate to determine the best therapeutic option and subsequently to assess response to therapy. Integration of molecular imaging for the evaluation of brain tumours has for this reason become necessary, and an important role in this setting is played by imaging biomarkers in PET and MRI. In the current review, we describe most relevant techniques and biomarkers used for imaging primary brain tumours in clinical practice, and discuss potential future developments from the experimental context.
Collapse
|
45
|
Role of magnetic resonance spectroscopy in differentiation between recurrence of glioma and post radiation injury. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
46
|
El Sherbeny AE, El-Shafey MH, Biomy SL, Shakal AA, Hefeda MM, Seiam AHR. Diagnostic yield of combined magnetic resonance spectroscopy and diffusion weighted imaging in intracranial neoplasms. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
47
|
Treister D, Kingston S, Hoque KE, Law M, Shiroishi MS. Multimodal Magnetic Resonance Imaging Evaluation of Primary Brain Tumors. Semin Oncol 2014; 41:478-495. [DOI: 10.1053/j.seminoncol.2014.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
48
|
Raimbault A, Cazals X, Lauvin MA, Destrieux C, Chapet S, Cottier JP. Radionecrosis of malignant glioma and cerebral metastasis: a diagnostic challenge in MRI. Diagn Interv Imaging 2014; 95:985-1000. [PMID: 25001364 DOI: 10.1016/j.diii.2014.06.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Detecting a new area of contrast-enhancement at MRI after irradiation of malignant brain tumor arises the problem of differential diagnosis between tumor recurrence and radiation necrosis induced by the treatment. The challenge for imaging is to distinguish the two diagnoses given: the prognostic and therapeutic issues. Various criteria have been proposed in the literature based on morphological, functional or metabolic MRI. The purpose of this study was to perform an analysis of these tools to identify MRI best criteria to differentiate radiation necrosis lesions from malignant gliomas and brain metastases recurrence. For gliomas, the morphology of the contrast-enhancement cannot guide the diagnosis and the use of perfusion techniques and spectroscopy (multivoxels if possible) are necessary. In the follow-up of metastasis, a transient increase and moderate lesion volume is possible with a good prognosis. Morphological characteristics (volume ratio T2/T1Gd) and perfusion analysis provide valuable tools for approaching the diagnosis of radionecrosis.
Collapse
Affiliation(s)
- A Raimbault
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - X Cazals
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - M-A Lauvin
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - C Destrieux
- Department of Neurosurgery, Bretonneau Hospital, Tours University Hospitals, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - S Chapet
- Department of radiotherapy, Bretonneau Hospital, Tours University Hospitals, 2, boulevard Tonnellé, 37044 Tours cedex, France
| | - J-P Cottier
- General Radiology - Diagnostic and Therapeutic Neuroradiology, Bretonneau Hospital, 2, boulevard Tonnellé, 37044 Tours cedex, France.
| |
Collapse
|
49
|
3-Dimensional magnetic resonance spectroscopic imaging at 3 Tesla for early response assessment of glioblastoma patients during external beam radiation therapy. Int J Radiat Oncol Biol Phys 2014; 90:181-9. [PMID: 24986746 DOI: 10.1016/j.ijrobp.2014.05.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/09/2014] [Accepted: 05/13/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the utility of 3-dimensional magnetic resonance (3D-MR) proton spectroscopic imaging for treatment planning and its implications for early response assessment in glioblastoma multiforme. METHODS AND MATERIALS Eighteen patients with newly diagnosed, histologically confirmed glioblastoma had 3D-MR proton spectroscopic imaging (MRSI) along with T2 and T1 gadolinium-enhanced MR images at simulation and at boost treatment planning after 17 to 20 fractions of radiation therapy. All patients received standard radiation therapy (RT) with concurrent temozolomide followed by adjuvant temozolomide. Imaging for response assessment consisted of MR scans every 2 months. Progression-free survival was defined by the criteria of MacDonald et al. MRSI images obtained at initial simulation were analyzed for choline/N-acetylaspartate ratios (Cho/NAA) on a voxel-by-voxel basis with abnormal activity defined as Cho/NAA ≥2. These images were compared on anatomically matched MRSI data collected after 3 weeks of RT. Changes in Cho/NAA between pretherapy and third-week RT scans were tested using Wilcoxon matched-pairs signed rank tests and correlated with progression-free survival, radiation dose and location of recurrence using Cox proportional hazards regression. RESULTS After a median follow-up time of 8.6 months, 50% of patients had experienced progression based on imaging. Patients with a decreased or stable mean or median Cho/NAA values had less risk of progression (P<.01). Patients with an increase in mean or median Cho/NAA values at the third-week RT scan had a significantly greater chance of early progression (P<.01). An increased Cho/NAA at the third-week MRSI scan carried a hazard ratio of 2.72 (95% confidence interval, 1.10-6.71; P=.03). Most patients received the prescription dose of RT to the Cho/NAA ≥2 volume, where recurrence most often occurred. CONCLUSION Change in mean and median Cho/NAA detected at 3 weeks was a significant predictor of early progression. The potential impact for risk-adaptive therapy based on early spectroscopic findings is suggested.
Collapse
|
50
|
Lin G, Chung YL. Current opportunities and challenges of magnetic resonance spectroscopy, positron emission tomography, and mass spectrometry imaging for mapping cancer metabolism in vivo. BIOMED RESEARCH INTERNATIONAL 2014; 2014:625095. [PMID: 24724090 PMCID: PMC3958648 DOI: 10.1155/2014/625095] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 01/06/2014] [Accepted: 01/19/2014] [Indexed: 12/18/2022]
Abstract
Cancer is known to have unique metabolic features such as Warburg effect. Current cancer therapy has moved forward from cytotoxic treatment to personalized, targeted therapies, with some that could lead to specific metabolic changes, potentially monitored by imaging methods. In this paper we addressed the important aspects to study cancer metabolism by using image techniques, focusing on opportunities and challenges of magnetic resonance spectroscopy (MRS), dynamic nuclear polarization (DNP)-MRS, positron emission tomography (PET), and mass spectrometry imaging (MSI) for mapping cancer metabolism. Finally, we highlighted the future possibilities of an integrated in vivo PET/MR imaging systems, together with an in situ MSI tissue analytical platform, may become the ultimate technologies for unraveling and understanding the molecular complexities in some aspects of cancer metabolism. Such comprehensive imaging investigations might provide information on pharmacometabolomics, biomarker discovery, and disease diagnosis, prognosis, and treatment response monitoring for clinical medicine.
Collapse
Affiliation(s)
- Gigin Lin
- Department of Radiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan
- Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan
- Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, Chang Gung University, 5 Fuhsing Street, Guishan, Taoyuan 333, Taiwan
| | - Yuen-Li Chung
- The Institute of Cancer Research and Royal Marsden Hospital, CRUK Cancer Imaging Centre, Downs Road, Sutton, Surrey SM2 5PT, UK
| |
Collapse
|