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Alvaro-Heredia JA, Rodríguez-Hernández LA, Rodríguez-Rubio HA, Alvaro-Heredia I, Mondragon-Soto MG, Rodríguez-Hernández IA, Mateo-Nouel EDJ, Villanueva-Castro E, Uribe-Pacheco R, Castro-Martinez E, Gutierrez-Aceves GA, Moreno-Jiménez S, Reyes-Moreno I, Gonzalez-Aguilar A. Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography. Cureus 2024; 16:e61591. [PMID: 38962639 PMCID: PMC11221499 DOI: 10.7759/cureus.61591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
Background Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility. Purpose This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions. Methods A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions. Results We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%). Conclusion PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.
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Affiliation(s)
- Juan Antonio Alvaro-Heredia
- Neurological Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
- Spine Surgery, National Institute of Rehabilitation, Mexico City, MEX
| | | | | | - Isidro Alvaro-Heredia
- Emergency Medicine, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | | | | | | | | | - Rodrigo Uribe-Pacheco
- Neurological Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | | | | | - Sergio Moreno-Jiménez
- Neurosurgery-Radiosurgery, The American British Cowdray (ABC) Medical Center, Mexico City, MEX
- Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Ignacio Reyes-Moreno
- Neuro-Oncology, The American British Cowdray (ABC) Medical Center, Mexico City, MEX
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Agrawal I, Bano S, Chaudhary A, Ahuja A. Role of Permeability Surface Area Product in Grading of Brain Gliomas using CT Perfusion. Asian J Neurosurg 2023; 18:751-760. [PMID: 38161609 PMCID: PMC10756843 DOI: 10.1055/s-0043-1774820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity. Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product. Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.
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Affiliation(s)
- Ira Agrawal
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Shahina Bano
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Ajay Chaudhary
- Department of Neurosurgery, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India
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Hooper GW, Ansari S, Johnson JM, Ginat DT. Advances in the Radiological Evaluation of and Theranostics for Glioblastoma. Cancers (Basel) 2023; 15:4162. [PMID: 37627190 PMCID: PMC10453051 DOI: 10.3390/cancers15164162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Imaging is essential for evaluating patients with glioblastoma. Traditionally a multimodality undertaking, CT, including CT cerebral blood profusion, PET/CT with traditional fluorine-18 fluorodeoxyglucose (18F-FDG), and MRI have been the mainstays for diagnosis and post-therapeutic assessment. However, recent advances in these modalities, in league with the emerging fields of radiomics and theranostics, may prove helpful in improving diagnostic accuracy and treating the disease.
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Affiliation(s)
| | - Shehbaz Ansari
- Rush University Medical Center, Department of Radiology and Nuclear Medicine, Chicago, IL 60612, USA;
| | - Jason M. Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Daniel T. Ginat
- Department of Radiology, University of Chicago, Chicago, IL 60637, USA
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Raslan O, Ozturk A, Oguz KK, Sen F, Aboud O, Ivanovic V, Assadsangabi R, Hacein-Bey L. Imaging Cancer in Neuroradiology. Curr Probl Cancer 2023:100965. [PMID: 37349190 DOI: 10.1016/j.currproblcancer.2023.100965] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/24/2023]
Abstract
Neuroimaging plays a pivotal role in the diagnosis, management, and prognostication of brain tumors. Recently, the World Health Organization published the fifth edition of the WHO Classification of Tumors of the Central Nervous System (CNS5), which places greater emphasis on tumor genetics and molecular markers to complement the existing histological and immunohistochemical approaches. Recent advances in computational power allowed modern neuro-oncological imaging to move from a strictly morphology-based discipline to advanced neuroimaging techniques with quantifiable tissue characteristics such as tumor cellularity, microstructural organization, hemodynamic, functional, and metabolic features, providing more precise tumor diagnosis and management. The aim of this review is to highlight the key imaging features of the recently published CNS5, outlining the current imaging standards and summarizing the latest advances in neuro-oncological imaging techniques and their role in complementing traditional brain tumor imaging and management.
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Affiliation(s)
- Osama Raslan
- Department of Radiology, Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA.
| | - Arzu Ozturk
- Department of Radiology, Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA
| | - Kader Karli Oguz
- Department of Radiology, Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA
| | - Fatma Sen
- Department of Radiology, Division of Nuclear Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Orwa Aboud
- Department of Neurology and Neurological Surgery, UC Davis Comprehensive Cancer Center, CA
| | - Vladimir Ivanovic
- Department of Radiology, Division of Neuroradiology, Medical College of Wisconsin., Milwaukee, WI
| | - Reza Assadsangabi
- Department of Radiology, Keck School of Medicine of USC University of Southern California, Sacramento, CA
| | - Lotfi Hacein-Bey
- Department of Radiology, Division of Neuroradiology, University of California Davis Medical Center, Sacramento, CA
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5
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Mortier JR, Maddox TW, Blackwood L, La Fontaine MD, Busoni V. Dynamic contrast-enhanced computed tomography perfusion parameters of canine suspected brain tumors at baseline and during radiotherapy might be different depending on tumor location but not associated with survival. Front Vet Sci 2023; 10:1179762. [PMID: 37187932 PMCID: PMC10175699 DOI: 10.3389/fvets.2023.1179762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Treatment of brain tumors in dogs can be associated with significant morbidity and reliable prognostic factors are lacking. Dynamic contrast-enhanced computed tomography (DCECT) can be used to assess tumor perfusion. The objectives of this study were to assess perfusion parameters and change in size of suspected brain tumors before and during radiotherapy (RT) depending on their location and find a potential correlation with survival. Methods Seventeen client-owned dogs with suspected brain tumors were prospectively recruited. All dogs had a baseline DCECT to assess mass size, blood volume (BV), blood flow (BF), and transit time (TT). Twelve dogs had a repeat DCECT after 12 Gy of megavoltage RT. Survival times were calculated. Results Intra-axial masses had lower BF (p = 0.005) and BV (p < 0.001) than extra-axial masses but not than pituitary masses. Pituitary masses had lower BF (p = 0.001) and BV (p = 0.004) than extra-axial masses. The volume of the mass was positively associated with TT (p = 0.001) but not with BF and BV. Intra-axial masses showed a more marked decrease in size than extra-axial and pituitary masses during RT (p = 0.022 for length, p = 0.05 for height). Extra-axial masses showed a greater decrease in BF (p = 0.011) and BV (p = 0.012) during RT than pituitary masses and intra-axial masses. Heavier dogs had a shorter survival time (p = 0.011). Perfusion parameters were not correlated with survival. Conclusion DCECT perfusion parameters and change in size of brain masses during RT might be different based on the location of the mass.
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Affiliation(s)
- Jeremy R. Mortier
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
- Diagnostic Imaging Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
- *Correspondence: Jeremy R. Mortier,
| | - Thomas W. Maddox
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | - Laura Blackwood
- Small Animal Teaching Hospital, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
| | | | - Valeria Busoni
- Diagnostic Imaging Section, Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium
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Wang K, Li Y, Cheng H, Li S, Xiang W, Ming Y, Chen L, Zhou J. Perfusion CT detects alterations in local cerebral flow of glioma related to IDH, MGMT and TERT status. BMC Neurol 2021; 21:460. [PMID: 34814870 PMCID: PMC8611974 DOI: 10.1186/s12883-021-02490-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between tumor biology and values of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP), permeability surface (PS) of tumor in patients with glioma. METHODS Forty-six patients with glioma were involved in the study. Histopathologic and molecular pathology diagnoses were obtained by tumor resection, and all patients accepted perfusion computed tomography (PCT) before operation. Regions of interests were placed manually at tumor and contralateral normal-appearing thalamus. The parameters of tumor were divided by those of contralateral normal-appearing thalamus to normalize at tumor (relative [r] CBV, rCBF, rMTT, rTTP, rPS). The relationships of the parameters, world health organization (WHO) grade, molecular pathological findings were analysed. RESULTS The rCBV, rMTT and rPS of patients are positively related to the pathological classification (P < 0.05). The values of rCBV and rPS in IDH mutated patients were lower than those IDH wild-type. The values of rCBF in patients with MGMT methylation were lower than those MGMT unmethylation (P < 0.05). The MVD of TERT wild-type group was lower than TERT mutated group (P < 0.05). The values of rCBV were significant difference in the four molecular groups divided by the combined IDH/TERT classification (P < 0.05). The progression free survival (PFS) and overall survival (OS) were significant difference in the four molecular groups divided by the combined IDH/TERT classification (P < 0.05). CONCLUSIONS Our study introduces and supports the changes of glioma flow perfusion may be closely related to its biological characteristics.
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Affiliation(s)
- Ke Wang
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Department of Neurosurgery, The General Hospital of Western Theater Command PLA, Chengdu, China
| | - Yeming Li
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | | | - Shenjie Li
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Wei Xiang
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Yang Ming
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Ligang Chen
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Jie Zhou
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China. .,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China. .,Neurological Diseases and Brain Function Laboratory, Luzhou, China.
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7
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Oltra-Sastre M, Fuster-Garcia E, Juan-Albarracin J, Sáez C, Perez-Girbes A, Sanz-Requena R, Revert-Ventura A, Mocholi A, Urchueguia J, Hervas A, Reynes G, Font-de-Mora J, Muñoz-Langa J, Botella C, Aparici F, Marti-Bonmati L, Garcia-Gomez JM. Multi-parametric MR Imaging Biomarkers Associated to Clinical Outcomes in Gliomas: A Systematic Review. Curr Med Imaging 2020; 15:933-947. [PMID: 32008521 DOI: 10.2174/1573405615666190109100503] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 11/27/2018] [Accepted: 12/13/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE To systematically review evidence regarding the association of multiparametric biomarkers with clinical outcomes and their capacity to explain relevant subcompartments of gliomas. MATERIALS AND METHODS Scopus database was searched for original journal papers from January 1st, 2007 to February 20th, 2017 according to PRISMA. Four hundred forty-nine abstracts of papers were reviewed and scored independently by two out of six authors. Based on those papers we analyzed associations between biomarkers, subcompartments within the tumor lesion, and clinical outcomes. From all the articles analyzed, the twenty-seven papers with the highest scores were highlighted to represent the evidence about MR imaging biomarkers associated with clinical outcomes. Similarly, eighteen studies defining subcompartments within the tumor region were also highlighted to represent the evidence of MR imaging biomarkers. Their reports were critically appraised according to the QUADAS-2 criteria. RESULTS It has been demonstrated that multi-parametric biomarkers are prepared for surrogating diagnosis, grading, segmentation, overall survival, progression-free survival, recurrence, molecular profiling and response to treatment in gliomas. Quantifications and radiomics features obtained from morphological exams (T1, T2, FLAIR, T1c), PWI (including DSC and DCE), diffusion (DWI, DTI) and chemical shift imaging (CSI) are the preferred MR biomarkers associated to clinical outcomes. Subcompartments relative to the peritumoral region, invasion, infiltration, proliferation, mass effect and pseudo flush, relapse compartments, gross tumor volumes, and highrisk regions have been defined to characterize the heterogeneity. For the majority of pairwise cooccurrences, we found no evidence to assert that observed co-occurrences were significantly different from their expected co-occurrences (Binomial test with False Discovery Rate correction, α=0.05). The co-occurrence among terms in the studied papers was found to be driven by their individual prevalence and trends in the literature. CONCLUSION Combinations of MR imaging biomarkers from morphological, PWI, DWI and CSI exams have demonstrated their capability to predict clinical outcomes in different management moments of gliomas. Whereas morphologic-derived compartments have been mostly studied during the last ten years, new multi-parametric MRI approaches have also been proposed to discover specific subcompartments of the tumors. MR biomarkers from those subcompartments show the local behavior within the heterogeneous tumor and may quantify the prognosis and response to treatment of gliomas.
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Affiliation(s)
- Miquel Oltra-Sastre
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
| | - Elies Fuster-Garcia
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
| | - Javier Juan-Albarracin
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
| | - Carlos Sáez
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
| | - Alexandre Perez-Girbes
- GIBI230 (Grupo de Investigacion Biomedica en Imagen), Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | | | | | - Antonio Mocholi
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
| | - Javier Urchueguia
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
| | - Antonio Hervas
- Instituto de Matematica Multidisciplinar (IMM), Universitat Politecnica de Valencia, Valencia, Spain
| | - Gaspar Reynes
- Grupo de Investigacion Clinica y Traslacional del Cancer, Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | - Jaime Font-de-Mora
- Grupo de Investigacion Clinica y Traslacional del Cancer, Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | - Jose Muñoz-Langa
- GIBI230 (Grupo de Investigacion Biomedica en Imagen), Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | - Carlos Botella
- GIBI230 (Grupo de Investigacion Biomedica en Imagen), Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | - Fernando Aparici
- GIBI230 (Grupo de Investigacion Biomedica en Imagen), Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | - Luis Marti-Bonmati
- GIBI230 (Grupo de Investigacion Biomedica en Imagen), Instituto de Investigacion Sanitaria (IIS), Hospital la Fe, Valencia, Spain
| | - Juan M Garcia-Gomez
- Instituto de Aplicaciones de las Tecnologias de la Informaciony de las Comunicaciones Avanzadas (ITACA), Universitat Politecnica de Valencia, Camino de Vera s/n, 46022 Valencia, Spain
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Perfusion Computed Tomography Parameters Are Useful for Differentiating Glioblastoma, Lymphoma, and Metastasis. World Neurosurg 2018; 119:e890-e897. [DOI: 10.1016/j.wneu.2018.07.291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 01/25/2023]
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9
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Diagnosing Neoplastic Hematoma: Role of MR Perfusion. Clin Neuroradiol 2018; 29:263-268. [PMID: 29417155 DOI: 10.1007/s00062-018-0664-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH). MATERIAL AND METHODS A retrospective review was performed for consecutive patients with IPH, where MRP was performed. Routine, post-gadolinium MRI and MRP were analyzed. All patients were either operated on for evacuation of IPH or followed up on imaging. The MRP parameters of cerebral blood volume (CBV) and cerebral blood flow (CBF) and pattern of enhancement (peripheral linear vs. nodular) were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for these parameters for diagnosing neoplastic hematoma. RESULTS Of 116 patients with MRP, 16 patients (male 8; mean age-65.5 years) had IPH on their initial MRI. For diagnosing neoplastic hematoma, the sensitivity, specificity, PPV and NPV for increased CBF and CBV were 100%, 88.9%, 87.5%, and 100%; for peripheral linear enhancement were 100%, 28.6%, 50%, 100% and for nodular enhancement were 85.7%, 77.8%, 75% and 12.5%, respectively. The combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV. CONCLUSION In our small series, the combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV for diagnosing a neoplastic hematoma. These findings need to be validated in a larger study.
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Saito T, Sugiyama K, Ikawa F, Yamasaki F, Ishifuro M, Takayasu T, Nosaka R, Nishibuchi I, Muragaki Y, Kawamata T, Kurisu K. Permeability Surface Area Product Using Perfusion Computed Tomography Is a Valuable Prognostic Factor in Glioblastomas Treated with Radiotherapy Plus Concomitant and Adjuvant Temozolomide. World Neurosurg 2016; 97:21-26. [PMID: 27693246 DOI: 10.1016/j.wneu.2016.09.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The current standard treatment protocol for patients with newly diagnosed glioblastoma (GBM) includes surgery, radiotherapy, and concomitant and adjuvant temozolomide (TMZ). We hypothesized that the permeability surface area product (PS) from a perfusion computed tomography (PCT) study is associated with sensitivity to TMZ. The aim of this study was to determine whether PS values were correlated with prognosis of GBM patients who received the standard treatment protocol. METHODS This study included 36 patients with GBM that were newly diagnosed between October 2005 and September 2014 and who underwent preoperative PCT study and the standard treatment protocol. We measured the maximum value of relative cerebral blood volume (rCBVmax) and the maximum PS value (PSmax). We statistically examined the relationship between PSmax and prognosis using survival analysis, including other clinicopathologic factors (age, Karnofsky performance status [KPS], extent of resection, O6-methylguanine-DNA methyltransferase [MGMT] status, second-line use of bevacizumab, and rCBVmax). RESULTS Log-rank tests revealed that age, KPS, MGMT status, and PSmax were significantly correlated with overall survival. Multivariate analysis using the Cox regression model showed that PSmax was the most significant prognostic factor. Receiver operating characteristic curve analysis showed that PSmax had the highest accuracy in differentiating longtime survivors (LTSs) (surviving more than 2 years) from non-LTSs. At a cutoff point of 8.26 mL/100 g/min, sensitivity and specificity were 90% and 70%, respectively. CONCLUSIONS PSmax from PCT study can help predict survival time in patients with GBM receiving the standard treatment protocol. Survival may be related to sensitivity to TMZ.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan.
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Minoru Ishifuro
- Department of Diagnostic Imaging, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Ryo Nosaka
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
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Eilaghi A, Yeung T, d'Esterre C, Bauman G, Yartsev S, Easaw J, Fainardi E, Lee TY, Frayne R. Quantitative Perfusion and Permeability Biomarkers in Brain Cancer from Tomographic CT and MR Images. BIOMARKERS IN CANCER 2016; 8:47-59. [PMID: 27398030 PMCID: PMC4933536 DOI: 10.4137/bic.s31801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/28/2022]
Abstract
Dynamic contrast-enhanced perfusion and permeability imaging, using computed tomography and magnetic resonance systems, are important techniques for assessing the vascular supply and hemodynamics of healthy brain parenchyma and tumors. These techniques can measure blood flow, blood volume, and blood-brain barrier permeability surface area product and, thus, may provide information complementary to clinical and pathological assessments. These have been used as biomarkers to enhance the treatment planning process, to optimize treatment decision-making, and to enable monitoring of the treatment noninvasively. In this review, the principles of magnetic resonance and computed tomography dynamic contrast-enhanced perfusion and permeability imaging are described (with an emphasis on their commonalities), and the potential values of these techniques for differentiating high-grade gliomas from other brain lesions, distinguishing true progression from posttreatment effects, and predicting survival after radiotherapy, chemotherapy, and antiangiogenic treatments are presented.
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Affiliation(s)
- Armin Eilaghi
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Timothy Yeung
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Christopher d'Esterre
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Glenn Bauman
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Slav Yartsev
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Jay Easaw
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy.; Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Ting-Yim Lee
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Richard Frayne
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
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12
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Normalized Apparent Diffusion Coefficient in the Prognostication of Patients with Glioblastoma Multiforme. Can J Neurol Sci 2016; 43:127-33. [PMID: 26786643 DOI: 10.1017/cjn.2015.356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is known to have poor prognosis, with no available imaging marker that can predict survival at the time of diagnosis. Diffusion weighted images are used in characterisation of cellularity and necrosis of GBM. The purpose of this study was to assess whether pattern or degree of diffusion restriction could help in the prognostication of patients with GBM. MATERIAL AND METHODS We retrospectively analyzed 84 consecutive patients with confirmed GBM on biopsy or resection. The study was approved by the institutional ethics committee. The total volume of the tumor and total volume of tumor showing restricted diffusion were calculated. The lowest Apparent Diffusion Coefficient (ADC) in the region of the tumor and in the contralateral Normal Appearing White Matter were calculated in order to calculate the nADC. Treatment and follow-up data in these patients were recorded. Multivariate analsysis was completed to determine significant correlations between different variables and the survival of these patients. RESULTS Patient survival was significantly related to the age of the patient (p<0.0001; 95% CI-1.022-1.043) and the nADC value (p=0.014; 95% CI-0.269-0.860) in the tumor. The correlation coefficients of age and nADC with survival were -0.335 (p=0.002) and 0.390 (p<0.001), respectively. Kaplan Meier survival function, grouped by normalized Apparent Diffusion Coefficient cut off value of 0.75, was significant (p=0.007). CONCLUSION The survival of patients with GBM had small, but significant, correlations with the patient's age and nADC within the tumor.
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13
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Dynamic perfusion CT in brain tumors. Eur J Radiol 2015; 84:2386-92. [DOI: 10.1016/j.ejrad.2015.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/15/2015] [Indexed: 11/22/2022]
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Yeung TPC, Wang Y, He W, Urbini B, Gafà R, Ulazzi L, Yartsev S, Bauman G, Lee TY, Fainardi E. Survival prediction in high-grade gliomas using CT perfusion imaging. J Neurooncol 2015; 123:93-102. [PMID: 25862005 DOI: 10.1007/s11060-015-1766-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/02/2015] [Indexed: 11/24/2022]
Abstract
Patients with high-grade gliomas usually have heterogeneous response to surgery and chemoirradiation. The objectives of this study were (1) to evaluate serial changes in tumor volume and perfusion imaging parameters and (2) to determine the value of these data in predicting overall survival (OS). Twenty-nine patients with World Health Organization grades III and IV gliomas underwent magnetic resonance (MR) and computed tomography (CT) perfusion examinations before surgery, and 1, 3, 6, 9, and 12 months after radiotherapy. Serial measurements of tumor volumes and perfusion parameters were evaluated by receiver operating characteristic analysis, Cox proportional hazards regression, and Kaplan-Meier survival analysis to determine their values in predicting OS. Higher trends in blood flow (BF), blood volume (BV), and permeability-surface area product in the contrast-enhancing lesions (CEL) and the non-enhancing lesions (NEL) were found in patients with OS < 18 months compared to those with OS ≥ 18 months, and these values were significant at selected time points (P < 0.05). Only CT perfusion parameters yielded sensitivities and specificities of ≥ 70% in predicting 18 and 24 months OS. Pre-surgery BF in the NEL and BV in the CEL and NEL 3 months after radiotherapy had sensitivities and specificities >80% in predicting 24 months OS in patients with grade IV gliomas. Our study indicated that CT perfusion parameters were predictive of survival and could be useful in assessing early response and in selecting adjuvant treatment to prolong survival if verified in a larger cohort of patients.
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Serum microRNA-210 as a potential noninvasive biomarker for the diagnosis and prognosis of glioma. Br J Cancer 2015; 112:1241-6. [PMID: 25756397 PMCID: PMC4385967 DOI: 10.1038/bjc.2015.91] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 02/04/2015] [Accepted: 02/10/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND MicroRNA-210 (miR-210) is an oncogenic miRNA previously associated with prognosis in human gliomas, an incurable tumour type of the central nervous system. Here miR-210 was investigated as a potential serum biomarker in the diagnosis and prognosis of glioma. METHODS Serum was immediately prepared from blood samples collected from patients with glioma grades I-IV at primary diagnosis (n=136) and healthy controls (n=50) from February 2007 to March 2014 in the Department of Neurosurgery of the First Affiliated Hospital of Wannan Medical College (Wuhu, China). Total RNA was isolated from serum. cDNA was synthesised with primers specific for miR-210 and miR-16-1 (internal control), and quantitative real-time RT-PCR was performed. Results were statistically analysed to determine the role of miR-210 in the diagnosis and prognosis of human glioma patients. RESULTS An approximately seven-fold increase in miR-210 expression was detected in serum samples from glioblastoma patients relative to healthy controls. A threshold expression value (2.259) was chosen from receiver operator characteristic curves (ROC), and the low and high miR-210 expression groups were analysed by multivariate Cox proportional hazard regression and Kaplan-Meier analyses. Results revealed an association of high serum miR-210 expression with tumour grade and poor patient outcome (P-values <0.001). CONCLUSIONS Serum miR-210 is a promising diagnostic and prognostic biomarker that can be detected in the peripheral blood of patients with glioma.
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Łuczyńska E, Heinze-Paluchowska S, Blecharz P, Jereczek-Fossa B, Petralia G, Bellomi M, Stelmach A. Correlation between CT perfusion and clinico-pathological features in prostate cancer: a prospective study. Med Sci Monit 2015; 21:153-62. [PMID: 25582437 PMCID: PMC4301468 DOI: 10.12659/msm.891401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The aim of the study was to assess the correlation between computed tomography perfusion (PCT) parameters and PSA levels, Gleason score, and pTNM stage in patients with prostate cancer (PCa). Material/Methods One hundred twenty-five patients with localized PCa were prospectively enrolled in the study. All patients were diagnosed due to suspicious prostate findings and elevated PSA serum levels and underwent PCT followed by core biopsy and radical prostatectomy. Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability-surface (PS) area product were computed in the suspected PCa area and normal prostatic tissue. Core biopsy followed by prostatectomy was performed 2–4 weeks after PCT. Correlation between PCT findings and PSA levels, Gleason score, and pTNM stage were analyzed. Results The mean age of patients was 64 years. All patients had elevated PSA levels (mean value 6.2 ng/ml). Nineteen patients (15.9%) were at low risk of recurrence, 91 (76.5%) were at moderate risk, and 9 (7.6%) were at high risk according to National Comprehensive Cancer Network criteria. PCa was visible on PCT as focal peripheral CT enhancement in 119 out of 125 patients (sensitivity 95.2%). Significant correlations between BV, BF, and PS values and PSA level were found (p<0.05), as well as a trend for difference between BV, BF, and PS in poorly and moderately differentiated tumors (according to Gleason score) in comparison with highly differentiated PCa (p<0.08). The analysis also revealed a correlation between mean perfusion values and BV, MTT, PS, and pTNM cancer stage (p<0.04). Conclusions Our study suggests that in low- and intermediate- risk patients, PCT parameters correlate with PSA values, Gleason score, and pTNM stage and can be useful for initial tumor staging.
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Affiliation(s)
- Elżbieta Łuczyńska
- Department of Radiology, Center of Oncology, M. Skłodowska-Curie Memorial Institute, Cracow, Poland
| | | | - Paweł Blecharz
- Department of Gynecologic Oncology, Center of Oncology, M. Skłodowska-Curie Memorial Institute, Cracow, Poland
| | | | - Giuseppe Petralia
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Massimo Bellomi
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - Andrzej Stelmach
- Department of Surgery, Center of Oncology, M. Skłodowska-Curie Memorial Institute, Cracow, Poland
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Nguyen TB, Cron GO, Mercier JF, Foottit C, Torres CH, Chakraborty S, Woulfe J, Jansen GH, Caudrelier JM, Sinclair J, Hogan MJ, Thornhill RE, Cameron IG. Preoperative prognostic value of dynamic contrast-enhanced MRI-derived contrast transfer coefficient and plasma volume in patients with cerebral gliomas. AJNR Am J Neuroradiol 2015; 36:63-9. [PMID: 24948500 DOI: 10.3174/ajnr.a4006] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of dynamic contrast-enhanced MR imaging-derived plasma volume obtained in tumor and the contrast transfer coefficient has not been well-established in patients with gliomas. We determined whether plasma volume and contrast transfer coefficient in tumor correlated with survival in patients with gliomas in addition to other factors such as age, type of surgery, preoperative Karnofsky score, contrast enhancement, and histopathologic grade. MATERIALS AND METHODS This prospective study included 46 patients with a new pathologically confirmed diagnosis of glioma. The contrast transfer coefficient and plasma volume obtained in tumor maps were calculated directly from the signal-intensity curve without T1 measurements, and values were obtained from multiple small ROIs placed within tumors. Survival curve analysis was performed by dichotomizing patients into groups of high and low contrast transfer coefficient and plasma volume. Univariate analysis was performed by using dynamic contrast-enhanced parameters and clinical factors. Factors that were significant on univariate analysis were entered into multivariate analysis. RESULTS For all patients with gliomas, survival was worse for groups of patients with high contrast transfer coefficient and plasma volume obtained in tumor (P < .05). In subgroups of high- and low-grade gliomas, survival was worse for groups of patients with high contrast transfer coefficient and plasma volume obtained in tumor (P < .05). Univariate analysis showed that factors associated with lower survival were age older than 50 years, low Karnofsky score, biopsy-only versus resection, marked contrast enhancement versus no/mild enhancement, high contrast transfer coefficient, and high plasma volume obtained in tumor (P < .05). In multivariate analysis, a low Karnofsky score, biopsy versus resection in combination with marked contrast enhancement, and a high contrast transfer coefficient were associated with lower survival rates (P < .05). CONCLUSIONS In patients with glioma, those with a high contrast transfer coefficient have lower survival than those with low parameters.
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Affiliation(s)
- T B Nguyen
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - G O Cron
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - J F Mercier
- Department of Radiology (J.F.M.), Hôpital de Hull, Gatineau, Québec, Canada
| | | | - C H Torres
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - S Chakraborty
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | | | | | - J M Caudrelier
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - J Sinclair
- Surgery, Division of Neurosurgery (J.S.)
| | - M J Hogan
- Medicine, Division of Neurology (M.J.H.), The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - R E Thornhill
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.)
| | - I G Cameron
- From the Departments of Diagnostic Imaging (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C., J.M.C.) Medical Physics (C.F., I.G.C.)
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Luczynska E, Blecharz P, Dyczek S, Stelmach A, Petralia G, Bellomi M, Jereczek-Fossa BA, Jakubowicz J. Perfusion CT is a valuable diagnostic method for prostate cancer: a prospective study of 94 patients. Ecancermedicalscience 2014; 8:476. [PMID: 25435904 PMCID: PMC4239130 DOI: 10.3332/ecancer.2014.476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this study is to assess the usefulness of perfusion computer tomography (pCT) in prostate cancer (PCa) diagnostics. Materials and Methods 94 patients with biopsy-proven PCa were enrolled in the study. Dynamic pCT of the prostate gland was performed for 50 seconds after an intravenous injection of contrast medium. Blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) were computed in the suspected PCa area and in normal prostatic tissue. Results PCa was visible in pCT in 90 of the 94 examined patients as a focal peripheral CT enhancement. When PCa was located in the peripheral zone (PZ), it was visible on perfusion maps, mostly showing an early peak followed by wash-out. The average values of all perfusion parameters were higher for tumour than for normal prostate tissue (p < 0.000). BV and BF were dependent on tumour grade expressed by the Gleason score (GS). All PCa cases were divided into groups, according to histological grade, as low (GS ≤ 6), medium (GS = 7), and high (GS > 7). In high-grade PCa, the mean BF value was significantly higher (p = 0.001) than the mean value of BF low- and medium-grade PCa (p = 0.011). Similar results were obtained regarding the mean values of BV; the more aggressive the cancer grade, the higher the mean BV value (p = 0.04). Conclusion CT quantitative perfusion imaging allows PCa to be distinguished from normal prostate tissue. The highest values for BF and BV were observed in the most aggressive PCa grade.
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Affiliation(s)
- Elzbieta Luczynska
- Radiology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Pawel Blecharz
- Gynecologic Oncology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Sonia Dyczek
- Radiology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Andrzej Stelmach
- Radiotherapy Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | | | - Massimo Bellomi
- Radiology Department, European Institute of Oncology, Milan, Italy ; Radiology Department, European Institute of Oncology, Milan, Italy
| | | | - Jerzy Jakubowicz
- Surgery Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
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