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Wei R, Chen H, Cai Y, Chen J. Application of intraoperative ultrasound in the resection of high-grade gliomas. Front Neurol 2023; 14:1240150. [PMID: 37965171 PMCID: PMC10640994 DOI: 10.3389/fneur.2023.1240150] [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: 06/14/2023] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
The incidence of gliomas is approximately 3-5/100,000, with high-grade gliomas accounting for approximately 30-40% of these tumors. Surgery is a confirmed positive factor in prolonging the survival of these patients, and a larger resection range means a longer survival time. Therefore, surgery for high-grade glioma patients should aim to maximize the extent of resection while preserving neurological function to achieve a better quality of life. There is consensus regarding the need to lengthen progression-free survival (PFS) and overall survival (OS) times. In glioma surgery, methods such as intraoperative computed tomography (ICT), intraoperative magnetic resonance imaging (IMRI), navigation, 5-aminolevulinic acid (5-ALA), and intraoperative ultrasound (IOUS) are used to achieve an expanded resection during the surgical procedure. IOUS has been increasingly used in the surgery of high-grade gliomas and various tumors due to its convenient intraoperative use, its flexible repeatability, and the relatively low cost of operating room construction. With the continuous upgrading of ultrasound equipment, IOUS has been able to better assist surgeons in achieving an increased extent of resection. This review aims to summarize the application of ultrasound in the surgery of high-grade gliomas in the past decade, its improvement in patient prognosis, and its prospects.
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Affiliation(s)
- RenJie Wei
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - YuXiang Cai
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - JingCao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China
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2
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Baria E, Giordano F, Guerrini R, Caporalini C, Buccoliero AM, Cicchi R, Pavone FS. Dysplasia and tumor discrimination in brain tissues by combined fluorescence, Raman, and diffuse reflectance spectroscopies. BIOMEDICAL OPTICS EXPRESS 2023; 14:1256-1275. [PMID: 36950232 PMCID: PMC10026567 DOI: 10.1364/boe.477035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 06/18/2023]
Abstract
Identification of neoplastic and dysplastic brain tissues is of paramount importance for improving the outcomes of neurosurgical procedures. This study explores the combined application of fluorescence, Raman and diffuse reflectance spectroscopies for the detection and classification of brain tumor and cortical dysplasia with a label-free modality. Multivariate analysis was performed to evaluate classification accuracies of these techniques-employed both in individual and multimodal configuration-obtaining high sensitivity and specificity. In particular, the proposed multimodal approach allowed discriminating tumor/dysplastic tissues against control tissue with 91%/86% sensitivity and 100%/100% specificity, respectively, whereas tumor from dysplastic tissues were discriminated with 89% sensitivity and 86% specificity. Hence, multimodal optical spectroscopy allows reliably differentiating these pathologies using a non-invasive, label-free approach that is faster than the gold standard technique and does not require any tissue processing, offering the potential for the clinical translation of the technology.
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Affiliation(s)
- Enrico Baria
- National Institute of Optics, National Research Council, Via Nello Carrara 1, Sesto Fiorentino 50019, Italy
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Via Nello Carrara 1, Sesto Fiorentino 50019, Italy
| | - Flavio Giordano
- Division of Neurosurgery, Department of Neuroscience I, "A. Meyer" Children's Hospital, Viale Gaetano Pieraccini 24, Florence 50141, Italy
| | - Renzo Guerrini
- Division of Neurosurgery, Department of Neuroscience I, "A. Meyer" Children's Hospital, Viale Gaetano Pieraccini 24, Florence 50141, Italy
| | - Chiara Caporalini
- Division of Pathology, Department of Critical Care Medicine and Surgery, University of Florence, Viale Giovanni Battista Morgagni 85, Florence 50134, Italy
| | - Anna Maria Buccoliero
- Division of Pathology, Department of Critical Care Medicine and Surgery, University of Florence, Viale Giovanni Battista Morgagni 85, Florence 50134, Italy
| | - Riccardo Cicchi
- National Institute of Optics, National Research Council, Via Nello Carrara 1, Sesto Fiorentino 50019, Italy
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Via Nello Carrara 1, Sesto Fiorentino 50019, Italy
| | - Francesco Saverio Pavone
- National Institute of Optics, National Research Council, Via Nello Carrara 1, Sesto Fiorentino 50019, Italy
- European Laboratory for Non-Linear Spectroscopy, University of Florence, Via Nello Carrara 1, Sesto Fiorentino 50019, Italy
- Department of Physics and Astrophysics, University of Florence, Via Sansone 1, Sesto Fiorentino 50019, Italy
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3
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Singh A, Das KK, Khatri D, Singh S, Gosal JS, Jaiswal S, Mishra P, Mehrotra A, Bhaisora K, Sardhara J, Srivastava AK, Jaiswal A, Behari S. Insular glioblastoma: surgical challenges, survival outcomes and prognostic factors. Br J Neurosurg 2023; 37:26-34. [PMID: 33356607 DOI: 10.1080/02688697.2020.1859089] [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] [Indexed: 12/29/2022]
Abstract
BACKGROUND Insular gliomas are unique, challenging and evoke a lot of interest amongst neurosurgeons. Publications on insular glioma generally focus on the surgical intricacies and extent of resection pertaining to the low-grade gliomas. Insular glioblastomas (iGBM) have not been analysed separately before. METHODS Histologically proven WHO grade IV gliomas involving the insula over a 9-year period were studied. Their clinical presentation, radiological features, surgical findings and survival outcomes were assessed. Statistical methods were used to determine the favourable predictors of survival. RESULTS Out of 27 patients (M:F = 2.9:1), 18 (66%) patients had a tumour extension beyond the insula, 10 (37%) of whom had basal ganglia involvement. Total, near total and subtotal excisions were performed in 7 (26%), 9 (33%) and 11 (40.7%) patients, respectively. Twenty-three patients had glioblastoma, while four had gliosarcoma. IDH mutation was negative in six of the seven patients where it was done. Median overall survival was 5 months. Multivariate analysis showed that a female gender (p = 0.013), seizures in the preoperative period (p = 0.048) and completion of adjuvant therapy (p = 0.003) were associated with a longer survival. CONCLUSION Insular glioblastomas have a poor prognosis. Insular location and certain tumour characteristics often limit the extent of resection of iGBMs. Moreover, postoperative complications sometimes negate the advantages of a radical resection. A female gender, presentation with seizures and completion of adjuvant chemoradiotherapy appear to be good prognostic factors.
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Affiliation(s)
- Amanjot Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Deepak Khatri
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Suyash Singh
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jaskaran Singh Gosal
- Department of Neurosurgery, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Sushila Jaiswal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anant Mehrotra
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kamlesh Bhaisora
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Arun Kumar Srivastava
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Awadhesh Jaiswal
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Zhang Y, Yu H, Li Y, Xu H, Yang L, Shan P, Du Y, Yan X, Chen X. Raman spectroscopy: A prospective intraoperative visualization technique for gliomas. Front Oncol 2023; 12:1086643. [PMID: 36686726 PMCID: PMC9849680 DOI: 10.3389/fonc.2022.1086643] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
The infiltrative growth and malignant biological behavior of glioma make it one of the most challenging malignant tumors in the brain, and how to maximize the extent of resection (EOR) while minimizing the impact on normal brain tissue is the pursuit of neurosurgeons. The current intraoperative visualization assistance techniques applied in clinical practice suffer from low specificity, slow detection speed and low accuracy, while Raman spectroscopy (RS) is a novel spectroscopy technique gradually developed and applied to clinical practice in recent years, which has the advantages of being non-destructive, rapid and accurate at the same time, allowing excellent intraoperative identification of gliomas. In the present work, the latest research on Raman spectroscopy in glioma is summarized to explore the prospect of Raman spectroscopy in glioma surgery.
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Review of Intraoperative Adjuncts for Maximal Safe Resection of Gliomas and Its Impact on Outcomes. Cancers (Basel) 2022; 14:cancers14225705. [PMID: 36428797 PMCID: PMC9688206 DOI: 10.3390/cancers14225705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Maximal safe resection is the mainstay of treatment in the neurosurgical management of gliomas, and preserving functional integrity is linked to favorable outcomes. How these modalities differ in their effectiveness on the extent of resection (EOR), survival, and complications remains unknown. A systematic literature search was performed with the following inclusion criteria: published between 2005 and 2022, involving brain glioma surgery, and including one or a combination of intraoperative modalities: intraoperative magnetic resonance imaging (iMRI), awake/general anesthesia craniotomy mapping (AC/GA), fluorescence-guided imaging, or combined modalities. Of 525 articles, 464 were excluded and 61 articles were included, involving 5221 glioma patients, 7(11.4%) articles used iMRI, 21(36.8%) used cortical mapping, 15(24.5%) used 5-aminolevulinic acid (5-ALA) or fluorescein sodium, and 18(29.5%) used combined modalities. The heterogeneity in reporting the amount of surgical resection prevented further analysis. Progression-free survival/overall survival (PFS/OS) were reported in 18/61(29.5%) articles, while complications and permanent disability were reported in 38/61(62.2%) articles. The reviewed studies demonstrate that intraoperative adjuncts such as iMRI, AC/GA mapping, fluorescence-guided imaging, and a combination of these modalities improve EOR. However, PFS/OS were underreported. Combining multiple intraoperative modalities seems to have the highest effect compared to each adjunct alone.
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6
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Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends. J Clin Med 2022; 11:jcm11185354. [PMID: 36143001 PMCID: PMC9505564 DOI: 10.3390/jcm11185354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/17/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Glioblastoma (GBM) is a highly aggressive disease and is associated with poor prognosis despite treatment advances in recent years. Surgical resection of tumor remains the main therapeutic option when approaching these patients, especially when combined with adjuvant radiochemotherapy. In the present study, we conducted a comprehensive literature review on the state-of-the-art and future trends of the surgical treatment of GBM, emphasizing topics that have been the object of recent study.
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7
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Optical molecular imaging and theranostics in neurological diseases based on aggregation-induced emission luminogens. Eur J Nucl Med Mol Imaging 2022; 49:4529-4550. [PMID: 35781601 PMCID: PMC9606072 DOI: 10.1007/s00259-022-05894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/25/2022] [Indexed: 11/17/2022]
Abstract
Optical molecular imaging and image-guided theranostics benefit from special and specific imaging agents, for which aggregation-induced emission luminogens (AIEgens) have been regarded as good candidates in many biomedical applications. They display a large Stokes shift, high quantum yield, good biocompatibility, and resistance to photobleaching. Neurological diseases are becoming a substantial burden on individuals and society that affect over 50 million people worldwide. It is urgently needed to explore in more detail the brain structure and function, learn more about pathological processes of neurological diseases, and develop more efficient approaches for theranostics. Many AIEgens have been successfully designed, synthesized, and further applied for molecular imaging and image-guided theranostics in neurological diseases such as cerebrovascular disease, neurodegenerative disease, and brain tumor, which help us understand more about the pathophysiological state of brain through noninvasive optical imaging approaches. Herein, we focus on representative AIEgens investigated on brain vasculature imaging and theranostics in neurological diseases including cerebrovascular disease, neurodegenerative disease, and brain tumor. Considering different imaging modalities and various therapeutic functions, AIEgens have great potential to broaden neurological research and meet urgent needs in clinical practice. It will be inspiring to develop more practical and versatile AIEgens as molecular imaging agents for preclinical and clinical use on neurological diseases.
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8
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Jabarkheel R, Ho CS, Rodrigues AJ, Jin MC, Parker JJ, Mensah-Brown K, Yecies D, Grant GA. Rapid intraoperative diagnosis of pediatric brain tumors using Raman spectroscopy: A machine learning approach. Neurooncol Adv 2022; 4:vdac118. [PMID: 35919071 PMCID: PMC9341441 DOI: 10.1093/noajnl/vdac118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Surgical resection is a mainstay in the treatment of pediatric brain tumors to achieve tissue diagnosis and tumor debulking. While maximal safe resection of tumors is desired, it can be challenging to differentiate normal brain from neoplastic tissue using only microscopic visualization, intraoperative navigation, and tactile feedback. Here, we investigate the potential for Raman spectroscopy (RS) to accurately diagnose pediatric brain tumors intraoperatively. Methods Using a rapid acquisition RS device, we intraoperatively imaged fresh ex vivo brain tissue samples from 29 pediatric patients at the Lucile Packard Children’s Hospital between October 2018 and March 2020 in a prospective fashion. Small tissue samples measuring 2-4 mm per dimension were obtained with each individual tissue sample undergoing multiple unique Raman spectra acquisitions. All tissue samples from which Raman spectra were acquired underwent individual histopathology review. A labeled dataset of 678 unique Raman spectra gathered from 160 samples was then used to develop a machine learning model capable of (1) differentiating normal brain from tumor tissue and (2) normal brain from low-grade glioma (LGG) tissue. Results Trained logistic regression model classifiers were developed using our labeled dataset. Model performance was evaluated using leave-one-patient-out cross-validation. The area under the curve (AUC) of the receiver-operating characteristic (ROC) curve for our tumor vs normal brain model was 0.94. The AUC of the ROC curve for LGG vs normal brain was 0.91. Conclusions Our work suggests that RS can be used to develop a machine learning-based classifier to differentiate tumor vs non-tumor tissue during resection of pediatric brain tumors.
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Affiliation(s)
- Rashad Jabarkheel
- Department of Neurosurgery, Stanford University , Stanford, California , USA
- Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania , USA
| | - Chi-Sing Ho
- Department of Applied Physics, Stanford University , Stanford, California , USA
| | - Adrian J Rodrigues
- Department of Neurosurgery, Stanford University , Stanford, California , USA
| | - Michael C Jin
- Department of Neurosurgery, Stanford University , Stanford, California , USA
| | - Jonathon J Parker
- Department of Neurosurgery, Stanford University , Stanford, California , USA
| | - Kobina Mensah-Brown
- Department of Neurosurgery, University of Pennsylvania , Philadelphia, Pennsylvania , USA
| | - Derek Yecies
- Department of Neurosurgery, Stanford University , Stanford, California , USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University , Stanford, California , USA
- Department of Neurosurgery, Duke University , Durham, North Carolina , USA
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Dolganova IN, Varvina DA, Shikunova IA, Alekseeva AI, Karalkin PA, Kuznetsov MR, Nikitin PV, Zotov AK, Mukhina EE, Katyba GM, Zaytsev KI, Tuchin VV, Kurlov VN. Proof of concept for the sapphire scalpel combining tissue dissection and optical diagnosis. Lasers Surg Med 2021; 54:611-622. [PMID: 34918347 DOI: 10.1002/lsm.23509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/18/2021] [Accepted: 11/27/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The development of compact diagnostic probes and instruments with an ability to direct access to organs and tissues and integration of these instruments into surgical workflows is an important task of modern physics and medicine. The need for such tools is essential for surgical oncology, where intraoperative visualization and demarcation of tumor margins define further prognosis and survival of patients. In this paper, the possible solution for this intraoperative imaging problem is proposed and its feasibility to detect tumorous tissue is studied experimentally. METHODS For this aim, the sapphire scalpel was developed and fabricated using the edge-defined film-fed growth technique aided by mechanical grinding, polishing, and chemical sharpening of the cutting edge. It possesses optical transparency, mechanical strength, chemical inertness, and thermal resistance alongside the presence of the as-grown hollow capillary channels in its volume for accommodating optical fibers. The rounding of the cutting edge exceeds the same for metal scalpels and can be as small as 110 nm. Thanks to these features, sapphire scalpel combines tissue dissection with light delivering and optical diagnosis. The feasibility for the tumor margin detection was studied, including both gelatin-based tissue phantoms and ex vivo freshly excised specimens of the basal cell carcinoma from humans and the glioma model 101.8 from rats. These tumors are commonly diagnosed either non-invasively or intraoperatively using different modalities of fluorescence spectroscopy and imaging, which makes them ideal candidates for our feasibility test. For this purpose, fiber-based spectroscopic measurements of the backscattered laser radiation and the fluorescence signals were carried out in the visible range. RESULTS Experimental studies show the feasibility of the proposed sapphire scalpel to provide a 2-mm-resolution of the tumor margins' detection, along with an ability to distinguish the tumor invasion region, which results from analysis of the backscattered optical fields and the endogenous or exogenous fluorescence data. CONCLUSIONS Our findings justified a strong potential of the sapphire scalpel for surgical oncology. However, further research and engineering efforts are required to optimize the sapphire scalpel geometry and the optical diagnosis protocols to meet the requirements of oncosurgery, including diagnosis and resection of neoplasms with different localizations and nosologies.
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Affiliation(s)
- Irina N Dolganova
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia.,Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.,Bauman Moscow State Technical University, Moscow, Russia
| | - Daria A Varvina
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.,International School "Medicine of the Future", Sechenov University, Moscow, Russia
| | - Irina A Shikunova
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - Anna I Alekseeva
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.,Research Institute of Human Morphology, Moscow, Russia
| | - Pavel A Karalkin
- Institute for Cluster Oncology, Sechenov University, Moscow, Russia.,Hertsen Moscow Oncology Research Institute, National Medical Research Radiological Centre, Moscow, Russia
| | | | - Pavel V Nikitin
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia
| | - Arsen K Zotov
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia.,Bauman Moscow State Technical University, Moscow, Russia.,Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | | | - Gleb M Katyba
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia.,Bauman Moscow State Technical University, Moscow, Russia.,Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - Kirill I Zaytsev
- Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.,Bauman Moscow State Technical University, Moscow, Russia.,Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | - Valery V Tuchin
- Science Medical Center, Saratov State University, Saratov, Russia.,Institute of Precision Mechanics and Control of the Russian Academy of Sciences, Saratov, Russia.,National Research Tomsk University, Tomsk, Russia
| | - Vladimir N Kurlov
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia.,Institute for Regenerative Medicine, Sechenov University, Moscow, Russia.,Bauman Moscow State Technical University, Moscow, Russia
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10
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Yoo K, Yun HH, Jung SY, Lee JH. KRIBB11 Induces Apoptosis in A172 Glioblastoma Cells via MULE-Dependent Degradation of MCL-1. Molecules 2021; 26:molecules26144165. [PMID: 34299435 PMCID: PMC8305965 DOI: 10.3390/molecules26144165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022] Open
Abstract
KRIBB11, an HSF1 inhibitor, was shown to sensitize various types of cancer cells to treatment with several anticancer drugs. However, the exclusive effects of KRIBB11 in preventing the growth of glioblastoma cells and the related mechanisms have not been elucidated yet. Herein, we aimed to examine the potential of KRIBB11 as an anticancer agent for glioblastoma. Using MTT and colony formation assays and Western blotting for c-PARP, we demonstrated that KRIBB11 substantially inhibits the growth of A172 glioma cells by inducing apoptosis. At the molecular level, KRIBB11 decreased anti-apoptotic protein MCL-1 levels, which was attributable to the increase in MULE ubiquitin ligase levels. However, the constitutive activity of HSF1 in A172 cells was not influenced by the exclusive treatment with KRIBB11. Additionally, based on cycloheximide chase assay, we found that KRIBB11 markedly retarded the degradation of MULE. In conclusion, stabilization of MULE upon KRIBB11 treatment is apparently an essential step for degradation of MCL-1 and the subsequent induction of apoptosis in A172 cells. Our results have expanded the knowledge on molecular pathways controlled by KRIBB11 and could be potentially effective for developing an inhibitory therapeutic strategy for glioblastoma.
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Affiliation(s)
- Kyunghyun Yoo
- Department of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea; (K.Y.); (H.-H.Y.); (S.-Y.J.)
- Institute for Aging and Metabolic Diseases, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea
- Department of Biomedicine & Health Sciences, Graduate School, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea
| | - Hye-Hyeon Yun
- Department of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea; (K.Y.); (H.-H.Y.); (S.-Y.J.)
- Institute for Aging and Metabolic Diseases, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea
| | - Soon-Young Jung
- Department of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea; (K.Y.); (H.-H.Y.); (S.-Y.J.)
- Institute for Aging and Metabolic Diseases, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea
| | - Jeong-Hwa Lee
- Department of Biochemistry, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea; (K.Y.); (H.-H.Y.); (S.-Y.J.)
- Institute for Aging and Metabolic Diseases, College of Medicine, The Catholic University of Korea, Seoul 16591, Korea
- Correspondence: ; Tel.: +82-2-2258-7293
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11
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Park HC, Li A, Guan H, Bettegowda C, Chaichana K, Quiñones-Hinojosa A, Li X. Minimizing OCT quantification error via a surface-tracking imaging probe. BIOMEDICAL OPTICS EXPRESS 2021; 12:3992-4002. [PMID: 34457394 PMCID: PMC8367274 DOI: 10.1364/boe.423233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
OCT-based quantitative tissue optical properties imaging is a promising technique for intraoperative brain cancer assessment. The attenuation coefficient analysis relies on the depth-dependent OCT intensity profile, thus sensitive to tissue surface positions relative to the imaging beam focus. However, it is almost impossible to maintain a steady tissue surface during intraoperative imaging due to the patient's arterial pulsation and breathing, the operator's motion, and the complex tissue surface geometry of the surgical cavity. In this work, we developed an intraoperative OCT imaging probe with a surface-tracking function to minimize the quantification errors in optical attenuation due to the tissue surface position variations. A compact OCT imaging probe was designed and engineered to have a long working distance of ∼ 41 mm and a large field of view of 4 × 4 mm2 while keeping the probe diameter small (9 mm) to maximize clinical versatility. A piezo-based linear motor was integrated with the imaging probe and controlled based upon real-time feedback of tissue surface position inferred from OCT images. A GPU-assisted parallel processing algorithm was implemented, enabling detection and tracking of tissue surface in real-time and successfully suppressing more than 90% of the typical physiologically induced motion range. The surface-tracking intraoperative OCT imaging probe could maintain a steady beam focus inside the target tissue regardless of the surface geometry or physiological motions and enabled to obtain tissue optical attenuation reliably for assessing brain cancer margins in challenging intraoperative settings.
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Affiliation(s)
- Hyeon-Cheol Park
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21215, USA
| | - Ang Li
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21215, USA
| | - Honghua Guan
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Kaisorn Chaichana
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Xingde Li
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21215, USA
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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12
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Yin L, Cheng L, Wang F, Zhu X, Hua Y, He W. Application of intraoperative B-mode ultrasound and shear wave elastography for glioma grading. Quant Imaging Med Surg 2021; 11:2733-2743. [PMID: 34079737 DOI: 10.21037/qims-20-1368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background To evaluate the value of intraoperative B-mode ultrasound and shear wave elastography (SWE) in differentiating low-grade and high-grade gliomas. Methods A total of 172 patients with glioma were examined by B-mode ultrasound to obtain a tumor sonogram. Intraoperative SWE was performed on 52 patients to obtain Young's modulus values of peritumor tissue and tumor tissue, and the differences in conventional B-mode signs and Young's modulus values of gliomas of different grades were then compared. The diagnostic performance of SWE in glioma grading was assessed by receiver operating characteristic (ROC) curve analysis, and the intra- and interobserver reliability of SWE was analyzed by the intraclass correlation coefficient (ICC). Results For B-mode ultrasound, patient age, cystic degeneration, and peritumor edema were independent risk factors for high-grade glioma (P<0.05, OR >1). For SWE, Young's modulus values of peritumor tissue, low-grade glioma, and high-grade glioma tissues were 8.20 (7.50, 9.70) kPa, 19.65 (15.30, 24.75) kPa, and 9.55 (8.50, 13.80) kPa, respectively. The area under the ROC curve for the diagnosis of high-grade glioma by SWE was 0.859 (95% CI: 0.758-0.961, P<0.05), and the optimal cutoff value was 12.1 kPa, with 89.3% sensitivity and 75.0% specificity. The intra- and interobserver reliability of SWE in grading gliomas was excellent, with ICCs ranging from 0.921 to 0.965. Conclusions High-grade glioma is associated with significantly more severe necrotic cystic degeneration and peritumoral edema on B-mode ultrasound and lower stiffness on SWE. Further, SWE exhibits excellent intra- and interobserver reliability. Intraoperative B-mode ultrasound combined with SWE helps differentiate different grades of gliomas.
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Affiliation(s)
- Lu Yin
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggang Cheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fumin Wang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Xueli Zhu
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yue Hua
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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13
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Daisy PS, Anitha TS. Can artificial intelligence overtake human intelligence on the bumpy road towards glioma therapy? Med Oncol 2021; 38:53. [PMID: 33811540 DOI: 10.1007/s12032-021-01500-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/20/2021] [Indexed: 12/17/2022]
Abstract
Gliomas are one of the most devastating primary brain tumors which impose significant management challenges to the clinicians. The aggressive behaviour of gliomas is mainly attributed to their rapid proliferation, unravelled genomics and the blood-brain barrier which protects the tumor cells from chemotherapeutic regimens. Suspects of brain tumors are usually assessed by magnetic resonance imaging and computed tomography. These images allow surgeons to decide on the tumor grading, intra-operative pathology, feasibility of surgery, and treatment planning. All these data are compiled manually by physicians, wherein it takes time for the validation of results and concluding the treatment modality. In this context, the arrival of artificial intelligence in this era of personalized medicine, has proven promising performance in the diagnosis and management of gliomas. Starting from grading prediction till outcome evaluation, artificial intelligence-based forefronts have revolutionized oncological research. Interestingly, this approach has also been able to precisely differentiate tumor lesion from healthy tissues. However, till date, their utility in neuro-oncological field remains limited due to the issues pertaining to their reliability and transparency. Hence, to shed novel insights on the "clinical utility of this novel approach on glioma management" and to reveal "the black-boxes that have to be solved for fruitful application of artificial intelligence in neuro-oncology research", we provide in this review, a succinct description of the potential gear of artificial intelligence-based avenues in glioma treatment and the barriers that impede their rapid implementation in neuro-oncology.
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Affiliation(s)
- Precilla S Daisy
- Central Inter-Disciplinary Research Facility, School of Biological Sciences, Sri Balaji Vidyapeeth (Deemed to-be University), Pillaiyarkuppam, Puducherry, India
| | - T S Anitha
- Central Inter-Disciplinary Research Facility, School of Biological Sciences, Sri Balaji Vidyapeeth (Deemed to-be University), Pillaiyarkuppam, Puducherry, India. .,Central Inter-Disciplinary Research Facility, School of Biological Sciences, Sri Balaji Vidyapeeth, Mahatma Gandhi Medical College and Research Institute Campus, Pillaiyarkuppam, Puducherry, 607403, India.
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14
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Barkley A, McGrath LB, Hofstetter CP. Intraoperative contrast-enhanced ultrasound for intramedullary spinal neoplasms: patient series. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2083. [PMID: 36046770 PMCID: PMC9394227 DOI: 10.3171/case2083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Primary intramedullary spinal tumors cause significant morbidity and death.
Intraoperative ultrasound as an adjunct for localization and monitoring the
extent of resection has not been systematically evaluated in these patients;
the effectiveness of intraoperative contrast-enhanced ultrasound (CEUS)
remains almost completely unexplored. OBSERVATIONS A retrospective case series of patients at a single institution who had
consented to the off-label use of intraoperative CEUS was identified. Seven
patients with a mean age of 52.8 ± 15.8 years underwent resection of
intramedullary tumors assisted by CEUS performed by a single attending
neurosurgeon. Histopathological evaluation revealed 3 cases of
hemangioblastoma, 1 case of pilocytic astrocytoma, 2 cases of ependymoma,
and 1 case of subependymoma. Contrast enhancement correlated with gadolinium
enhancement on preoperative magnetic resonance imaging. Intraoperative CEUS
facilitated precise lesion localization and myelotomy planning. Dynamic CEUS
studies were useful in demonstrating the blood supply to lesions with a
dominant vascular pedicle. Regardless of contrast uptake, the differential
enhancement between spinal cord tissue and neoplasm assisted in determining
interface boundaries. LESSONS Intraoperative CEUS constitutes a useful adjunct for the intraoperative
delineation of contrast-enhancing intramedullary tumors and in vivo
confirmation of gross-total resection. Systematic investigation is needed to
establish the role of CEUS for resection of intramedullary spinal tumors of
various pathologies.
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Affiliation(s)
- Ariana Barkley
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Lynn B McGrath
- Department of Neurological Surgery, University of Washington, Seattle, Washington
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15
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Nagaraja TN, Lee IY. Cerebral microcirculation in glioblastoma: A major determinant of diagnosis, resection, and drug delivery. Microcirculation 2021; 28:e12679. [PMID: 33474805 DOI: 10.1111/micc.12679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/12/2021] [Indexed: 12/25/2022]
Abstract
Glioblastoma (GBM) is the most common primary brain tumor with a dismal prognosis. Current standard of treatment is safe maximal tumor resection followed by chemotherapy and radiation. Altered cerebral microcirculation and elevated blood-tumor barrier (BTB) permeability in tumor periphery due to glioma-induced vascular dysregulation allow T1 contrast-enhanced visualization of resectable tumor boundaries. Newer tracers that label the tumor and its vasculature are being increasingly used for intraoperative delineation of glioma boundaries for even more precise resection. Fluorescent 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) are examples of such intraoperative tracers. Recently, magnetic resonance imaging (MRI)-based MR thermometry is being employed for laser interstitial thermal therapy (LITT) for glioma debulking. However, aggressive, fatal recurrence always occurs. Postsurgical chemotherapy is hampered by the inability of most drugs to cross the blood-brain barrier (BBB). Understanding postsurgical changes in brain microcirculation and permeability is crucial to improve chemotherapy delivery. It is important to understand whether any microcirculatory indices can differentiate between true recurrence and radiation necrosis. LITT leads to peri-ablation BBB opening that persists for several weeks. Whether it can be a conduit for chemotherapy delivery is yet to be explored. This review will address the role of cerebral microcirculation in such emerging ideas in GBM diagnosis and therapy.
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Affiliation(s)
| | - Ian Y Lee
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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16
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Gómez-Oliva R, Domínguez-García S, Carrascal L, Abalos-Martínez J, Pardillo-Díaz R, Verástegui C, Castro C, Nunez-Abades P, Geribaldi-Doldán N. Evolution of Experimental Models in the Study of Glioblastoma: Toward Finding Efficient Treatments. Front Oncol 2021; 10:614295. [PMID: 33585240 PMCID: PMC7878535 DOI: 10.3389/fonc.2020.614295] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022] Open
Abstract
Glioblastoma (GBM) is the most common form of brain tumor characterized by its resistance to conventional therapies, including temozolomide, the most widely used chemotherapeutic agent in the treatment of GBM. Within the tumor, the presence of glioma stem cells (GSC) seems to be the reason for drug resistance. The discovery of GSC has boosted the search for new experimental models to study GBM, which allow the development of new GBM treatments targeting these cells. In here, we describe different strategies currently in use to study GBM. Initial GBM investigations were focused in the development of xenograft assays. Thereafter, techniques advanced to dissociate tumor cells into single-cell suspensions, which generate aggregates referred to as neurospheres, thus facilitating their selective expansion. Concomitantly, the finding of genes involved in the initiation and progression of GBM tumors, led to the generation of mice models for the GBM. The latest advances have been the use of GBM organoids or 3D-bioprinted mini-brains. 3D bio-printing mimics tissue cytoarchitecture by combining different types of cells interacting with each other and with extracellular matrix components. These in vivo models faithfully replicate human diseases in which the effect of new drugs can easily be tested. Based on recent data from human glioblastoma, this review critically evaluates the different experimental models used in the study of GB, including cell cultures, mouse models, brain organoids, and 3D bioprinting focusing in the advantages and disadvantages of each approach to understand the mechanisms involved in the progression and treatment response of this devastating disease.
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Affiliation(s)
- Ricardo Gómez-Oliva
- Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain
| | - Samuel Domínguez-García
- Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain
| | - Livia Carrascal
- Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain.,Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | | | - Ricardo Pardillo-Díaz
- Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain
| | - Cristina Verástegui
- Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain.,Departamento de Anatomía y Embriología Humanas, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain
| | - Carmen Castro
- Área de Fisiología, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain
| | - Pedro Nunez-Abades
- Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain.,Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain
| | - Noelia Geribaldi-Doldán
- Departamento de Anatomía y Embriología Humanas, Facultad de Medicina, Universidad de Cádiz, Cádiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INIBICA), Cádiz, Spain
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17
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Li Z, Yang F, Xu C, Ma C, Zhao Y. Clinical value of neuronavigation combined with a fluorescent staining technique during microsurgery for treating supratentorial glioma: A case-control observational study. GLIOMA 2021. [DOI: 10.4103/glioma.glioma_27_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Mishra A, Shetty P, Singh V, Moiyadi A. Microsurgical subpial resections for diffuse gliomas-old wine in a new bottle. Acta Neurochir (Wien) 2020; 162:3031-3035. [PMID: 32772163 DOI: 10.1007/s00701-020-04524-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/30/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Maximizing resection is an oft-sought-after albeit challenging goal in diffuse gliomas. Microsurgical technique remains the mainstay. METHOD By virtue of their pattern of growth and spread, gliomas respect anatomical boundaries like the pia. Using subpial dissection, en bloc resections provide the most optimal surgical technique. This paper revisits this technique and describes the rationale and basic principles integrating it in the modern multimodal glioma surgery workflow. CONCLUSION Subpial resection is a very useful and "anatomical" technique for en bloc resection of diffuse gliomas which is easy to master and execute and optimizes the extent of resection and minimizes complications effectively.
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19
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De Barros A, Attal J, Roques M, Nicolau J, Sol JC, Charni S, Cohen-Jonathan-Moyal E, Roux FE. Glioblastoma survival is better analyzed on preradiotherapy MRI than on postoperative MRI residual volumes: A retrospective observational study. Clin Neurol Neurosurg 2020; 196:105972. [PMID: 32512407 DOI: 10.1016/j.clineuro.2020.105972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Establishing an overall survival prognosis for resected glioblastoma during routine postoperative management remains a challenge. The aim of our single-center study was to assess the usefulness of basing survival analyses on preradiotherapy MRI (PRMR) rather than on postoperative MRI (POMR). PATIENTS AND METHODS A retrospective review was undertaken of 75 patients with glioblastoma treated at our institute. We collected overall survival and MRI volumetric data. We analyzed two types of volumetric data: residual tumor volume and extent of resection. Overall survival rates were compared according to these two types of volumetric data, calculated on either POMR or PRMR and according to the presence or absence of residual enhancement. RESULTS Analysis of volumetric data revealed progression of some residual tumors between POMR and PRMR. Kaplan-Meier analysis of the correlations between extent of resection, residual tumor volume, and overall survival revealed significant differences between POMR and PRMR data. Both MRI scans indicated a difference between the complete resection subgroup and the incomplete resection subgroup, as median overall survival was longer in patients with complete resection. However, differences were significant for PRMR (25.3 vs. 15.5, p = 0.012), but not for POMR (21.3 vs. 15.8 months, p = 0.145). With a residual tumor volume cut-off value of 3 cm3, Kaplan-Meier survival analysis revealed non-significant differences on POMR (p = 0.323) compared with PRMR (p = 0.007). CONCLUSION Survival in patients with resected glioblastoma was more accurately predicted by volumetric data acquired with PRMR. Differences in predicted survival between the POMR and PRMR groups can be attributed to changes in tumor behavior before adjuvant therapy.
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Affiliation(s)
- Amaury De Barros
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.
| | - Justine Attal
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Margaux Roques
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Julien Nicolau
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France
| | - Jean-Christophe Sol
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France
| | - Saloua Charni
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France
| | - Elizabeth Cohen-Jonathan-Moyal
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France; INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - Franck-Emmanuel Roux
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France
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20
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5-Aminolevulinic Acid Hydrochloride (5-ALA)-Guided Surgical Resection of High-Grade Gliomas: A Health Technology Assessment. ONTARIO HEALTH TECHNOLOGY ASSESSMENT SERIES 2020; 20:1-92. [PMID: 32194883 PMCID: PMC7077938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND High-grade gliomas are a type of malignant brain tumour. Optimal management often includes maximal surgical resection. 5-aminolevulinic acid hydrochloride (5-ALA) is an imaging agent that makes a high-grade glioma fluoresce under blue light, which can help guide the surgeon when removing the tumour. We conducted a health technology assessment of 5-ALA-guided surgical resection of high-grade gliomas, which included an evaluation of effectiveness, safety, the budget impact of publicly funding 5-ALA, and patient preferences and values. METHODS We performed a systematic literature search of the clinical evidence to retrieve systematic reviews, and selected and reported results from one review that was recent, of high quality, and relevant to our research question. We complemented the identified systematic review with a literature search to identify randomized controlled trials published after the review. We reported the risk of bias of each included study and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also performed a systematic economic literature search to identify economic studies that compared 5-ALA-guided surgical resection of high-grade gliomas with standard surgical care or other intraoperative imaging modalities. We did not conduct a primary economic evaluation due to lack of high-quality published clinical evidence evaluating 5-ALA-guided surgical resection. From the perspective of the Ontario Ministry of Health, we analyzed the 5-year budget impact of publicly funding 5-ALA-guided surgical resection for adults with newly diagnosed, primary, high-grade gliomas for which resection is considered feasible. To contextualize the potential value of 5-ALA, we spoke with someone who had experience with high-grade glioma, 5-ALA-guided resection, and standard surgical treatment. RESULTS We included one systematic review reporting on a single randomized controlled trial in the clinical evidence review. 5-ALA increased the proportion of patients achieving complete tumour resection compared with standard care (relative risk of incomplete resection 0.55, 95% confidence interval 0.42-0.71; GRADE: Low). Evidence was uncertain for an effect on overall survival with 5-ALA (hazard ratio for death 0.82, 95% confidence interval 0.62-1.07; GRADE: Low), but there may be an improvement in 6-month progression-free survival (GRADE: Very low). Adverse events between groups was insufficiently reported, but appeared similar between groups for overall and neurological adverse events, with an observed increase in neurological deficits 48 hours after surgery with 5-ALA (GRADE: Very low). The economic literature search identified five studies that met our inclusion criteria because they evaluated the cost-effectiveness of 5-ALA-guided surgical resection as compared with surgery with a standard operating microscope under white light ("white-light microscopy"). Most of these studies found 5-ALA-guided surgical resection was cost-effective compared to white-light microscopy for high-grade gliomas. However, all studies derived clinical model inputs of the comparative safety and effectiveness parameters of 5-ALA from limited and low-quality evidence. Public funding of 5-ALA-guided surgical resection in Ontario over the next 5 years would result in a budget impact of about $930,000 in year 1 to about $1,765,000 in year 5, yielding a total budget impact of about $7,500,000 over this period. The one participant we interviewed had experience with high-grade glioma, standard surgical treatment, and 5-ALA-guided resection. The participant felt that 5-ALA-guided resection resulted in accurate tumour removal and also found it reassuring that 5-ALA could help the surgeon better visualize the tumour. CONCLUSIONS 5-ALA-guided surgical resection appears to improve the extent of resection of high-grade gliomas compared with surgery using standard white-light microscopy (GRADE: Low). The evidence suggests 5-ALA-guided resection may improve overall survival; however, we cannot exclude the possibility of no effect (Grade: Low). 5-ALA may improve 6-month progression-free survival, although the results are highly uncertain (GRADE: Very low). There is an uncertain impact on overall or neurological adverse events (GRADE: Very low). We did not identify any economic studies conducted from the perspective of the Ontario or Canadian public health care payer. Of the studies that met our inclusion criteria, most found 5-ALA-guided surgical resection was cost-effective compared to white-light microscopy for high-grade gliomas. However, clinical model inputs for the comparative effectiveness and safety of 5-ALA were based on limited and low-quality evidence. We estimate that publicly funding 5-ALA-guided surgical resection in Ontario over the next 5 years would result in a total 5-year budget impact of about $7,500,000. For people diagnosed with high-grade gliomas, 5-ALA is seen positively as a useful imaging tool for brain tumour resection.
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Abstract
This is a review of relevant Raman spectroscopy (RS) techniques and their use in structural biology, biophysics, cells, and tissues imaging towards development of various medical diagnostic tools, drug design, and other medical applications. Classical and contemporary structural studies of different water-soluble and membrane proteins, DNA, RNA, and their interactions and behavior in different systems were analyzed in terms of applicability of RS techniques and their complementarity to other corresponding methods. We show that RS is a powerful method that links the fundamental structural biology and its medical applications in cancer, cardiovascular, neurodegenerative, atherosclerotic, and other diseases. In particular, the key roles of RS in modern technologies of structure-based drug design are the detection and imaging of membrane protein microcrystals with the help of coherent anti-Stokes Raman scattering (CARS), which would help to further the development of protein structural crystallography and would result in a number of novel high-resolution structures of membrane proteins—drug targets; and, structural studies of photoactive membrane proteins (rhodopsins, photoreceptors, etc.) for the development of new optogenetic tools. Physical background and biomedical applications of spontaneous, stimulated, resonant, and surface- and tip-enhanced RS are also discussed. All of these techniques have been extensively developed during recent several decades. A number of interesting applications of CARS, resonant, and surface-enhanced Raman spectroscopy methods are also discussed.
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22
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Genina EA, Bashkatov AN, Tuchina DK, Dyachenko (Timoshina) PA, Navolokin N, Shirokov A, Khorovodov A, Terskov A, Klimova M, Mamedova A, Blokhina I, Agranovich I, Zinchenko E, Semyachkina-Glushkovskaya OV, Tuchin VV. Optical properties of brain tissues at the different stages of glioma development in rats: pilot study. BIOMEDICAL OPTICS EXPRESS 2019; 10:5182-5197. [PMID: 31646040 PMCID: PMC6788608 DOI: 10.1364/boe.10.005182] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 05/03/2023]
Abstract
In this paper, measurements of the optical properties (diffuse reflectance, total and collimated transmittance) of brain tissues in healthy rats and rats with C6-glioma were performed in the spectral range from 350 to 1800 nm. Using these measurements, characteristic tissue optical parameters, such as absorption coefficient, scattering coefficient, reduced scattering coefficient, and scattering anisotropy factor were reconstructed. It was obtained that the 10-day development of glioma led to increase of absorption coefficient, which was associated with the water content elevation in the tumor. However, further development of the tumor (formation of the necrotic core) led to decrease in the water content. The dependence of the scattering properties on the different stages of model glioma development was more complex. Light penetration depth into the healthy and tumor brain was evaluated.
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Affiliation(s)
- Elina A. Genina
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
- Tomsk State University, 36 Lenin Avenue, Tomsk 634050, Russia
| | - Alexey N. Bashkatov
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
- Tomsk State University, 36 Lenin Avenue, Tomsk 634050, Russia
| | - Daria K. Tuchina
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
- Tomsk State University, 36 Lenin Avenue, Tomsk 634050, Russia
- Prokhorov General Physics Institute of the Russian Academy of Sciences, 38 Vavilova str., Moscow 119991, Russia
| | - Polina A. Dyachenko (Timoshina)
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
- Tomsk State University, 36 Lenin Avenue, Tomsk 634050, Russia
| | - Nikita Navolokin
- Saratov State Medical University, 112, B. Kazachya str., Saratov 410012, Russia
| | - Alexander Shirokov
- Institute of Biochemistry and Physiology of Plants and Microorganisms, Russian Academy of Sciences, IBPPM RAS, 13 Prospekt Entuziastov, Saratov 410049, Russia
| | | | - Andrey Terskov
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
| | - Maria Klimova
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
| | - Aysel Mamedova
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
| | - Inna Blokhina
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
| | - Ilana Agranovich
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
| | | | | | - Valery V. Tuchin
- Saratov State University, 83 Astrakhanskaya Str., Saratov 410012, Russia
- Tomsk State University, 36 Lenin Avenue, Tomsk 634050, Russia
- Institute of Precision Mechanics and Control of the Russian Academy of Sciences, 24, Rabochaya Str., Saratov 410028, Russia
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23
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Lichtenegger A, Gesperger J, Kiesel B, Muck M, Eugui P, Harper DJ, Salas M, Augustin M, Merkle CW, Hitzenberger CK, Widhalm G, Woehrer A, Baumann B. Revealing brain pathologies with multimodal visible light optical coherence microscopy and fluorescence imaging. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-11. [PMID: 31240898 PMCID: PMC6977170 DOI: 10.1117/1.jbo.24.6.066010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 06/07/2019] [Indexed: 05/28/2023]
Abstract
We present a multimodal visible light optical coherence microscopy (OCM) and fluorescence imaging (FI) setup. Specification and phantom measurements were performed to characterize the system. Two applications in neuroimaging were investigated. First, curcumin-stained brain slices of a mouse model of Alzheimer's disease were examined. Amyloid-beta plaques were identified based on the fluorescence of curcumin, and coregistered morphological images of the brain tissue were provided by the OCM channel. Second, human brain tumor biopsies retrieved intraoperatively were imaged prior to conventional neuropathologic work-up. OCM revealed the three-dimensional structure of the brain parenchyma, and FI added the tumor tissue-specific contrast. Attenuation coefficients computed from the OCM data and the florescence intensity values were analyzed and showed a statistically significant difference for 5-aminolevulinic acid (5-ALA)-positive and -negative brain tissues. OCM findings correlated well with malignant hot spots within brain tumor biopsies upon histopathology. The combination of OCM and FI seems to be a promising optical imaging modality providing complementary contrast for applications in the field of neuroimaging.
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Affiliation(s)
- Antonia Lichtenegger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Johanna Gesperger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- General Hospital and Medical University of Vienna, Institute of Neurology, Vienna, Austria
| | - Barbara Kiesel
- General Hospital and Medical University of Vienna, Univ. Klinik Neurochirurgie, Vienna, Austria
| | - Martina Muck
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
- General Hospital and Medical University of Vienna, Institute of Neurology, Vienna, Austria
| | - Pablo Eugui
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Danielle J. Harper
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Matthias Salas
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Marco Augustin
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Conrad W. Merkle
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Christoph K. Hitzenberger
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
| | - Georg Widhalm
- General Hospital and Medical University of Vienna, Univ. Klinik Neurochirurgie, Vienna, Austria
| | - Adelheid Woehrer
- General Hospital and Medical University of Vienna, Institute of Neurology, Vienna, Austria
| | - Bernhard Baumann
- Medical University of Vienna, Center for Medical Physics and Biomedical Engineering, Vienna, Austria
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Zhu M, Chang W, Jing L, Fan Y, Liang P, Zhang X, Wang G, Liao H. Dual-modality optical diagnosis for precise in vivo identification of tumors in neurosurgery. Am J Cancer Res 2019; 9:2827-2842. [PMID: 31244926 PMCID: PMC6568186 DOI: 10.7150/thno.33823] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 03/09/2019] [Indexed: 12/13/2022] Open
Abstract
In neurosurgery, the precise diagnosis and treatment of tumor diseases are challenging to realize. Current clinical diagnoses lack fast and accurate intraoperative information. Therefore, the development of new methods and techniques to assist neurosurgeons intraoperatively is necessary. Optical diagnosis is a promising method to provide accurate information about biological tissues in a short time. Therefore, in this study, we proposed a dual-modality optical diagnostic method through point-to-face registration fusion in the optical system. We incorporated quantitative autofluorescence spectroscopy and optical coherence tomography (OCT) and evaluated our methods in an animal model. Methods: A mouse model consisting of 16 nude mice was built by injecting the mouse brains with human glioma cells. Preoperative bioluminescence imaging was used to evaluate the growth states of tumors and locate the tumor sites. Quantitative autofluorescence spectroscopy, which provided local biochemical information with single-point detection, and OCT, which provided relatively global structural information with en face mapping scanning, were combined using the point-to-face registration fusion method to provide precise diagnostic information for identifying the brain tumors. Postoperative pathology was performed to evaluate the sensitivity and specificity of optical diagnosis. Results: Ex vivo quantitative autofluorescence spectroscopy and OCT imaging were first performed in eight mice to acquire the optimal measuring parameters for tumor staging and identification. We then performed in vivo quantitative autofluorescence spectroscopy and OCT imaging. The results showed that tumor staging could be realized through quantitative autofluorescence spectroscopy, and fusion images could be used to precisely identify tumors. The autofluorescence spectral map, OCT en face map, and fused diagnostic map had average sensitivities of 91.7%, 86.1%, and 95.9% and specificities of 93.2%, 96.0%, and 88.7%, respectively, for tumor identification. Conclusion: The dual-modality optical point-to-face registration fusion method and system we proposed could provide both biochemical information and structural information. The in vivo experimental results validated that the sensitivity (95.9%) of the fused map was higher than that of either single diagnostic modality (86.1% or 91.7%). Tumor staging was realized through quantitative autofluorescence spectroscopy. The proposed method will be applicable to future intelligent theranostic systems and improve many clinical neurosurgeries.
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Gavdush AA, Chernomyrdin NV, Malakhov KM, Beshplav SIT, Dolganova IN, Kosyrkova AV, Nikitin PV, Musina GR, Katyba GM, Reshetov IV, Cherkasova OP, Komandin GA, Karasik VE, Potapov AA, Tuchin VV, Zaytsev KI. Terahertz spectroscopy of gelatin-embedded human brain gliomas of different grades: a road toward intraoperative THz diagnosis. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-5. [PMID: 30729762 PMCID: PMC6988181 DOI: 10.1117/1.jbo.24.2.027001] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/11/2019] [Indexed: 05/18/2023]
Abstract
We applied terahertz (THz)-pulsed spectroscopy to study ex vivo the refractive index and absorption coefficient of human brain gliomas featuring different grades, as well as perifocal regions containing both intact and edematous tissues. Glioma samples from 26 patients were considered and analyzed according to further histological examination. In order to fix tissues for the THz measurements, we applied gelatin embedding, which allows for sustaining their THz response unaltered, as compared to that of the freshly excised tissues. We observed a statistical difference between the THz optical constants of intact tissues and gliomas of grades I to IV, while the response of edema was similar to that of tumor. The results of this paper justify a potential of THz technology in the intraoperative label-free diagnosis of human brain gliomas for ensuring the gross-total resection.
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Affiliation(s)
- Arseniy A. Gavdush
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | - Nikita V. Chernomyrdin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | - Kirill M. Malakhov
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | | | - Irina N. Dolganova
- Bauman Moscow State Technical University, Moscow, Russia
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | | | | | - Guzel R. Musina
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
| | - Gleb M. Katyba
- Bauman Moscow State Technical University, Moscow, Russia
- Institute of Solid State Physics of the Russian Academy of Sciences, Chernogolovka, Russia
| | - Igor V. Reshetov
- Sechenov First Moscow State Medical University, Institute of Regenerative Medicine, Moscow, Russia
| | - Olga P. Cherkasova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Institute of Laser Physics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
| | - Gennady A. Komandin
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
| | | | | | | | - Kirill I. Zaytsev
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Moscow, Russia
- Bauman Moscow State Technical University, Moscow, Russia
- Address all correspondence to Kirill I. Zaytsev, E-mail:
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26
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Huang LC, Chang YC, Wu YS, Sun WL, Liu CC, Sze CI, Chen SY. Glioblastoma cells labeled by robust Raman tags for enhancing imaging contrast. BIOMEDICAL OPTICS EXPRESS 2018; 9:2142-2153. [PMID: 29760976 PMCID: PMC5946777 DOI: 10.1364/boe.9.002142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/27/2018] [Accepted: 03/29/2018] [Indexed: 05/16/2023]
Abstract
Complete removal of a glioblastoma multiforme (GBM), a highly malignant brain tumor, is challenging due to its infiltrative characteristics. Therefore, utilizing imaging agents such as fluorophores to increase the contrast between GBM and normal cells can help neurosurgeons to locate residual cancer cells during image guided surgery. In this work, Raman tag based labeling and imaging for GBM cells in vitro is described and evaluated. The cell membrane of a GBM adsorbs a substantial amount of functionalized Raman tags through overexpression of the epidermal growth factor receptor (EGFR) and "broadcasts" stronger pre-defined Raman signals than normal cells. The average ratio between Raman signals from a GBM cell and autofluorescence from a normal cell can be up to 15. In addition, the intensity of these images is stable under laser illuminations without suffering from the severe photo-bleaching that usually occurs in fluorescent imaging. Our results show that labeling and imaging GBM cells via robust Raman tags is a viable alternative method to distinguish them from normal cells. This Raman tag based method can be used solely or integrated into an existing fluorescence system to improve the identification of infiltrative glial tumor cells around the boundary, which will further reduce GBM recurrence. In addition, it can also be applied/extended to other types of cancer to improve the effectiveness of image guided surgery.
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Affiliation(s)
- Li-Ching Huang
- Department of Photonics, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Yung-Ching Chang
- Department of Photonics, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Yi-Syuan Wu
- Departmet of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Wei-Lun Sun
- Department of Photonics, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Chan-Chuan Liu
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Chun-I Sze
- Departmet of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, 70101, Taiwan
| | - Shiuan-Yeh Chen
- Department of Photonics, National Cheng Kung University, Tainan, 70101, Taiwan
- Advanced Optoelectronic Technology Center, National Cheng Kung University, Tainan, 70101, Taiwan
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27
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Fan Y, Xia Y, Zhang X, Sun Y, Tang J, Zhang L, Liao H. Optical coherence tomography for precision brain imaging, neurosurgical guidance and minimally invasive theranostics. Biosci Trends 2018; 12:12-23. [PMID: 29332928 DOI: 10.5582/bst.2017.01258] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This review focuses on optical coherence tomography (OCT)-based neurosurgical application for imaging and treatment of brain tumors. OCT has emerged as one of the most innovative and successful translational biomedical-diagnostic techniques. It is a useful imaging tool for noninvasive, in vivo, in situ and real-time imaging in soft biological tissues, such as brain tumor imaging. OCT can detect the structure of biological tissue in a micrometer scale, and functional OCT has some clinical researches and applications, such as nerve fiber tracts and neurovascular imaging. OCT is able to identify tumor margins, and it gives intraoperative precision identification and resection guidance. OCT-based theranostics is introduced into preclinical neurosurgical resection, such as the integration of OCT and laser ablation. We discuss the challenges and opportunities of OCT-based system in the field of combination of intraoperative structural and functional imaging, neurosurgical guidance and minimally invasive theranostics. We point out that OCT and laser ablation-based theranostics can give more precision and intelligence for intraoperative diagnosis and therapeutics in clinical applications. The theranostics can precisely locate, or specifically target cancerous tissues, and then as much as possiblly eliminate them.
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Affiliation(s)
- Yingwei Fan
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
| | - Yan Xia
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
| | - Yu Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University
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