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Youssef G, Rahman R, Bay C, Wang W, Lim-Fat MJ, Arnaout O, Bi WL, Cagney DN, Chang YS, Cloughesy TF, DeSalvo M, Ellingson BM, Flood TF, Gerstner ER, Gonzalez Castro LN, Guenette JP, Kim AE, Lee EQ, McFaline-Figueroa JR, Potter CA, Reardon DA, Huang RY, Wen PY. Evaluation of Standard Response Assessment in Neuro-Oncology, Modified Response Assessment in Neuro-Oncology, and Immunotherapy Response Assessment in Neuro-Oncology in Newly Diagnosed and Recurrent Glioblastoma. J Clin Oncol 2023; 41:3160-3171. [PMID: 37027809 DOI: 10.1200/jco.22.01579] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/13/2023] [Accepted: 03/06/2023] [Indexed: 04/09/2023] Open
Abstract
PURPOSE The Response Assessment in Neuro-Oncology (RANO) criteria are widely used in high-grade glioma clinical trials. We compared the RANO criteria with updated modifications (modified RANO [mRANO] and immunotherapy RANO [iRANO] criteria) in patients with newly diagnosed glioblastoma (nGBM) and recurrent GBM (rGBM) to evaluate the performance of each set of criteria and inform the development of the planned RANO 2.0 update. MATERIALS AND METHODS Evaluation of tumor measurements and fluid-attenuated inversion recovery (FLAIR) sequences were performed by blinded readers to determine disease progression using RANO, mRANO, iRANO, and other response assessment criteria. Spearman's correlations between progression-free survival (PFS) and overall survival (OS) were calculated. RESULTS Five hundred twenty-six nGBM and 580 rGBM cases were included. Spearman's correlations were similar between RANO and mRANO (0.69 [95% CI, 0.62 to 0.75] v 0.67 [95% CI, 0.60 to 0.73]) in nGBM and rGBM (0.48 [95% CI, 0.40 to 0.55] v 0.50 [95% CI, 0.42 to 0.57]). In nGBM, requirement of a confirmation scan within 12 weeks of completion of radiotherapy to determine progression was associated with improved correlations. Use of the postradiation magnetic resonance imaging (MRI) as baseline scan was associated with improved correlation compared with use of the pre-radiation MRI (0.67 [95% CI, 0.60 to 0.73] v 0.53 [95% CI, 0.42 to 0.62]). Evaluation of FLAIR sequences did not improve the correlation. Among patients who received immunotherapy, Spearman's correlations were similar among RANO, mRANO, and iRANO. CONCLUSION RANO and mRANO demonstrated similar correlations between PFS and OS. Confirmation scans were only beneficial in nGBM within 12 weeks of completion of radiotherapy, and there was a trend in favor of the use of postradiation MRI as the baseline scan in nGBM. Evaluation of FLAIR can be omitted. The iRANO criteria did not add significant benefit in patients who received immune checkpoint inhibitors.
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Affiliation(s)
- Gilbert Youssef
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Rifaquat Rahman
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA
| | - Camden Bay
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Wei Wang
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
- Division of Sleep Medicine, Harvard Medical School, Boston, MA
| | - Mary Jane Lim-Fat
- Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Omar Arnaout
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA
| | - Daniel N Cagney
- Radiotherapy Department, Mater Private Network, Dublin, Ireland
| | - Yuh-Shin Chang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Radiology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, University of California Los Angeles, Los Angeles, CA
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Matthew DeSalvo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, CA
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Thomas F Flood
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - L Nicolas Gonzalez Castro
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA
| | - Jeffrey P Guenette
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Albert E Kim
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | - Christopher A Potter
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA
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Negroni D, Bono R, Soligo E, Longo V, Cossandi C, Carriero A, Stecco A. T1-Weighted Contrast Enhancement, Apparent Diffusion Coefficient, and Cerebral-Blood-Volume Changes after Glioblastoma Resection: MRI within 48 Hours vs. beyond 48 Hours. Tomography 2023; 9:342-351. [PMID: 36828379 PMCID: PMC9967426 DOI: 10.3390/tomography9010027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/27/2023] [Accepted: 01/28/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of the study is to identify the advantages, if any, of post-operative MRIs performed at 48 h compared to MRIs performed after 48 h in glioblastoma surgery. MATERIALS AND METHODS To assess the presence of a residual tumor, the T1-weighted Contrast Enhancement (CE), Apparent Diffusion Coefficient (ADC), and Cerebral Blood Volume (rCBV) in the proximity of the surgical cavity were considered. The rCBV ratio was calculated by comparing the rCBV with the contralateral normal white matter. After the blind image examinations by the two radiologists, the patients were divided into two groups according to time window after surgery: ≤48 h (group 1) and >48 h (group 2). RESULTS A total of 145 patients were enrolled; at the 6-month follow-up MRI, disease recurrence was 89.9% (125/139), with a mean patient survival of 8.5 months (SD 7.8). The mean ADC and rCBV ratio values presented statistical differences between the two groups (p < 0.05). Of these 40 patients in whom an ADC value was not obtained, the rCBV values could not be calculated in 52.5% (21/40) due to artifacts (p < 0.05). CONCLUSION The study showed differences in CE, rCBV, and ADC values between the groups of patients undergoing MRIs before and after 48 h. An MRI performed within 48 h may increase the ability of detecting GBM by the perfusion technique with the calculation of the rCBV ratio.
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Affiliation(s)
- Davide Negroni
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
- Correspondence:
| | - Romina Bono
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Eleonora Soligo
- Radiology Department, San Andrea Hospital of Vercelli, 13100 Vercelli, Italy
| | - Vittorio Longo
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Christian Cossandi
- Neurosurgery Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Alessandro Carriero
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
| | - Alessandro Stecco
- Radiology Department, Maggiore della Carità Hospital of Novara, 28100 Novara, Italy
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Bernstock JD, Gary SE, Klinger N, Valdes PA, Ibn Essayed W, Olsen HE, Chagoya G, Elsayed G, Yamashita D, Schuss P, Gessler FA, Peruzzi PP, Bag A, Friedman GK. Standard clinical approaches and emerging modalities for glioblastoma imaging. Neurooncol Adv 2022; 4:vdac080. [PMID: 35821676 PMCID: PMC9268747 DOI: 10.1093/noajnl/vdac080] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Glioblastoma (GBM) is the most common primary adult intracranial malignancy and carries a dismal prognosis despite an aggressive multimodal treatment regimen that consists of surgical resection, radiation, and adjuvant chemotherapy. Radiographic evaluation, largely informed by magnetic resonance imaging (MRI), is a critical component of initial diagnosis, surgical planning, and post-treatment monitoring. However, conventional MRI does not provide information regarding tumor microvasculature, necrosis, or neoangiogenesis. In addition, traditional MRI imaging can be further confounded by treatment-related effects such as pseudoprogression, radiation necrosis, and/or pseudoresponse(s) that preclude clinicians from making fully informed decisions when structuring a therapeutic approach. A myriad of novel imaging modalities have been developed to address these deficits. Herein, we provide a clinically oriented review of standard techniques for imaging GBM and highlight emerging technologies utilized in disease characterization and therapeutic development.
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Affiliation(s)
- Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Sam E Gary
- Medical Scientist Training Program, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Neil Klinger
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Pablo A Valdes
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Walid Ibn Essayed
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Hannah E Olsen
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Daisuke Yamashita
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
| | - Patrick Schuss
- Department of Neurosurgery, Unfallkrankenhaus Berlin , Berlin, Germany
| | | | - Pier Paolo Peruzzi
- Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School , Boston, Massachusetts, USA
| | - Asim Bag
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital , Memphis, TN USA
| | - Gregory K Friedman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham , AL, USA
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham , Birmingham, AL, USA
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham , AL, USA
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Ille S, Schoen S, Wiestler B, Meyer B, Krieg SM. Subcortical motor ischemia can be detected by intraoperative MRI within 1 h – A feasibility study. BRAIN AND SPINE 2022; 2:100862. [PMID: 36248167 PMCID: PMC9560708 DOI: 10.1016/j.bas.2022.100862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/07/2022] [Accepted: 01/16/2022] [Indexed: 10/26/2022]
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Rykkje AM, Li D, Skjøth-Rasmussen J, Larsen VA, Nielsen MB, Hansen AE, Carlsen JF. Surgically Induced Contrast Enhancements on Intraoperative and Early Postoperative MRI Following High-Grade Glioma Surgery: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11081344. [PMID: 34441279 PMCID: PMC8392564 DOI: 10.3390/diagnostics11081344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
For the radiological assessment of resection of high-grade gliomas, a 72-h diagnostic window is recommended to limit surgically induced contrast enhancements. However, such enhancements may occur earlier than 72 h post-surgery. This systematic review aimed to assess the evidence on the timing of the postsurgical MRI. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles describing surgically induced contrast enhancements on MRI after resection for high-grade gliomas were included and analysed. The frequency of different contrast enhancement patterns on intraoperative MRI (iMRI) and early postoperative MRI (epMRI) was recorded. The search resulted in 1443 studies after removing duplicates, and a total of 12 studies were chosen for final review. Surgically induced contrast enhancements were reported at all time points after surgery, including on iMRI, but their type and frequency vary. Thin linear contrast enhancements were commonly found to be surgically induced and were less frequently recorded on postoperative days 1 and 2. This suggests that the optimal time to scan may be at or before this time. However, the evidence is limited, and higher-quality studies using larger and consecutively sampled populations are needed.
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Affiliation(s)
- Alexander Malcolm Rykkje
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Dana Li
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Vibeke Andrée Larsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jonathan Frederik Carlsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
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Miskin N, Unadkat P, Carlton ME, Golby AJ, Young GS, Huang RY. Frequency and Evolution of New Postoperative Enhancement on 3 Tesla Intraoperative and Early Postoperative Magnetic Resonance Imaging. Neurosurgery 2020; 87:238-246. [PMID: 31584071 DOI: 10.1093/neuros/nyz398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (IO-MRI) provides real-time assessment of extent of resection of brain tumor. Development of new enhancement during IO-MRI can confound interpretation of residual enhancing tumor, although the incidence of this finding is unknown. OBJECTIVE To determine the frequency of new enhancement during brain tumor resection on intraoperative 3 Tesla (3T) MRI. To optimize the postoperative imaging window after brain tumor resection using 1.5 and 3T MRI. METHODS We retrospectively evaluated 64 IO-MRI performed for patients with enhancing brain lesions referred for biopsy or resection as well as a subset with an early postoperative MRI (EP-MRI) within 72 h of surgery (N = 42), and a subset with a late postoperative MRI (LP-MRI) performed between 120 h and 8 wk postsurgery (N = 34). Three radiologists assessed for new enhancement on IO-MRI, and change in enhancement on available EP-MRI and LP-MRI. Consensus was determined by majority response. Inter-rater agreement was assessed using percentage agreement. RESULTS A total of 10 out of 64 (16%) of the IO-MRI demonstrated new enhancement. Seven of 10 patients with available EP-MRI demonstrated decreased/resolved enhancement. One out of 42 (2%) of the EP-MRI demonstrated new enhancement, which decreased on LP-MRI. Agreement was 74% for the assessment of new enhancement on IO-MRI and 81% for the assessment of new enhancement on the EP-MRI. CONCLUSION New enhancement occurs in intraoperative 3T MRI in 16% of patients after brain tumor resection, which decreases or resolves on subsequent MRI within 72 h of surgery. Our findings indicate the opportunity for further study to optimize the postoperative imaging window.
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Affiliation(s)
- Nityanand Miskin
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Prashin Unadkat
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.,Department of Neurosurgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.,Department of Surgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Michael E Carlton
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Alexandra J Golby
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts.,Department of Neurosurgery, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Geoffrey S Young
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Medical School, Harvard University, Boston, Massachusetts
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Palpan Flores A, Vivancos Sanchez C, Roda JM, Cerdán S, Barrios AJ, Utrilla C, Royo A, Gandía González ML. Assessment of Pre-operative Measurements of Tumor Size by MRI Methods as Survival Predictors in Wild Type IDH Glioblastoma. Front Oncol 2020; 10:1662. [PMID: 32984040 PMCID: PMC7492614 DOI: 10.3389/fonc.2020.01662] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/28/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: We evaluate the performance of three MRI methods to determine non-invasively tumor size, as overall survival (OS) and Progression Free Survival (PFS) predictors, in a cohort of wild type, IDH negative, glioblastoma patients. Investigated protocols included bidimensional (2D) diameter measurements, and three-dimensional (3D) estimations by the ellipsoid or semi-automatic segmentation methods. Methods: We investigated OS in a cohort of 44 patients diagnosed with wild type IDH glioblastoma (58.2 ± 11.4 years, 1.9/1 male/female) treated with neurosurgical resection followed by adjuvant chemo and radiotherapy. Pre-operative MRI images were evaluated to determine tumor mass area and volume, gadolinium enhancement volume, necrosis volume, and FLAIR-T2 hyper-intensity area and volume. We implemented then multivariate Cox statistical analysis to select optimal predictors for OS and PFS. Results: Median OS was 16 months (1–42 months), ranging from 9 ± 2.4 months in patients over 65 years, to 18 ± 1.6 months in younger ones. Patients with tumors carrying O6-methylguanin-DNA-methyltransferase (MGMT) methylation survived 30 ± 5.2 vs. 13 ± 2.5 months in non-methylated. Our study evidenced high and positive correlations among the results of the three methods to determine tumor size. FLAIR-T2 hyper-intensity areas (2D) and volumes (3D) were also similar as determined by the three methods. Cox proportional hazards analysis with the 2D and 3D methods indicated that OS was associated to age ≥ 65 years (HR 2.70, 2.94, and 3.16), MGMT methylation (HR 2.98, 3.07, and 2.90), and FLAIR-T2 ≥ 2,000 mm2 or ≥60 cm3 (HR 4.16, 3.93, and 3.72), respectively. Other variables including necrosis, tumor mass, necrosis/tumor ratio, and FLAIR/tumor ratio were not significantly correlated with OS. Conclusion: Our results reveal a high correlation among measurements of tumor size performed with the three methods. Pre-operative FLAIR-T2 hyperintensity area and volumes provided, independently of the measurement method, the optimal neuroimaging features predicting OS in primary glioblastoma patients, followed by age ≥ 65 years and MGMT methylation.
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Affiliation(s)
| | | | - José M Roda
- Department of Neurosurgery, University Hospital La Paz, Madrid, Spain
| | - Sebastian Cerdán
- Institute of Biomedical Research "Alberto Sols" CSIC/UAM, Madrid, Spain
| | | | - Cristina Utrilla
- Department of Neuroradiology, University Hospital La Paz, Madrid, Spain
| | - Aranzazu Royo
- Department of Neuroradiology, University Hospital La Paz, Madrid, Spain
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Ye Z, Price RL, Liu X, Lin J, Yang Q, Sun P, Wu AT, Wang L, Han RH, Song C, Yang R, Gary SE, Mao DD, Wallendorf M, Campian JL, Li JS, Dahiya S, Kim AH, Song SK. Diffusion Histology Imaging Combining Diffusion Basis Spectrum Imaging (DBSI) and Machine Learning Improves Detection and Classification of Glioblastoma Pathology. Clin Cancer Res 2020; 26:5388-5399. [PMID: 32694155 DOI: 10.1158/1078-0432.ccr-20-0736] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/01/2020] [Accepted: 07/15/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Glioblastoma (GBM) is one of the deadliest cancers with no cure. While conventional MRI has been widely adopted to examine GBM clinically, accurate neuroimaging assessment of tumor histopathology for improved diagnosis, surgical planning, and treatment evaluation remains an unmet need in the clinical management of GBMs. EXPERIMENTAL DESIGN We employ a novel diffusion histology imaging (DHI) approach, combining diffusion basis spectrum imaging (DBSI) and machine learning, to detect, differentiate, and quantify areas of high cellularity, tumor necrosis, and tumor infiltration in GBM. RESULTS Gadolinium-enhanced T1-weighted or hyperintense fluid-attenuated inversion recovery failed to reflect the morphologic complexity underlying tumor in patients with GBM. Contrary to the conventional wisdom that apparent diffusion coefficient (ADC) negatively correlates with increased tumor cellularity, we demonstrate disagreement between ADC and histologically confirmed tumor cellularity in GBM specimens, whereas DBSI-derived restricted isotropic diffusion fraction positively correlated with tumor cellularity in the same specimens. By incorporating DBSI metrics as classifiers for a supervised machine learning algorithm, we accurately predicted high tumor cellularity, tumor necrosis, and tumor infiltration with 87.5%, 89.0%, and 93.4% accuracy, respectively. CONCLUSIONS Our results suggest that DHI could serve as a favorable alternative to current neuroimaging techniques in guiding biopsy or surgery as well as monitoring therapeutic response in the treatment of GBM.
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Affiliation(s)
- Zezhong Ye
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard L Price
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Xiran Liu
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Joshua Lin
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Qingsong Yang
- Department of Radiology, Changhai Hospital, Yangpu District, Shanghai, China
| | - Peng Sun
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Anthony T Wu
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Liang Wang
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Rowland H Han
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Chunyu Song
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri
| | - Ruimeng Yang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China
| | - Sam E Gary
- Medical Scientist Training Program, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Diane D Mao
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Michael Wallendorf
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Jian L Campian
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Jr-Shin Li
- Department of Electrical & System Engineering, Washington University, St. Louis, Missouri
| | - Sonika Dahiya
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
| | - Albert H Kim
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri.
| | - Sheng-Kwei Song
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri
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9
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Golub D, Hyde J, Dogra S, Nicholson J, Kirkwood KA, Gohel P, Loftus S, Schwartz TH. Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis. J Neurosurg 2020; 134:484-498. [PMID: 32084631 DOI: 10.3171/2019.12.jns191203] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 12/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-grade gliomas (HGGs) continue to carry poor prognoses, and patient outcomes depend heavily on the extent of resection (EOR). The utility of conventional image-guided surgery is limited by intraoperative brain shift. More recent techniques to maximize EOR, including intraoperative imaging and the use of fluorescent dyes, combat these limitations. However, the relative efficacy of these two techniques has never been systematically compared. Thus, the authors performed an exhaustive systematic review in conjunction with quantitative network meta-analyses to evaluate the comparative effectiveness of 5-aminolevulinic acid (5-ALA) and intraoperative MRI (IMRI) in optimizing EOR in HGG. They secondarily analyzed associated progression-free and overall survival and performed subgroup analyses by level of evidence. METHODS PubMed, Embase, Cochrane Central, and Web of Science were searched for studies evaluating conventional neuronavigation, IMRI, and 5-ALA in HGG resection. The primary study endpoint was the proportion of patients attaining gross-total resection (GTR), defined as 100% elimination of contrast-enhancing lesion on postoperative MRI. Secondary endpoints included overall and progression-free survival and subgroup analyses for level of evidence. Comparative efficacy analysis of IMRI and 5-ALA was performed using Bayesian network meta-analysis models. RESULTS This analysis included 11 studies. In a classic meta-analysis, both IMRI (OR 4.99, 95% CI 2.65-9.39, p < 0.001) and 5-ALA (OR 2.866, 95% CI 2.127-3.863, p < 0.001) were superior to conventional navigation in achieving GTR. Bayesian network analysis was employed to indirectly compare IMRI to 5-ALA, and no significant difference in GTR was found between the two (OR 1.9 favoring IMRI, 95% CI 0.905-3.989, p = 0.090). A handful of studies additionally suggested that the use of either IMRI (2 and 4 studies, respectively) or 5-ALA (2 and 2 studies, respectively) improves progression-free and overall survival. CONCLUSIONS IMRI and 5-ALA are individually superior to conventional neuronavigation for achieving GTR of HGG. Between IMRI and 5-ALA, neither method is clearly more effective. Future studies evaluating the comparative cost and surgical time associated with IMRI and 5-ALA will better inform any cost-benefit analysis.
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Affiliation(s)
| | | | - Siddhant Dogra
- 2Radiology, New York University School of Medicine, New York, New York
| | - Joseph Nicholson
- 3NYU Health Sciences Library, New York University School of Medicine, New York, New York
| | - Katherine A Kirkwood
- 4Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Stephen Loftus
- 5Department of Science, Technology, Engineering and Math, Sweet Briar College, Sweet Briar, Virginia
| | - Theodore H Schwartz
- 6Departments of Neurosurgery, Otolaryngology, and Neuroscience, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York; and
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Masuda Y, Akutsu H, Ishikawa E, Matsuda M, Masumoto T, Hiyama T, Yamamoto T, Kohzuki H, Takano S, Matsumura A. Evaluation of the extent of resection and detection of ischemic lesions with intraoperative MRI in glioma surgery: is intraoperative MRI superior to early postoperative MRI? J Neurosurg 2019; 131:209-216. [PMID: 30095340 DOI: 10.3171/2018.3.jns172516] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE MRI scans obtained within 48-72 hours (early postoperative MRI [epMRI]), prior to any postoperative reactive changes, are recommended for the accurate assessment of the extent of resection (EOR) after glioma surgery. Diffusion-weighted imaging (DWI) enables ischemic lesions to be detected and distinguished from the residual tumor. Prior studies, however, revealed that postoperative reactive changes were often present, even in epMRI. Although intraoperative MRI (iMRI) is widely used to maximize safe resection during glioma surgery, it is unclear whether iMRI is superior to epMRI when evaluating the EOR, because it theoretically shows fewer postoperative reactive changes. In addition, the ability to detect ischemic lesions using iMRI has not been investigated. METHODS The authors retrospectively analyzed prospectively collected data in 30 patients with glioma (22 and 8 patients with enhancing and nonenhancing lesions, respectively) who underwent tumor resection. These patients had received preoperative MRI within 24 hours prior to surgery, postresection radiological evaluation with iMRI during surgery, and epMRI within 24 hours after surgery, with all neuroimaging performed using identical 1.5T MRI scanners. The authors compared iMRI or epMRI with preoperative MRI, and defined a postoperative reactive change as a new postoperative enhancement or T2 high-intensity area (HIA), if this lesion was outside of the preoperative original tumor location. In addition, postoperative ischemia was evaluated on DWI. The iMRI and epMRI findings were compared in terms of 1) postoperative reactive changes, 2) evaluation of the EOR, and 3) presence of ischemic lesion on DWI. RESULTS In patients with enhancing lesions, a new enhancement was seen in 8 of 22 patients (36.4%) on iMRI and in 12 of 22 patients (54.5%) on epMRI. In patients with nonenhancing lesions, a new T2 HIA was seen in 4 of 8 patients (50.0%) on iMRI and in 7 of 8 patients (87.5%) on epMRI. A discrepancy between the EOR measured on iMRI and epMRI was noted in 5 of the 22 patients (22.7%) with enhancing lesions, and in 3 of the 8 patients (37.5%) with nonenhancing lesions. The occurrence of ischemic lesions on DWI was found in 5 of 30 patients (16.7%) on iMRI, whereas it was found in 16 of 30 patients (53.3%) on epMRI (p = 0.003); ischemic lesions were underestimated on iMRI in 11 patients. CONCLUSIONS Overall, given the lower incidence of postoperative reactive changes on iMRI, it was superior to epMRI in evaluating the EOR in patients with glioma, both with enhancing and nonenhancing lesions. However, because ischemic lesions can be overlooked on iMRI, the authors recommend only the additional DWI scan during the early postoperative period. Clinicians need to be mindful about not overestimating the presence of residual tumor on epMRI due to the high incidence of postoperative reactive changes.
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Affiliation(s)
| | | | | | | | - Tomohiko Masumoto
- 2Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki; and
| | - Takashi Hiyama
- 2Radiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki; and
| | - Tetsuya Yamamoto
- Departments of1Neurosurgery and.,3Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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Post-operative complications of craniotomy and craniectomy. Emerg Radiol 2018; 26:99-107. [PMID: 30255407 DOI: 10.1007/s10140-018-1647-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022]
Abstract
Craniotomy and craniectomy are widely performed emergent neurosurgical procedures and are the prescribed treatment for a variety of conditions from trauma to cancer. It is vital for the emergency radiologist to be aware of expected neuroimaging findings in post-craniotomy and craniectomy patients in order to avoid false positives. It is just as necessary to be familiar with postsurgical complications in these patients to avoid delay in lifesaving treatment. This article will review the commonly encountered normal and abnormal findings in post-craniotomy and craniectomy patients. The expected postoperative CT and MRI appearance of these procedures are discussed, followed by complications. These include hemorrhage, tension pneumocephalus, wound/soft tissue infection, bone flap infection and extradural abscesses. Complications specifically related to craniectomies include extracranial herniation, external brain tamponade, paradoxical herniation, and trephine syndrome.
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Nakashima T, Hatano N, Kanamori F, Muraoka S, Kawabata T, Takasu S, Watanabe T, Kojima T, Nagatani T, Seki Y. Tumor Volume Decrease via Feeder Occlusion for Treating a Large, Firm Trigone Meningioma. NMC Case Rep J 2017; 5:9-14. [PMID: 29354332 PMCID: PMC5767480 DOI: 10.2176/nmccrj.cr.2017-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/28/2017] [Indexed: 12/18/2022] Open
Abstract
Trigone meningiomas are considered a surgical challenge, as they tend to be considerably large and hypervascularized at the time of presentation. We experienced a case of a large and very hard trigone meningioma that was effectively treated using initial microsurgical feeder occlusion followed by surgery in stages. A 19-year-old woman who presented with loss of consciousness was referred to our hospital for surgical treatment of a brain tumor. Radiological findings were compatible with a left ventricular trigone meningioma extending laterally in proximity to the Sylvian fissure. At initial surgery using the transsylvian approach, main feeders originating from the anterior and lateral posterior choroidal arteries were occluded at the inferior horn; however, only a small section of the tumor could initially be removed because of its firmness. Over time, feeder occlusion resulted in tumor necrosis and a 20% decrease in its diameter; the mass effect was alleviated within 1 year. The residual meningioma was then totally excised in staged surgical procedures after resection became more feasible owing to ischemia-induced partial softening of the tumor. When a trigone meningioma is large and very hard, initial microsurgical feeder occlusion in the inferior horn can be a safe and effective option, and can lead to necrosis, volume decrease, and partial softening of the residual tumor to allow for its staged surgical excision.
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Affiliation(s)
- Takuma Nakashima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norikazu Hatano
- Department of Stroke Medicine, Kawashima Hospital, Nagoya, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Shinsuke Muraoka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Teppei Kawabata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Syuntaro Takasu
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tadashi Watanabe
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takao Kojima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yukio Seki
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
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Abstract
The imaging of treated gliomas is complicated by a variety of treatment related effects, which can falsely simulate disease improvement or progression. Distinguishing between disease progression and treatment effects is difficult with standard MR imaging pulse sequences and added specificity can be gained by the addition of advanced imaging techniques.
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Affiliation(s)
- Mark F Dalesandro
- Department of Radiology, Harborview Medical Center, University of Washington, Box 357115, 1959 Northeast Pacific Street, NW011, Seattle, WA 98195-7115, USA
| | - Jalal B Andre
- Department of Radiology, Harborview Medical Center, University of Washington, Box 357115, 1959 Northeast Pacific Street, NW011, Seattle, WA 98195-7115, USA.
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Patterns and Time Dependence of Unspecific Enhancement in Postoperative Magnetic Resonance Imaging After Glioblastoma Resection. World Neurosurg 2016; 90:440-447. [PMID: 27001238 DOI: 10.1016/j.wneu.2016.03.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Postoperative magnetic resonance imaging (MRI) is recommended soon after glioma surgery to avoid reactive nonneoplastic contrast enhancement indistinguishable from tumor. The purpose of this study was to analyze these patterns of postoperative contrast enhancement at 3 T to define the optimal time frame for postoperative MRI. METHODS MRI for 206 glioblastoma surgeries in 173 patients who underwent pre- and postoperative and at least 1 follow-up 3T MRI for each surgery were analyzed retrospectively. Postoperative MRI was assessed in consensus by 2 neuroradiologists, blinded to the time after surgery. Postoperative contrast enhancement marginal to the resection cavity was analyzed and classified as vascular, linear, or nodular. The cause of the contrast enhancement (ie, reactive vs. tumor) was assessed by comparing pre-, postoperative, and follow-up MRI. RESULTS Within 45 hours after surgery, reactive enhancement appeared in 17.9% of cases. After 45 hours, the fraction of reactive changes increased to 34.1%. Linear enhancement was more often reactive (66.1%, 39/59 cases), whereas nodular enhancement was mainly residual tumor (93.2%, 68/73 cases). Specificity of nodular enhancement was high for tumor recurrence/tumor progression (91.5%). CONCLUSIONS To avoid an increasing number of MRIs with reactive contrast enhancement, postoperative MRI at 3 T should be performed within 45 hours after surgery. However, reactive contrast enhancement can occur at all time points. In these cases, the pattern of the contrast enhancement may help to differentiate its cause.
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Teixidor P, Arráez MÁ, Villalba G, Garcia R, Tardáguila M, González JJ, Rimbau J, Vidal X, Montané E. Safety and Efficacy of 5-Aminolevulinic Acid for High Grade Glioma in Usual Clinical Practice: A Prospective Cohort Study. PLoS One 2016; 11:e0149244. [PMID: 26885645 PMCID: PMC4757411 DOI: 10.1371/journal.pone.0149244] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/28/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND During the last decade, the use of 5-aminolevulinic acid (5-ALA) has been steadily increasing in neurosurgery. The study's main objectives were to prospectively evaluate the effectiveness and safety of 5-ALA when used in clinical practice setting on high-grade gliomas' patients. METHODS National, multicenter and prospective observational study. INCLUSION CRITERIA authorized conditions of use of 5-ALA. EXCLUSION CRITERIA contraindication to 5-ALA, inoperable or partial resected tumors, pregnancy and children. Epidemiological, clinical, laboratory, radiological, and safety data were collected. Effectiveness was assessed using complete resection of the tumor, and progression-free and overall survival probabilities. RESULTS Between May 2010 and September 2014, 85 patients treated with 5-ALA were included, and 77 were suitable for the effectiveness analysis. Complete resection was achieved in 41 patients (54%). Surgeons considered suboptimal the fluorescence of 5-ALA in 40% of the patients assessed. The median duration of follow-up was 12.3 months. The progression-free survival probability at 6 months was 58%. The median duration overall survival was 14.2 months. Progression tumor risk factors were grade of glioma, age and resection degree; and death risk factors were grade of glioma and gender. No severe adverse effects were reported. At one month after surgery, new or increased neurological morbidity was 6.5%. Hepatic enzymes were frequently increased within the first month after surgery; however, they subsequently normalized, and this was found to have no clinical significance. CONCLUSION In clinical practice, the 5-ALA showed a good safety profile, but the benefits related to 5-ALA have not been yet clearly shown. The improved differentiation expected by fluorescence between normal and tumor cerebral tissue was suboptimal in a relevant number of patients; in addition, the expected higher degree of resection was lower than in clinical trials as well as incomplete resection was not identified as a prognostic factor risk for death. Because optimal fluorescence was correlated to higher complete resection rate, further research is needed to identify patients (or tumors) with more surgery benefits when using the 5-ALA.
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Affiliation(s)
- Pilar Teixidor
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Glòria Villalba
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain
| | - Roser Garcia
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Manel Tardáguila
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan José González
- Department of Neurosurgery, Hospital Clínic I Provincial de Barcelona, Barcelona, Spain
| | - Jordi Rimbau
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xavier Vidal
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Montané
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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Nguyen HS, Doan N, Gelsomino M, Shabani S, Mueller W. Dilemmas surrounding the diagnosis of deep brain stimulation electrode infection without associated wound complications: A series of two cases. Surg Neurol Int 2016; 7:S121-4. [PMID: 26958428 PMCID: PMC4765243 DOI: 10.4103/2152-7806.176133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background: When wounds are benign, diagnosis of deep brain stimulation (DBS) electrode infection and associated intraparenchymal infection can be challenging. Only a couple, such cases exist in literature. Since infections of the central nervous system can be life-threatening, prompt diagnosis is necessary to prevent neurological injury. Employed within the appropriate context, magnetic resonance imaging (MRI) of the brain, as well as laboratory data and clinical presentation, may help guide diagnosis. Case Descriptions: Case 1 - A 55-year-old male with bilateral DBS electrodes and generators (49 days from last procedure), who presented with confusion and fever. Pertinent positive laboratory was white blood cell 20.5K. MRI of the brain showed edema with enhancement along the right DBS electrode. Wound exploration revealed gross purulence in the subgaleal space. The entire system was removed; cultures from subgaleal space revealed Propionibacterium acnes; cultures from electrode were negative. The patient was sent home on antibiotics. Case 2 - A 68-year-old male with a right DBS electrode (11 days from placement), who presented after an unwitnessed fall, followed by confusion and amnesia. Pertinent laboratory examinations were negative. MRI of the brain showed edema with enhancement along the DBS electrode. Wound exploration revealed no infection. The DBS system was left in place; final cultures were negative; no antibiotics were prescribed. Repeat MRI showed resolving fluid-attenuated inversion recovery (FLAIR) signal and contrast enhancement. Conclusions: Contrast enhancement, T2 FLAIR, and diffusion weighted imaging are influenced by postoperative changes. Caution is stressed regarding dependence on these features for acute diagnosis of infection and indication for electrode removal. Timing of the imaging after surgery must be considered. Other factors, such as systemic signs and abnormal laboratory data, should be evaluated. Based on these guidelines, retrospectively, the patient in Case 2 should not have been rushed for a wound exploration; close observation with serial imaging and laboratory data may have prevented an unnecessary procedure.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
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Lee EK, Choi SH, Yun TJ, Kang KM, Kim TM, Lee SH, Park CK, Park SH, Kim IH. Prediction of Response to Concurrent Chemoradiotherapy with Temozolomide in Glioblastoma: Application of Immediate Post-Operative Dynamic Susceptibility Contrast and Diffusion-Weighted MR Imaging. Korean J Radiol 2015; 16:1341-8. [PMID: 26576125 PMCID: PMC4644757 DOI: 10.3348/kjr.2015.16.6.1341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/22/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To determine whether histogram values of the normalized apparent diffusion coefficient (nADC) and normalized cerebral blood volume (nCBV) maps obtained in contrast-enhancing lesions detected on immediate post-operative MR imaging can be used to predict the patient response to concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ). Materials and Methods Twenty-four patients with GBM who had shown measurable contrast enhancement on immediate post-operative MR imaging and had subsequently undergone CCRT with TMZ were retrospectively analyzed. The corresponding histogram parameters of nCBV and nADC maps for measurable contrast-enhancing lesions were calculated. Patient groups with progression (n = 11) and non-progression (n = 13) at one year after the operation were identified, and the histogram parameters were compared between the two groups. Receiver operating characteristic (ROC) analysis was used to determine the best cutoff value for predicting progression. Progression-free survival (PFS) was determined with the Kaplan-Meier method and the log-rank test. Results The 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033). ROC analysis showed that the best cutoff value for predicting progression after CCRT was 5.537 (sensitivity and specificity were 72.7% and 76.9%, respectively). The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026). Conclusion The nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea. ; Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
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Yoo RE, Choi SH, Kim TM, Lee SH, Park CK, Park SH, Kim IH, Yun TJ, Kim JH, Sohn CH. Independent Poor Prognostic Factors for True Progression after Radiation Therapy and Concomitant Temozolomide in Patients with Glioblastoma: Subependymal Enhancement and Low ADC Value. AJNR Am J Neuroradiol 2015; 36:1846-52. [PMID: 26294653 DOI: 10.3174/ajnr.a4401] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/02/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Subependymal enhancement and DWI have been reported to be useful MR imaging markers for identifying true progression. Our aim was to determine whether the subependymal enhancement pattern and ADC can differentiate true progression from pseudoprogression in patients with glioblastoma multiforme treated with concurrent chemoradiotherapy by using temozolomide. MATERIALS AND METHODS Forty-two patients with glioblastoma multiforme with newly developed or enlarged enhancing lesions on the first follow-up MR images obtained within 2 months of concurrent chemoradiotherapy completion were included. Subependymal enhancement was analyzed for the presence, location, and pattern (local or distant relative to enhancing lesions). The mean ADC value and the fifth percentile of the cumulative ADC histogram were determined. A multiple logistic regression analysis was performed to identify independent factors associated with true progression. RESULTS Distant subependymal enhancement (ie, extending >1 cm or isolated from the enhancing lesion) was significantly more common in true progression (n = 24) than in pseudoprogression (n = 18) (P = .042). The fifth percentile of the cumulative ADC histogram was significantly lower in true progression than in pseudoprogression (P = .014). Both the distant subependymal enhancement and the fifth percentile of the cumulative ADC histogram were independent factors associated with true progression (P = .041 and P = .033, respectively). Sensitivity and specificity for the diagnosis of true progression were 83% and 67%, respectively, by using both factors. CONCLUSIONS Both the distant subependymal enhancement and the fifth percentile of the cumulative ADC histogram were significant independent factors predictive of true progression.
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Affiliation(s)
- R-E Yoo
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S) Center for Nanoparticle Research (R.-E.Y., S.H.C.) Institute for Basic Science and School of Chemical and Biological Engineering (R.-E.Y., S.H.C.), Seoul National University, Seoul, Korea
| | - S H Choi
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S) Center for Nanoparticle Research (R.-E.Y., S.H.C.) Institute for Basic Science and School of Chemical and Biological Engineering (R.-E.Y., S.H.C.), Seoul National University, Seoul, Korea.
| | - T M Kim
- Departments of Internal Medicine (S.-H.L., T.M.K.)
| | - S-H Lee
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S)
| | - C-K Park
- Department of Neurosurgery (C.-K.P.), Biomedical Research Institute; Seoul National University College of Medicine, Seoul, Korea
| | - S-H Park
- Pathology (S.-H.P.) Departments of Internal Medicine (S.-H.L., T.M.K.)
| | - I H Kim
- Radiation Oncology (C.H.S., I.H.K.), Cancer Research Institute
| | - T J Yun
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S)
| | - J-H Kim
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S)
| | - C H Sohn
- From the Departments of Radiology (R.-E.Y., S.H.C., T.J.Y., J.-H.K, C.H.S) Radiation Oncology (C.H.S., I.H.K.), Cancer Research Institute
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11C-MET PET/CT and advanced MRI in the evaluation of tumor recurrence in high-grade gliomas. Clin Nucl Med 2015; 39:791-8. [PMID: 25036022 DOI: 10.1097/rlu.0000000000000532] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the performance of l-[methyl-()11C]methionine (11C-MET) PET/CT and MRI (with the inclusion of advanced imaging techniques, namely, MR spectroscopy and MR perfusion) in the assessment of tumor recurrence in high-grade gliomas. PATIENTS AND METHODS Twenty-nine patients with high-grade gliomas who underwent surgical resection, external beam radiation therapy, and standard regimens of chemotherapy were subjected to MRI (conventional, MR perfusion, and MR spectroscopy) and 11C-MET PET/CT scans. A definitive diagnosis was made based on histopathology and/or long-term clinical and radiological follow-up. Several indices were obtained for lesion characterization, namely, SUVmean, SUVmax, and mean lesion-to-normal tissue on PET/CT, as well as relative cerebral blood volume and choline-to-creatine ratio on MRI. RESULTS Histological examination revealed viable tumor cells in 19 cases, whereas the remaining 10 were deemed to be negative based on histology (3 cases) or long-term follow-up (7 cases). All the quantitative indices mentioned previously tended to be higher in patients with tumor recurrence/residual. The sensitivity, specificity, and accuracy of 11C-MET PET/CT in identifying tumor recurrence/residual were 94.7%, 80%, and 89.6%, respectively, whereas that of MRI were 84.2%, 90%, and 86.2%, respectively. CONCLUSIONS Both 11C-MET PET/CT and MRI (with the inclusion of advanced MRI techniques) demonstrated a high diagnostic performance in the identification of tumor residual/recurrence in high-grade gliomas posttherapy. Although 11C-MET PET/CT seemed to be more sensitive, whereas advanced MRI seemed more specific, there was no statistically significant difference in the diagnostic performance of either modality in the present study. Further studies with a larger group of patients are warranted.
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Yang D. Standardized MRI assessment of high-grade glioma response: a review of the essential elements and pitfalls of the RANO criteria. Neurooncol Pract 2015; 3:59-67. [PMID: 31579522 DOI: 10.1093/nop/npv023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Indexed: 01/01/2023] Open
Abstract
Accurately evaluating response in the treatment of high-grade gliomas presents considerable challenges. This review looks at the advancements made in response criteria while critically outlining remaining weaknesses, and directs our vision toward promising endpoints to come. The 2010 guidelines from the Response Assessment in Neuro-Oncology (RANO) working group have enhanced interpretation of clinical trials involving novel treatments for high-grade glioma. Yet, while the criteria are considered clinically applicable to high-grade glioma trials, as well as reasonably accurate and reproducible, RANO lacks sufficient detail for consistent implementation in certain aspects and leaves some issues from the original Macdonald guidelines unresolved. To provide the most accurate assessment of response to therapeutic intervention currently possible, it is essential that trial oncologists and radiologists not only have a solid understanding of RANO guidelines, but also proper insight into the inherent limitations of the criteria. With the expectation of improved data collection as a standard, the author anticipates that the next high-grade glioma response criteria updates will incorporate advanced MRI methods and quantitative tumor volume measurements, availing a more accurate interpretation of response in the future.
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Affiliation(s)
- Dewen Yang
- ICON Medical Imaging, 2800 Kelly Road, Warrington, PA 18976
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Wen PY, Cloughesy TF, Ellingson BM, Reardon DA, Fine HA, Abrey L, Ballman K, Bendszuz M, Buckner J, Chang SM, Prados MD, Pope WB, Gregory Sorensen A, van den Bent M, Yung WKA. Report of the Jumpstarting Brain Tumor Drug Development Coalition and FDA clinical trials neuroimaging endpoint workshop (January 30, 2014, Bethesda MD). Neuro Oncol 2015; 16 Suppl 7:vii36-47. [PMID: 25313237 DOI: 10.1093/neuonc/nou226] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
On January 30, 2014, a workshop was held on neuroimaging endpoints in high-grade glioma. This workshop was sponsored by the Jumpstarting Brain Tumor Drug Development Coalition, consisting of the National Brain Tumor Society, the Society for Neuro-Oncology, Accelerate Brain Cancer Cure, and the Musella Foundation for Research and Information, and conducted in collaboration with the Food and Drug Administration. The workshop included neuro-oncologists, neuroradiologists, radiation oncologists, neurosurgeons, biostatisticians, patient advocates, and representatives from industry, clinical research organizations, and the National Cancer Institute. This report summarizes the presentations and discussions of that workshop and the proposals that emerged to improve the Response Assessment in Neuro-Oncology (RANO) criteria and standardize neuroimaging parameters.
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Affiliation(s)
- Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Timothy F Cloughesy
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Benjamin M Ellingson
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Howard A Fine
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Lauren Abrey
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Karla Ballman
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Martin Bendszuz
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Jan Buckner
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Susan M Chang
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Michael D Prados
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Whitney B Pope
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Alma Gregory Sorensen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Martin van den Bent
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
| | - Wai-Kwan Alfred Yung
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts (P.Y.W., D.A.R.); University of California, Los Angeles School of Medicine, Los Angeles, California (T.F.C., B.M.E., W.B.P.); New York University Langone Medical Center, New York, New York (H.A.F.); Hoffmann-La Roche, Basel, Switzerland (L.A.); Department of Biostatistics, Mayo Clinic Rochester, Rochester, Minnesota (K.B.); Department of Neuro-radiology, University of Heidelberg, Heidelberg, Germany (M.B.); Department of Medical Oncology, Mayo Clinic Rochester, Rochester, Minnesota (J.B.); Brain Tumor Center, University of California, San Francisco, California (S.M.C., M.D.P.); Siemens Healthcare North America, Malvern, Pennsylvania (A.G.S.); Department of Neuro-Oncology, Erasmus M.C.-Daniel den Hoed Cancer Center, Rotterdam, Netherlands (M.v.d.B.); Department of Neuro-Oncology, M.D. Anderson Cancer Center, Houston, Texas (W-K.A.Y.)
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Lescher S, Schniewindt S, Jurcoane A, Senft C, Hattingen E. Time window for postoperative reactive enhancement after resection of brain tumors: less than 72 hours. Neurosurg Focus 2014; 37:E3. [DOI: 10.3171/2014.9.focus14479] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Early postoperative MRI within 72 hours after brain tumor surgery is commonly used to assess residual contrast-enhancing tumor. The 72-hour window is commonly accepted because previous 1.5-T MRI studies have not found confounding postoperative reactive contrast enhancement in this time frame. The sensitivity to detect contrast enhancement increases with the field strengths. Therefore, the authors aimed to assess whether the 72-hour window is also appropriate for the MRI scanner with a field strength of 3 T.
Methods
The authors retrospectively analyzed findings on early postsurgical MR images acquired in 46 patients treated for high-grade gliomas. They performed 3-T MRI within 7 days before surgery and within 72 hours thereafter. The appearance of enhancement was categorized as postoperative reactive enhancement or tumoral enhancement by comparison with the pattern and location of presurgical enhancing tumor.
Results
Postoperative reactive enhancement was present in 15 patients (32.6%). This enhancement, not seen on presurgical MRI, had a marginal or leptomeningeal/dural pattern. In 13 patients (28.3%) postsurgical enhancement was found within the first 72 postoperative hours, with the earliest seen 22:57 hours after surgery. Subsequent MR scans in patients with postoperative reactive enhancement did not reveal tumor recurrence in these regions.
Conclusions
Postoperative reactive enhancement earlier than 72 hours after brain tumor surgery can be expected in about one-third of the cases in which a 3-T scanner is used. This might be due to the higher enhancement-to-brain contrast at higher field strengths. Therefore, the time window of 72 hours does not prevent reactive enhancement, which, however, can be recognized as such comparing it with presurgical enhancing tumor.
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Affiliation(s)
| | | | | | - Christian Senft
- 2Department of Neurosurgery, Hospital of Goethe University, Frankfurt am Main, Germany
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Zaidi HA, Chowdhry SA, Wilson DA, Spetzler RF. The dilemma of early postoperative magnetic resonance imaging: when efficiency compromises accuracy: case report. Neurosurgery 2014; 74:E335-40; discussion E340. [PMID: 24077584 DOI: 10.1227/neu.0000000000000191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Postoperative magnetic resonance imaging (MRI) is critical to the clinical decision-making process for patients undergoing resection of intracranial tumors. The accuracy of immediate postoperative MRI in determining the presence of residual disease following intracranial tumor resection, however, has not been studied. CLINICAL PRESENTATION A 57-year-old man underwent an uncomplicated retrosigmoid craniotomy for the resection of a cystic vestibular schwannoma. Immediate gadolinium-enhanced postoperative MRI, performed within 1.5 hours of surgery, was notable for a plaquelike, lobular, avidly enhancing collection with MRI characteristics consistent with fluid density extending from the porus acusticus into the cerebellopontine angle. This anomalous lesion disappeared upon repeat imaging 48 hours later, and the patient had no attributable clinical sequelae. He was discharged home without issues within 12 hours of repeat imaging. CONCLUSION We demonstrate here that immediate postoperative, gadolinium-enhanced MRI scans after tumor resection may result in avid enhancement in the region of surgical manipulation, likely due to leakage of gadolinium chelates into the subarachnoid space from residual compromise of the blood-brain barrier immediately following surgical manipulation. Early imaging is no longer routinely performed at our institution unless otherwise clinically indicated. ABBREVIATIONS FLAIR, fluid-attenuated inversion recoveryIAC, internal auditory canal.
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Affiliation(s)
- Hasan A Zaidi
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Rygh CB, Wang J, Thuen M, Gras Navarro A, Huuse EM, Thorsen F, Poli A, Zimmer J, Haraldseth O, Lie SA, Enger PØ, Chekenya M. Dynamic contrast enhanced MRI detects early response to adoptive NK cellular immunotherapy targeting the NG2 proteoglycan in a rat model of glioblastoma. PLoS One 2014; 9:e108414. [PMID: 25268630 PMCID: PMC4182474 DOI: 10.1371/journal.pone.0108414] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 08/27/2014] [Indexed: 01/05/2023] Open
Abstract
There are currently no established radiological parameters that predict response to immunotherapy. We hypothesised that multiparametric, longitudinal magnetic resonance imaging (MRI) of physiological parameters and pharmacokinetic models might detect early biological responses to immunotherapy for glioblastoma targeting NG2/CSPG4 with mAb9.2.27 combined with natural killer (NK) cells. Contrast enhanced conventional T1-weighted MRI at 7±1 and 17±2 days post-treatment failed to detect differences in tumour size between the treatment groups, whereas, follow-up scans at 3 months demonstrated diminished signal intensity and tumour volume in the surviving NK+mAb9.2.27 treated animals. Notably, interstitial volume fraction (ve), was significantly increased in the NK+mAb9.2.27 combination therapy group compared mAb9.2.27 and NK cell monotherapy groups (p = 0.002 and p = 0.017 respectively) in cohort 1 animals treated with 1 million NK cells. ve was reproducibly increased in the combination NK+mAb9.2.27 compared to NK cell monotherapy in cohort 2 treated with increased dose of 2 million NK cells (p<0.0001), indicating greater cell death induced by NK+mAb9.2.27 treatment. The interstitial volume fraction in the NK monotherapy group was significantly reduced compared to mAb9.2.27 monotherapy (p<0.0001) and untreated controls (p = 0.014) in the cohort 2 animals. NK cells in monotherapy were unable to kill the U87MG cells that highly expressed class I human leucocyte antigens, and diminished stress ligands for activating receptors. A significant association between apparent diffusion coefficient (ADC) of water and ve in combination NK+mAb9.2.27 and NK monotherapy treated tumours was evident, where increased ADC corresponded to reduced ve in both cases. Collectively, these data support histological measures at end-stage demonstrating diminished tumour cell proliferation and pronounced apoptosis in the NK+mAb9.2.27 treated tumours compared to the other groups. In conclusion, ve was the most reliable radiological parameter for detecting response to intralesional NK cellular therapy.
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Affiliation(s)
- Cecilie Brekke Rygh
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Cardiovascular Research Group, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Jian Wang
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Marte Thuen
- MI Lab, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | | | - Else Marie Huuse
- MI Lab, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
| | - Frits Thorsen
- Molecular Imaging Center, Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Aurelie Poli
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Laboratoire d'Immunogénétique-Allergologie, CRP-Santé, Luxembourg City, Luxembourg
| | - Jacques Zimmer
- Laboratoire d'Immunogénétique-Allergologie, CRP-Santé, Luxembourg City, Luxembourg
| | - Olav Haraldseth
- MI Lab, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway
- Department of Medical Imaging, St. Olavs Hospital, Trondheim, Norway
| | - Stein Atle Lie
- Institute for Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Per Øyvind Enger
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Martha Chekenya
- Department of Biomedicine, University of Bergen, Bergen, Norway
- Institute for Clinical Dentistry, University of Bergen, Bergen, Norway
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Poulsen HS, Urup T, Michaelsen SR, Staberg M, Villingshøj M, Lassen U. The impact of bevacizumab treatment on survival and quality of life in newly diagnosed glioblastoma patients. Cancer Manag Res 2014; 6:373-87. [PMID: 25298738 PMCID: PMC4186574 DOI: 10.2147/cmar.s39306] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma multiforme (GBM) remains one of the most devastating tumors, and patients have a median survival of 15 months despite aggressive local and systemic therapy, including maximal surgical resection, radiation therapy, and concomitant and adjuvant temozolomide. The purpose of antineoplastic treatment is therefore to prolong life, with a maintenance or improvement of quality of life. GBM is a highly vascular tumor and overexpresses the vascular endothelial growth factor A, which promotes angiogenesis. Preclinical data have suggested that anti-angiogenic treatment efficiently inhibits tumor growth. Bevacizumab is a humanized monoclonal antibody against vascular endothelial growth factor A, and treatment has shown impressive response rates in recurrent GBM. In addition, it has been shown that response is correlated to prolonged survival and improved quality of life. Several investigations in newly diagnosed GBM patients have been performed during recent years to test the hypothesis that newly diagnosed GBM patients should be treated with standard multimodality treatment, in combination with bevacizumab, in order to prolong life and maintain or improve quality of life. The results of these studies along with relevant preclinical data will be described, and pitfalls in clinical and paraclinical endpoints will be discussed.
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Affiliation(s)
- Hans Skovgaard Poulsen
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Urup
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Regner Michaelsen
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mikkel Staberg
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette Villingshøj
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrik Lassen
- Department of Radiation Biology, Copenhagen University Hospital, Copenhagen, Denmark ; Department of Oncology, Copenhagen University Hospital, Copenhagen, Denmark ; Phase I Unit, The Finsencenter, Copenhagen University Hospital, Copenhagen, Denmark
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Contrast-enhanced FLAIR (fluid-attenuated inversion recovery) for evaluating mild traumatic brain injury. PLoS One 2014; 9:e102229. [PMID: 25028975 PMCID: PMC4100883 DOI: 10.1371/journal.pone.0102229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 06/16/2014] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To evaluate whether adding a contrast-enhanced fluid-attenuated inversion recovery (FLAIR) sequence to routine magnetic resonance imaging (MRI) can detect additional abnormalities in the brains of symptomatic patients with mild traumatic brain injury. MATERIALS AND METHODS Fifty-four patients with persistent symptoms following mild closed head injury were included in our retrospective study (M ∶ F = 32 ∶ 22, mean age: 59.8 ± 16.4, age range: 26-84 years). All MRI examinations were obtained within 14 days after head trauma (mean: 3.2 ± 4.1 days, range: 0.2-14 days). Two neuroradiologists recorded (1) the presence of traumatic brain lesions on MR images with and without contrast-enhanced FLAIR images and (2) the pattern and location of meningeal enhancement depicted on contrast-enhanced FLAIR images. The number of additional traumatic brain lesions diagnosed with contrast-enhanced FLAIR was recorded. Correlations between meningeal enhancement and clinical findings were also evaluated. RESULTS Traumatic brain lesions were detected on routine image sequences in 25 patients. Three additional cases of brain abnormality were detected with the contrast-enhanced FLAIR images. Meningeal enhancement was identified on contrast-enhanced FLAIR images in 9 cases while the other routine image sequences showed no findings of traumatic brain injury. Overall, the additional contrast-enhanced FLAIR images revealed more extensive abnormalities than routine imaging in 37 cases (p<0.001). In multivariate logistic regression analysis, subdural hematoma and posttraumatic loss of consciousness showed a significant association with meningeal enhancement on contrast-enhanced FLAIR images, with odds ratios 13.068 (95% confidence interval 2.037 to 83.852), and 15.487 (95% confidence interval 2.545 to 94.228), respectively. CONCLUSION Meningeal enhancement on contrast-enhanced FLAIR images can help detect traumatic brain lesions as well as additional abnormalities not identified on routine unenhanced MRI. Therefore contrast-enhanced FLAIR MR imaging is recommended when a contrast MR study is indicated in a patient with a symptomatic prior closed mild head injury.
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Sie M, den Dunnen WF, Hoving EW, de Bont ES. Anti-angiogenic therapy in pediatric brain tumors: An effective strategy? Crit Rev Oncol Hematol 2014; 89:418-32. [DOI: 10.1016/j.critrevonc.2013.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 08/10/2013] [Accepted: 09/27/2013] [Indexed: 12/15/2022] Open
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Shiroishi MS, Booker MT, Agarwal M, Jain N, Naghi I, Lerner A, Law M. Posttreatment evaluation of central nervous system gliomas. Magn Reson Imaging Clin N Am 2013; 21:241-68. [PMID: 23642552 DOI: 10.1016/j.mric.2013.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although conventional contrast-enhanced MR imaging remains the standard-of-care imaging method in the posttreatment evaluation of gliomas, recent developments in therapeutic options such as chemoradiation and antiangiogenic agents have caused the neuro-oncology community to rethink traditional imaging criteria. This article highlights the latest recommendations. These recommendations should be viewed as works in progress. As more is learned about the pathophysiology of glioma treatment response, quantitative imaging biomarkers will be validated within this context. There will likely be further refinements to glioma response criteria, although the lack of technical standardization in image acquisition, postprocessing, and interpretation also need to be addressed.
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Affiliation(s)
- Mark S Shiroishi
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Abstract
BACKGROUND The impact of malignant glioma resection on survival is still a matter of controversy. The lack of well-designed prospective studies as well as control of all factors in retrospective studies plays an important role in this debate. Amongst some of these uncontrolled factors, are the inclusion of different histological grades, the lack of objective methods to estimate the extent of resection and unspecified delays in post-operative imaging. METHODS We retrospectively reviewed 126 consecutive patients with glioblastoma, operated on by the senior authors at the Centre Hospitalier Universitaire de Sherbrooke, who met the following criteria: >18 years of age, newly diagnosed glioblastoma, pre-operative magnetic resonance imaging (MRI) within 2 weeks prior to surgery, and a post-operative MRI within 72 hours after surgery. Extent of tumour resection was calculated using pre and post-operative tumour delimitation on gadolinium-enhanced T1 MRI in a volumetric analysis. RESULTS Applying stringent specific inclusion criteria, 126 patients were retained in the analysis. The median overall survival was 271 days and the median extent of resection was 65%. Patients with more than 90% of tumour resection had a significantly better outcome, improving median survival from 225 to 519 days (P=0.006). Other factors that significantly improved survival were the use of radiotherapy, the number of regimens and type of chemotherapy used. CONCLUSION A more aggressive approach combining maximal safe resection and use of salvage chemotherapy seems to confer a survival advantage for glioblastoma patients.
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Lucas J, Zada G. Radiology: Criteria for Determining Response to Treatment and Recurrence of High-Grade Gliomas. Neurosurg Clin N Am 2012; 23:269-76, viii. [DOI: 10.1016/j.nec.2012.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Radbruch A, Lutz K, Wiestler B, Bäumer P, Heiland S, Wick W, Bendszus M. Relevance of T2 signal changes in the assessment of progression of glioblastoma according to the Response Assessment in Neurooncology criteria. Neuro Oncol 2011; 14:222-9. [PMID: 22146386 DOI: 10.1093/neuonc/nor200] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND According to the Response Assessment in Neurooncology (RANO) criteria, significant nonenhancing signal increase in T2-weighted images qualifies for progression in high-grade glioma (T2-progress), even if there is no change in the contrast-enhancing tumor portion. The purpose of this retrospective study was to assess the frequency of isolated T2-progress and its predictive value on subsequent T1-progress, as determined by a T2 signal increase of 15% or 25%, respectively. The frequency of T2-progress was correlated with antiangiogenic therapy. PATIENTS AND METHODS MRI follow-up examinations (n = 777) of 144 patients with histologically proven glioblastoma were assessed for contrast-enhanced T1 and T2-weighted images. Examinations were classified as T1-progress, T2-progress with 15% or 25% T2-signal increase, stable disease, or partial or complete response. RESULTS Thirty-five examinations revealed exclusive T2-progress using the 15% criterion, and only 2 examinations qualified for the 25% criterion; 61.8% of the scans presenting T2-progress and 31.5% of the scans presenting stable disease revealed T1-progress in the next follow-up examination. The χ(2) test showed a highly significant correlation (P < .001) between T2-progress, with the 15% criterion and subsequent T1-progress. No correlation between antiangiogenic therapy and T2-progress was shown. CONCLUSION Tumor progression, as determined by both contrast-enhanced T1 and T2 sequences is more frequently diagnosed than when considering only contrast-enhanced T1 sequences. Definition of T2-progress by a 15% T2-signal increase criterion is superior to a 25% criterion. The missing correlation of T2-progress and antiangiogenic therapy supports the hypothesis of T2-progress as part of the natural course of the tumor disease.
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Affiliation(s)
- Alexander Radbruch
- Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
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Shiroishi MS, Habibi M, Rajderkar D, Yurko C, Go JL, Lerner A, Mogensen MA, Kim PE, Boyko OB, Zee CS, Law M. Perfusion and permeability MR imaging of gliomas. Technol Cancer Res Treat 2011; 10:59-71. [PMID: 21214289 DOI: 10.7785/tcrt.2012.500180] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Conventional contrast-enhanced MR imaging is the current standard technique for the diagnosis and treatment evaluation of gliomas and other brain neoplasms. However, this method is quite limited in its ability to characterize the complex biology of gliomas and so there is a need to develop more quantitative imaging methods. Perfusion and permeability MR imaging are two such techniques that have shown promise in this regard. This review will highlight the underlying principles, applications, and pitfalls of these evolving advanced MRI methods.
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Affiliation(s)
- M S Shiroishi
- Division of Neuroradiology, Department of Radiology, Keck School of Medicine, University of Southern California, 1500 San Pablo St, Los Angeles, CA 90033, USA.
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Vos MJ, Berkhof J, Hoekstra OS, Bosma I, Sizoo EM, Heimans JJ, Reijneveld JC, Sanchez E, Lagerwaard FJ, Buter J, Noske DP, Postma TJ. MRI and thallium-201 SPECT in the prediction of survival in glioma. Neuroradiology 2011; 54:539-46. [DOI: 10.1007/s00234-011-0908-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 07/01/2011] [Indexed: 10/18/2022]
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Vogelbaum MA, Jost S, Aghi MK, Heimberger AB, Sampson JH, Wen PY, Macdonald DR, Van den Bent MJ, Chang SM. Application of Novel Response/Progression Measures for Surgically Delivered Therapies for Gliomas. Neurosurgery 2011; 70:234-43; discussion 243-4. [DOI: 10.1227/neu.0b013e318223f5a7] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
BACKGROUND
The Response Assessment in Neuro-Oncology (RANO) Working Group is an international, multidisciplinary effort to develop new standardized response criteria for clinical trials in brain tumors. The RANO group identified knowledge gaps relating to the definitions of tumor response and progression after the use of surgical or surgically based treatments.
OBJECTIVE
To outline a proposal for new response and progression criteria for the assessment of the effects of surgery and surgically delivered therapies for patients with gliomas.
METHODS
The Surgery Working Group of RANO identified surgically related end-point evaluation problems that were not addressed in the original Macdonald criteria, performed an extensive literature review, and used a consensus-building process to develop recommendations for how to address these issues in the setting of clinical trials.
RESULTS
Recommendations were formulated for surgically related issues, including imaging changes associated with surgical resection or surgically mediated adjuvant local therapies, the determination of progression in the setting where all enhancing tumor has been removed, and how new enhancement should be interpreted in the setting where local therapies that are known to produce nonspecific enhancement have been used. Additionally, the terminology used to describe the completeness of surgical resections has been recognized to be inconsistently applied to enhancing vs nonenhancing tumors, and a new set of descriptors is proposed.
CONCLUSION
The RANO process is intended to produce end-point criteria for clinical trials that take into account the effects of prior and ongoing therapies. The RANO criteria will continue to evolve as new therapies and technologies are introduced into clinical trial and/or practice.
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Affiliation(s)
- Michael A. Vogelbaum
- Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Cleveland Clinic, Cleveland Ohio
| | - Sarah Jost
- Ivy Center for Advanced Brain Tumor Treatment, Department of Neurosurgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Manish K. Aghi
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Amy B. Heimberger
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John H. Sampson
- Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, North Carolina
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center and Division of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - David R. Macdonald
- Department of Oncology, Medical Oncology, London Regional Cancer Program, University of Western Ontario, London, Ontario, Canada
| | - Martin J. Van den Bent
- Neuro-Oncology Unit, Daniel den Hoed Cancer Center/Erasmus University Hospital Rotterdam, Rotterdam, the Netherlands
| | - Susan M. Chang
- Division of Neuro-Oncology, Department of Neurological Surgery, University of California, San Francisco, California
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37
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Abstract
Accuracy and reproducibility in determining response to therapy and tumor progression can be difficult to achieve for nervous system tumors. Current response criteria vary depending on the pathology and have several limitations. Until recently, the most widely used criteria for gliomas were "Macdonald criteria," based on two-dimensional tumor measurements on neuroimaging studies. However, the Response Assessment in Neuro-Oncology (RANO) Working Group has published new recommendations in high-grade gliomas and is working on recommendations for other nervous system tumors. This article reviews current response criteria for high-grade glioma, low-grade glioma, brain metastasis, meningioma, and schwannoma.
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Jakobsen JN, Hasselbalch B, Stockhausen MT, Lassen U, Poulsen HS. Irinotecan and bevacizumab in recurrent glioblastoma multiforme. Expert Opin Pharmacother 2011; 12:825-33. [DOI: 10.1517/14656566.2011.566558] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Reardon DA, Galanis E, DeGroot JF, Cloughesy TF, Wefel JS, Lamborn KR, Lassman AB, Gilbert MR, Sampson JH, Wick W, Chamberlain MC, Macdonald DR, Mehta MP, Vogelbaum MA, Chang SM, Van den Bent MJ, Wen PY. Clinical trial end points for high-grade glioma: the evolving landscape. Neuro Oncol 2011; 13:353-61. [PMID: 21310734 PMCID: PMC3064608 DOI: 10.1093/neuonc/noq203] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 11/26/2010] [Indexed: 01/13/2023] Open
Abstract
To review the strengths and weaknesses of primary and auxiliary end points for clinical trials among patients with high-grade glioma (HGG). Recent advances in outcome for patients with newly diagnosed and recurrent HGG, coupled with the development of multiple promising therapeutics with myriad antitumor actions, have led to significant growth in the number of clinical trials for patients with HGG. Appropriate clinical trial design and the incorporation of optimal end points are imperative to efficiently and effectively evaluate such agents and continue to advance outcome. Growing recognition of limitations weakening the reliability of traditional clinical trial primary end points has generated increasing uncertainty of how best to evaluate promising therapeutics for patients with HGG. The phenomena of pseudoprogression and pseudoresponse have made imaging-based end points, including overall radiographic response and progression-free survival, problematic. Although overall survival is considered the "gold-standard" end point, recently identified active salvage therapies such as bevacizumab may diminish the association between presalvage therapy and overall survival. Finally, advances in imaging as well as the assessment of patient function and well being have strengthened interest in auxiliary end points assessing these aspects of patient care and outcome. Better appreciation of the strengths and limitations of primary end points will lead to more effective clinical trial strategies. Technical advances in imaging as well as improved survival for patients with HGG support the further development of auxiliary end points evaluating novel imaging approaches as well as measures of patient function and well being.
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Affiliation(s)
- David A Reardon
- The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Box 3624, Durham, NC 27710, USA.
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Solheim O, Selbekk T, Jakola AS, Unsgård G. Ultrasound-guided operations in unselected high-grade gliomas--overall results, impact of image quality and patient selection. Acta Neurochir (Wien) 2010; 152:1873-86. [PMID: 20652608 DOI: 10.1007/s00701-010-0731-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 06/23/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND A number of tools, including intraoperative ultrasound, are reported to facilitate surgical resection of high-grade gliomas. However, results from selected surgical series do not necessarily reflect the effectiveness in common neurosurgical practice. Delineation of seemingly similar brain tumours vary in different ultrasound-guided operations, perhaps limiting usefulness in certain patients. METHODS We explore and describe the results associated with use of the SonoWand system with intraoperative ultrasound in a population-based, unselected, high-grade glioma series. Surgeons filled out questionnaires about presumed extent of resection, use of ultrasound and ultrasound image quality just after surgery. We evaluate the impact of ultrasound image quality. We also explore the importance of patient selection for surgical results. RESULTS Of 156 consecutive malignant glioma operations, 142 (91%) were resections whilst 14 (9%) were only biopsies. We achieved gross total resection (GTR) in 37% of all high-grade glioma resections, whilst worsening of functional status was seen in 13%. The risk of getting worse was significantly higher in reoperations, resections in eloquent locations, resections in cases with poor ultrasound image quality, resection when surgeons' resection grade estimates were inaccurate and in cases with surgery-related complications. Aiming for GTR, unifocality of lesion, non-eloquent location and medium or good ultrasound image quality were identified as independent factors associated with achieving GTR. CONCLUSION We report good overall results, both in terms of resection grades and functional outcome in consecutive malignant glioma resections, in which intraoperative ultrasound was used in 95%. We observed a seeming dose-response relationship between ultrasound image quality and clinical and radiological results. This may suggest that better ultrasound facilitates better surgery. The study also clearly demonstrates that, in terms of surgical results, the selection of patients seems to be much more important than the selection of surgical tools.
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Affiliation(s)
- Ole Solheim
- Department of Neuroscience, Norwegian University of Science and Technology, 7005, Trondheim, Norway.
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41
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Abstract
Accurate, reproducible criteria for determining tumor response and progression after therapy are critical for optimal patient care and effective evaluation of novel therapeutic agents. Currently, the most widely used criteria for determining treatment response in gliomas is based on two-dimensional tumor measurements using neuroimaging studies (Macdonald criteria). In recent years, the limitation of these criteria, which only address the contrast-enhancing component of the tumor, have become increasingly apparent. This review discusses challenges that have emerged in assessing response in patients with gliomas and approaches being introduced to address them.
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42
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Abstract
Imaging plays an essential role in the evaluation of patients after cranial surgery. It is important to be familiar with the normal anatomy of the cranium; the indications for different surgical techniques such as burr holes, craniotomy, craniectomy, and cranioplasty; their normal postoperative appearances; and complications such as tension pneumocephalus, infection, abscess, empyema, hemorrhage, hematoma, herniation, hygroma, and trephine syndrome. Postoperative infection and hemorrhage are common to all neurosurgical procedures, where-as other complications are peculiar to certain procedures (eg, drill "plunging" during burr hole creation and sinking skin flap after craniec-tomy). Recognizing life-threatening complications such as tension pneumocephalus and paradoxical herniation, which require urgent intervention, is important for a better clinical outcome. Computed tomography is fast, cost effective, and easily accessible for first-line imaging. Magnetic resonance imaging has higher sensitivity for detecting postoperative infection and ischemia, but diffusion-weighted imaging may be less reliable for detecting postoperative infections.
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Affiliation(s)
- Audrey G Sinclair
- Department of Radiology Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB20QQ, England
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43
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Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, Degroot J, Wick W, Gilbert MR, Lassman AB, Tsien C, Mikkelsen T, Wong ET, Chamberlain MC, Stupp R, Lamborn KR, Vogelbaum MA, van den Bent MJ, Chang SM. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol 2010; 28:1963-72. [PMID: 20231676 DOI: 10.1200/jco.2009.26.3541] [Citation(s) in RCA: 2745] [Impact Index Per Article: 196.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Currently, the most widely used criteria for assessing response to therapy in high-grade gliomas are based on two-dimensional tumor measurements on computed tomography (CT) or magnetic resonance imaging (MRI), in conjunction with clinical assessment and corticosteroid dose (the Macdonald Criteria). It is increasingly apparent that there are significant limitations to these criteria, which only address the contrast-enhancing component of the tumor. For example, chemoradiotherapy for newly diagnosed glioblastomas results in transient increase in tumor enhancement (pseudoprogression) in 20% to 30% of patients, which is difficult to differentiate from true tumor progression. Antiangiogenic agents produce high radiographic response rates, as defined by a rapid decrease in contrast enhancement on CT/MRI that occurs within days of initiation of treatment and that is partly a result of reduced vascular permeability to contrast agents rather than a true antitumor effect. In addition, a subset of patients treated with antiangiogenic agents develop tumor recurrence characterized by an increase in the nonenhancing component depicted on T2-weighted/fluid-attenuated inversion recovery sequences. The recognition that contrast enhancement is nonspecific and may not always be a true surrogate of tumor response and the need to account for the nonenhancing component of the tumor mandate that new criteria be developed and validated to permit accurate assessment of the efficacy of novel therapies. The Response Assessment in Neuro-Oncology Working Group is an international effort to develop new standardized response criteria for clinical trials in brain tumors. In this proposal, we present the recommendations for updated response criteria for high-grade gliomas.
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Affiliation(s)
- Patrick Y Wen
- Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, SW430D, 44 Binney St, Boston, MA 02115, USA.
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44
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Pirzkall A, McGue C, Saraswathy S, Cha S, Liu R, Vandenberg S, Lamborn KR, Berger MS, Chang SM, Nelson SJ. Tumor regrowth between surgery and initiation of adjuvant therapy in patients with newly diagnosed glioblastoma. Neuro Oncol 2010; 11:842-52. [PMID: 19229057 DOI: 10.1215/15228517-2009-005] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To assess incidence and degree of regrowth in glioblastoma between surgery and radiation therapy (RT) and to correlate regrowth with presurgical imaging and survival, we examined images of 32 patients with newly diagnosed glioblastoma who underwent MR spectroscopic imaging (MRSI), perfusion-weighted imaging (PWI), and diffusion-weighted imaging (DWI) prior to surgery, after surgery, and prior to RT/temozolomide. Contrast enhancement (CE) in the pre-RT MR image was compared with postsurgical DWI to differentiate tumor growth from postsurgical infarct. MRSI and PWI parameters were analyzed prior to surgery and pre-RT. Postsurgical MRI indicated that 18 patients had gross total and 14 subtotal resections. Twenty-one patients showed reduced diffusion, and 25 patients showed new or increased CE. In eight patients (25%), the new CE was confined to areas of postsurgical reduced diffusion. In the other 17 patients (53%), new CE was found to be indicative of tumor growth or a combination of tumor growth and surgical injury. Higher perfusion and creatine within nonenhancing tumor in the presurgery MR were associated with subsequent tumor growth. High levels of choline and reduced diffusion in pre-RT CE suggested active metabolism and tumor cell proliferation. Median survival was 14.6 months in patients with interim tumor growth and 24 months in patients with no growth. Increased volume or new onset of CE between surgery and RT was attributed to tumor growth in 53% of patients and was associated with shorter survival. This suggests that reducing the time between surgery and adjuvant therapy may be important. The acquisition of metabolic and physiologic imaging data prior to adjuvant therapy may also be valuable in assessing regions of new CE and nonenhancing tumor.
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Affiliation(s)
- Andrea Pirzkall
- Department of Radiology and Margaret Hart Surbeck Laboratory of Advanced Imaging, University of California, San Francisco, San Francisco, CA, USA.
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van den Bent MJ, Vogelbaum MA, Wen PY, Macdonald DR, Chang SM. End point assessment in gliomas: novel treatments limit usefulness of classical Macdonald's Criteria. J Clin Oncol 2009; 27:2905-8. [PMID: 19451418 DOI: 10.1200/jco.2009.22.4998] [Citation(s) in RCA: 207] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recent trials in glioma have revealed significant limitations in the end points used. This requires a critical and comprehensive review of how brain tumor trials are conducted, particularly of which end points are defined and how response and progression are defined.
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Affiliation(s)
- Martin J van den Bent
- Neuro-Oncology Unit, Daniel den Hoed Cancer Center, Erasmus University Hospital, Rotterdam, The Netherlands
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46
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Luijnenburg SE, Hanlo PW, Han KS, Kors WA, Witkamp TD, Verbeke JIML. Postoperative hemicerebellar inflammation mimicking recurrent tumor after resection of a medulloblastoma. Case report. J Neurosurg Pediatr 2008; 1:330-3. [PMID: 18377311 DOI: 10.3171/ped/2008/1/4/330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The authors present the case of a 4-year-old boy in whom a medulloblastoma in the left cerebellar hemisphere was successfully resected with no signs of residual tumor on the postoperative magnetic resonance (MR) images. A second MR imaging study performed 1 month after surgery demonstrated an extensive, contrast-enhancing lesion in the left cerebellar hemisphere, which simulated massive recurrent tumor, and repeated surgery was considered. A third postoperative MR imaging study, performed for evaluation of the craniospinal axis 10 days after the second postoperative study, still showed some contrast enhancement in the left cerebellar hemisphere, but the lesion had almost disappeared. Postoperative hemicerebellar inflammation seemed to be the most likely explanation. This case illustrates that early postoperative inflammation can mimic recurrent tumor on MR images obtained after resection of a medulloblastoma and caution should be taken in interpreting such images. Clinical history, neurological examination, laboratory findings, and repeated MR imaging studies can be helpful in evaluating the patient accurately.
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Affiliation(s)
- Saskia E Luijnenburg
- Department of Pediatrics, Wilhelmina Children's Hospital/University Medical Center Utrecht, The Netherlands
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47
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Abstract
Damage to the spinal cord may be caused by a wide range of pathologies and generally results in profound functional disability. A reliable diagnostic workup of the spine is very important because even relatively small lesions in this part of the central nervous system can have a profound clinical impact. MR imaging has become the method of choice for the detection and diagnosis of many spine disorders. Various innovative MR imaging methods have been developed to improve neuroimaging, including better pulse sequences and new MR contrast parameters. These new "cutting-edge" technologies have the potential to impact profoundly the ease and confidence of spinal disease interpretation and offer a more efficient diagnostic workup of patients suffering from spinal disease.
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Affiliation(s)
- A Talia Vertinsky
- Stanford University, Department of Radiology, Lucas Center, PS08, 1201 Welch Road, Stanford, CA 94305-5488, USA
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48
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Abstract
MRI has dramatically improved the management of cerebral tumors and consequently oligodendrogliomas. T1 and T2-weighted images and gadolinium enhancement are very useful for tumor detection and characterization. Tumor enhancement is of a great prognostic value because it is highly predictive of high-grade oligodendroglioma. Three-dimensional MR images provide, with high precision, the anatomical location and the relationships with functional structures (motor and language areas). The recent technical progress in MRI and the use of diffusion images in the screening of tumors lead to a better definition of the lesion. Comparative analysis of MRI images is helpful to detect eventual relapse and adverse effects of treatment.
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Affiliation(s)
- F Brami-Zylberberg
- Département d'Imagerie Morphologique et Fonctionnelle, Centre Hospitalier Sainte-Anne, Paris.
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49
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Erdoğan N, Tucer B, Mavili E, Menkü A, Kurtsoy A. Ultrasound guidance in intracranial tumor resection: correlation with postoperative magnetic resonance findings. Acta Radiol 2005; 46:743-9. [PMID: 16372696 DOI: 10.1080/02841850500223208] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To determine the inter-method agreement between intraoperative ultrasonography and postoperative contrast-enhanced magnetic resonance imaging (MRI) in detecting tumor residue. MATERIAL AND METHODS After resection was completed, the cavity borders of 32 tumors were examined with a 7 MHz intraoperative probe. Any echogenic region >5 mm in thickness extending from the surgical cavity into the brain substance was taken as the sonographic criterion for residual tumor. A continuous echogenic rim< 5 mm was considered normal. Results were correlated with gadolinium-enhanced MRI obtained within 48 h after surgery. RESULTS The kappa value for inter-method agreement was 0.72. There were four cases in whom MRI showed residue despite a negative sonography: extensive edema or Surgicel along the cavity borders (three cases with glioblastoma multiforme) and the cystic component in the vicinity of cerebrospinal fluid (a case with pituitary macroadenoma) may be the reason for the residue going undetected. In a case with glioblastoma multiforme, residual enhancement was < 5 mm in thickness. CONCLUSION Intraoperative ultrasound is an effective tool for maximizing the extent of intracranial tumor resection. Surgical use has to be minimized if intraoperative ultrasound is to be used as an adjunct to surgery. Tumors with preoperatively detected cystic components in the proximity of CSF-containing spaces have to be carefully evaluated with intraoperative ultrasound if residual cystic components are to be detected. A low-thickness echogenic rim should not be considered a reliable sign of the absence of residue.
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Affiliation(s)
- N Erdoğan
- Erciyes University Medical Faculty, Department of Radiology, Kayseri, Turkey.
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Widjaja E, Connolly DJA, Gatscher S, McMullen J, Griffiths PD. Spurious leptomeningeal enhancement on immediate post-operative MRI for paediatric brain tumours. Pediatr Radiol 2005; 35:334-8. [PMID: 15756544 DOI: 10.1007/s00247-004-1318-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 08/02/2004] [Accepted: 08/04/2004] [Indexed: 11/26/2022]
Abstract
Immediate post-operative MRI has been recommended as an accurate and robust method to assess residual brain tumour. Early enhancement at the resection margin and in the dura is well recognized, but we describe two cases of enhancement in the basal cisterns on immediate post-operative MRI that resolved on follow-up. The underlying cause of the enhancement remains to be elucidated, but it should be recognized that leptomeningeal enhancement may occur after surgery and that this does not necessarily imply tumour spread.
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Affiliation(s)
- Elysa Widjaja
- Department of Radiology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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