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Alcicek S, Pilatus U, Manzhurtsev A, Weber KJ, Ronellenfitsch MW, Steinbach JP, Hattingen E, Wenger KJ. Amino acid metabolism in glioma: in vivo MR-spectroscopic detection of alanine as a potential biomarker of poor survival in glioma patients. J Neurooncol 2024:10.1007/s11060-024-04803-2. [PMID: 39192067 DOI: 10.1007/s11060-024-04803-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 08/10/2024] [Indexed: 08/29/2024]
Abstract
PURPOSE Reprogramming of amino acid metabolism is relevant for initiating and fueling tumor formation and growth. Therefore, there has been growing interest in anticancer therapies targeting amino acid metabolism. While developing personalized therapeutic approaches to glioma, in vivo proton magnetic resonance spectroscopy (MRS) is a valuable tool for non-invasive monitoring of tumor metabolism. Here, we evaluated MRS-detected brain amino acids and myo-inositol as potential diagnostic and prognostic biomarkers in glioma. METHOD We measured alanine, glycine, glutamate, glutamine, and myo-inositol in 38 patients with MRI-suspected glioma using short and long echo-time single-voxel PRESS MRS sequences. The detectability of alanine, glycine, and myo-inositol and the (glutamate + glutamine)/total creatine ratio were evaluated against the patients' IDH mutation status, CNS WHO grade, and overall survival. RESULTS While the detection of alanine and non-detection of myo-inositol significantly correlated with IDH wildtype (p = 0.0008, p = 0.007, respectively) and WHO grade 4 (p = 0.01, p = 0.04, respectively), glycine detection was not significantly associated with either. The ratio of (glutamate + glutamine)/total creatine was significantly higher in WHO grade 4 than in 2 and 3. We found that the overall survival was significantly shorter in glioma patients with alanine detection (p = 0.00002). CONCLUSION Focusing on amino acids in MRS can improve its diagnostic and prognostic value in glioma. Alanine, which is visible at long TE even in the presence of lipids, could be a relevant indicator for overall survival.
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Affiliation(s)
- Seyma Alcicek
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany.
- University Cancer Center Frankfurt (UCT), Frankfurt/Main, Germany.
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany.
- German Cancer Research Center (DKFZ) Heidelberg, German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany.
| | - Ulrich Pilatus
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
| | - Andrei Manzhurtsev
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
| | - Katharina J Weber
- University Cancer Center Frankfurt (UCT), Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- German Cancer Research Center (DKFZ) Heidelberg, German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany
- Goethe University Frankfurt, University Hospital, Institute of Neurology (Edinger-Institute), Frankfurt/Main, Germany
| | - Michael W Ronellenfitsch
- University Cancer Center Frankfurt (UCT), Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- German Cancer Research Center (DKFZ) Heidelberg, German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany
- Goethe University Frankfurt, University Hospital, Dr. Senckenberg Institute of Neurooncology, Frankfurt/Main, Germany
| | - Joachim P Steinbach
- University Cancer Center Frankfurt (UCT), Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- German Cancer Research Center (DKFZ) Heidelberg, German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany
- Goethe University Frankfurt, University Hospital, Dr. Senckenberg Institute of Neurooncology, Frankfurt/Main, Germany
| | - Elke Hattingen
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
- University Cancer Center Frankfurt (UCT), Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- German Cancer Research Center (DKFZ) Heidelberg, German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany
| | - Katharina J Wenger
- Goethe University Frankfurt, University Hospital, Institute of Neuroradiology, Schleusenweg 2-16, 60528, Frankfurt/Main, Germany
- University Cancer Center Frankfurt (UCT), Frankfurt/Main, Germany
- Frankfurt Cancer Institute (FCI), Frankfurt/Main, Germany
- German Cancer Research Center (DKFZ) Heidelberg, German Cancer Consortium (DKTK), Partner Site, Frankfurt/Mainz, Germany
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2
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Henssen D, Meijer F, Verburg FA, Smits M. Challenges and opportunities for advanced neuroimaging of glioblastoma. Br J Radiol 2023; 96:20211232. [PMID: 36062962 PMCID: PMC10997013 DOI: 10.1259/bjr.20211232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Glioblastoma is the most aggressive of glial tumours in adults. On conventional magnetic resonance (MR) imaging, these tumours are observed as irregular enhancing lesions with areas of infiltrating tumour and cortical expansion. More advanced imaging techniques including diffusion-weighted MRI, perfusion-weighted MRI, MR spectroscopy and positron emission tomography (PET) imaging have found widespread application to diagnostic challenges in the setting of first diagnosis, treatment planning and follow-up. This review aims to educate readers with regard to the strengths and weaknesses of the clinical application of these imaging techniques. For example, this review shows that the (semi)quantitative analysis of the mentioned advanced imaging tools was found useful for assessing tumour aggressiveness and tumour extent, and aids in the differentiation of tumour progression from treatment-related effects. Although these techniques may aid in the diagnostic work-up and (post-)treatment phase of glioblastoma, so far no unequivocal imaging strategy is available. Furthermore, the use and further development of artificial intelligence (AI)-based tools could greatly enhance neuroradiological practice by automating labour-intensive tasks such as tumour measurements, and by providing additional diagnostic information such as prediction of tumour genotype. Nevertheless, due to the fact that advanced imaging and AI-diagnostics is not part of response assessment criteria, there is no harmonised guidance on their use, while at the same time the lack of standardisation severely hampers the definition of uniform guidelines.
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Affiliation(s)
- Dylan Henssen
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
| | - Frederick Meijer
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
| | - Frederik A. Verburg
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
| | - Marion Smits
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
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3
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Chawla S, Bukhari S, Afridi OM, Wang S, Yadav SK, Akbari H, Verma G, Nath K, Haris M, Bagley S, Davatzikos C, Loevner LA, Mohan S. Metabolic and physiologic magnetic resonance imaging in distinguishing true progression from pseudoprogression in patients with glioblastoma. NMR IN BIOMEDICINE 2022; 35:e4719. [PMID: 35233862 PMCID: PMC9203929 DOI: 10.1002/nbm.4719] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 05/15/2023]
Abstract
Pseudoprogression (PsP) refers to treatment-related clinico-radiologic changes mimicking true progression (TP) that occurs in patients with glioblastoma (GBM), predominantly within the first 6 months after the completion of surgery and concurrent chemoradiation therapy (CCRT) with temozolomide. Accurate differentiation of TP from PsP is essential for making informed decisions on appropriate therapeutic intervention as well as for prognostication of these patients. Conventional neuroimaging findings are often equivocal in distinguishing between TP and PsP and present a considerable diagnostic dilemma to oncologists and radiologists. These challenges have emphasized the need for developing alternative imaging techniques that may aid in the accurate diagnosis of TP and PsP. In this review, we encapsulate the current state of knowledge in the clinical applications of commonly used metabolic and physiologic magnetic resonance (MR) imaging techniques such as diffusion and perfusion imaging and proton spectroscopy in distinguishing TP from PsP. We also showcase the potential of promising imaging techniques, such as amide proton transfer and amino acid-based positron emission tomography, in providing useful information about the treatment response. Additionally, we highlight the role of "radiomics", which is an emerging field of radiology that has the potential to change the way in which advanced MR techniques are utilized in assessing treatment response in GBM patients. Finally, we present our institutional experiences and discuss future perspectives on the role of multiparametric MR imaging in identifying PsP in GBM patients treated with "standard-of-care" CCRT as well as novel/targeted therapies.
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Affiliation(s)
- Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sultan Bukhari
- Rowan School of Osteopathic Medicine at Rowan University, Voorhees, New Jersey, USA
| | - Omar M. Afridi
- Rowan School of Osteopathic Medicine at Rowan University, Voorhees, New Jersey, USA
| | - Sumei Wang
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, New York, USA
| | - Santosh K. Yadav
- Laboratory of Functional and Molecular Imaging, Sidra Medicine, Doha, Qatar
| | - Hamed Akbari
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gaurav Verma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Kavindra Nath
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mohammad Haris
- Laboratory of Functional and Molecular Imaging, Sidra Medicine, Doha, Qatar
| | - Stephen Bagley
- Department of Hematology-Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christos Davatzikos
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Laurie A. Loevner
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kumar M, Nanga RPR, Verma G, Wilson N, Brisset JC, Nath K, Chawla S. Emerging MR Imaging and Spectroscopic Methods to Study Brain Tumor Metabolism. Front Neurol 2022; 13:789355. [PMID: 35370872 PMCID: PMC8967433 DOI: 10.3389/fneur.2022.789355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Proton magnetic resonance spectroscopy (1H-MRS) provides a non-invasive biochemical profile of brain tumors. The conventional 1H-MRS methods present a few challenges mainly related to limited spatial coverage and low spatial and spectral resolutions. In the recent past, the advent and development of more sophisticated metabolic imaging and spectroscopic sequences have revolutionized the field of neuro-oncologic metabolomics. In this review article, we will briefly describe the scientific premises of three-dimensional echoplanar spectroscopic imaging (3D-EPSI), two-dimensional correlation spectroscopy (2D-COSY), and chemical exchange saturation technique (CEST) MRI techniques. Several published studies have shown how these emerging techniques can significantly impact the management of patients with glioma by determining histologic grades, molecular profiles, planning treatment strategies, and assessing the therapeutic responses. The purpose of this review article is to summarize the potential clinical applications of these techniques in studying brain tumor metabolism.
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Affiliation(s)
- Manoj Kumar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ravi Prakash Reddy Nanga
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Gaurav Verma
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Neil Wilson
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | | | - Kavindra Nath
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
- *Correspondence: Sanjeev Chawla
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Batalov AI, Zakharova NE, Pronin IN, Belyaev AY, Pogosbekyan EL, Goryaynov SA, Bykanov AE, Tyurina AN, Shevchenko AM, Solozhentseva KD, Nikitin PV, Potapov AA. 3D pCASL-perfusion in preoperative assessment of brain gliomas in large cohort of patients. Sci Rep 2022; 12:2121. [PMID: 35136119 PMCID: PMC8826414 DOI: 10.1038/s41598-022-05992-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/18/2022] [Indexed: 01/02/2023] Open
Abstract
The aim of the study was to evaluate the role of pseudocontinuous arterial spin labeling perfusion (pCASL-perfusion) in preoperative assessment of cerebral glioma grades. The study group consisted of 253 patients, aged 7-78 years with supratentorial gliomas (65 low-grade gliomas (LGG), 188 high-grade gliomas (HGG)). We used 3D pCASL-perfusion for each patient in order to calculate the tumor blood flow (TBF). We obtained maximal tumor blood flow (maxTBF) in small regions of interest (30 ± 10 mm2) and then normalized absolute maximum tumor blood flow (nTBF) to that of the contralateral normal-appearing white matter of the centrum semiovale. MaxTBF and nTBF values significantly differed between HGG and LGG groups (p < 0.001), as well as between patient groups separated by the grades (grade II vs. grade III) (p < 0.001). Moreover, we performed ROC-analysis which demonstrated high sensitivity and specificity in differentiating between HGG and LGG. We found significant differences for maxTBF and nTBF between grade III and IV gliomas, however, ROC-analysis showed low sensitivity and specificity. We did not observe a significant difference in TBF for astrocytomas and oligodendrogliomas. Our study demonstrates that 3D pCASL-perfusion as an effective diagnostic tool for preoperative differentiation of glioma grades.
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Affiliation(s)
- A I Batalov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - N E Zakharova
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - I N Pronin
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A Yu Belyaev
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - E L Pogosbekyan
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - S A Goryaynov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A E Bykanov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A N Tyurina
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A M Shevchenko
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.
| | - K D Solozhentseva
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - P V Nikitin
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A A Potapov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Hatakeyama J, Ono T, Takahashi M, Oda M, Shimizu H. Differentiating between Primary Central Nervous System Lymphoma and Glioblastoma: The Diagnostic Value of Combining 18F-fluorodeoxyglucose Positron Emission Tomography with Arterial Spin Labeling. Neurol Med Chir (Tokyo) 2021; 61:367-375. [PMID: 33967177 PMCID: PMC8258004 DOI: 10.2176/nmc.oa.2020-0375] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Using conventional magnetic resonance imaging (MRI) methods, the differentiation of primary central nervous system lymphoma (PCNSL) and glioblastoma (GBM) is often difficult due to overlapping imaging characteristics. This study aimed to evaluate the diagnostic value of combining 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) with arterial spin labeling (ASL) for differentiating PCNSL from GBM. In all, 20 patients with PCNSL and 55 with GBM were retrospectively examined. From the FDG-PET data, the maximum standardized uptake values (SUVmax) and the ratio of tumor to normal contralateral gray matter (T/N_SUVmax) were calculated. From the ASL data, the T/N ratio of the maximum tumor blood flow (relative TBFmax: rTBFmax) was obtained. Diagnostic performance of each parameter was analyzed using univariate and multivariate logistic regression analyses and receiver-operating characteristic (ROC) curve analyses. A generalized linear model was applied for comparing the performance of FDG-PET and ASL individually, and in combination. In univariate analysis, SUVmax and T/N_SUVmax were statistically higher in patients with PCNSL and rTBFmax was higher in patients with GBM. In the multivariate analysis, T/N_SUVmax and rTBFmax were statistically independent. The sensitivity, specificity, and area under the curve (AUC) for discriminating PCNSL from GBM were 100%, 87.3%, and 0.950 in T/N_SUVmax; 90%, 72.7%, and 0.824 in rTBFmax; and 95%, 96.4%, and 0.991 in the combined model, respectively. The combined use of T/N_SUVmax and rTBFmax may contribute to better differentiation between PCNSL and GBM.
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Affiliation(s)
- Junya Hatakeyama
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Takahiro Ono
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Masataka Takahashi
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Masaya Oda
- Department of Neurosurgery, Akita University Graduate School of Medicine
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Graduate School of Medicine
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7
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Su C, Jiang J, Liu C, Shi J, Li S, Chen X, Ao Q. Comparison of amide proton transfer imaging and magnetization transfer imaging in revealing glioma grades and proliferative activities: a histogram analysis. Neuroradiology 2020; 63:685-693. [PMID: 32997164 DOI: 10.1007/s00234-020-02547-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Comprehensive understanding glioma metabolic characters is of great help for patient management. We aimed to compare amide proton transfer imaging (APTw) and magnetization transfer imaging (MT) in predicting glioma malignancy and reflecting tumor proliferation. METHODS Thirty low-grade gliomas (LGGs) and 39 high-grade gliomas (HGGs) were prospectively included, of which 58 samples Ki-67 levels were quantified. Anatomical MRI, APTw, and MT were scanned, and magnetization transfer ratio (MTR) and asymmetric magnetic transfer ratio at 3.5 ppm (MTRasym(3.5ppm)) were calculated. ROIs were semi-automatically drawn with ImageJ, from which histogram features, including 5th, 25th, 50th, mean, 70th, 90th, and 95th percentiles were extracted. The independent t test was used to test differences in LGGs and HGGs, and correlations between histogram features and tumor grades, Ki-67 were revealed by Spearman's rank or Pearson's correlation analysis. RESULTS The maximum correlation coefficient (R) values of APTw were 0.526 (p < 0.001) with tumor grades and 0.397 (p < 0.001) with Ki-67 at 90th percentiles, while only 5th and 25th percentiles of MT significantly correlated with tumor grades. Moreover, APTw features were significantly different in LGGs and HGGs, except 5th percentile. The most significantly different feature was 95th percentile, providing the excellent AUC of 0.808. However, the best feature in MTR was 5th percentiles with AUC of 0.703. Combing 5th and 95th of APTw achieved highest AUC Of 0.837. CONCLUSIONS Both APTw and MT provide quantitative information for tumor metabolite imaging. However, APTw supplys more specific information in reflecting glioma biological behaviors than MT, and well differentiates glioma malignancy.
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Affiliation(s)
- Changliang Su
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
| | - Jingjing Jiang
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 JieFang Avenue, Hankou, Wuhan, 430030, People's Republic of China
| | - Chengxia Liu
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 JieFang Avenue, Hankou, Wuhan, 430030, People's Republic of China
| | - JingJing Shi
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 JieFang Avenue, Hankou, Wuhan, 430030, People's Republic of China
| | - Shihui Li
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 JieFang Avenue, Hankou, Wuhan, 430030, People's Republic of China
| | - Xiaowei Chen
- The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qilin Ao
- Department of Pathology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, No. 1095 JieFang Avenue, Hankou, Wuhan, 430030, People's Republic of China
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8
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Hashido T, Saito S, Ishida T. A radiomics-based comparative study on arterial spin labeling and dynamic susceptibility contrast perfusion-weighted imaging in gliomas. Sci Rep 2020; 10:6121. [PMID: 32273523 PMCID: PMC7145821 DOI: 10.1038/s41598-020-62658-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/09/2020] [Indexed: 01/16/2023] Open
Abstract
Radiomics has potential for reflecting the differences in glioma perfusion heterogeneity between arterial spin labeling (ASL) and dynamic susceptibility contrast (DSC) imaging. The aim of this study was to compare radiomic features of ASL and DSC imaging-derived parameters (cerebral blood flow, CBF) and assess radiomics-based classification models for low-grade gliomas (LGGs) and high-grade gliomas (HGGs) using their parameters. The ASL-CBF and DSC-relative CBF of 46 glioma patients were normalized (ASL-nCBF and DSC-nrCBF) for data analysis. For each map, 91 radiomic features were extracted from the tumor volume. Seventy-five radiomic features were significantly different (P < 0.00055) between ASL-nCBF and DSC-nrCBF. Positive correlations were observed in 75 radiomic features between ASL-nCBF and DSC-nrCBF. Even though ASL imaging underestimated CBF compared with DSC imaging, there were significant correlations (P < 0.00055) in the first-order-based mean, median, 90th percentile, and maximum. Texture analysis showed that ASL-nCBF and DSC-nrCBF characterized similar perfusion patterns, while ASL-nCBF could evaluate perfusion heterogeneity better. The areas under the curve of the ASL-nCBF and DSC-nrCBF radiomics-based classification models for gliomas were 0.888 and 0.962, respectively. Radiomics in ASL and DSC imaging is useful for characterizing glioma perfusion patterns quantitatively and for classifying LGGs and HGGs.
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Affiliation(s)
- Takashi Hashido
- Department of Medical Technology, Osaka University Hospital, Suita, Osaka, Japan.,Department of Medical Physics and Engineering, Division of Health Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shigeyoshi Saito
- Department of Medical Physics and Engineering, Division of Health Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayuki Ishida
- Department of Medical Physics and Engineering, Division of Health Science, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Gonçalves FG, Chawla S, Mohan S. Emerging MRI Techniques to Redefine Treatment Response in Patients With Glioblastoma. J Magn Reson Imaging 2020; 52:978-997. [PMID: 32190946 DOI: 10.1002/jmri.27105] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/14/2022] Open
Abstract
Glioblastoma is the most common and most malignant primary brain tumor. Despite aggressive multimodal treatment, its prognosis remains poor. Even with continuous developments in MRI, which has provided us with newer insights into the diagnosis and understanding of tumor biology, response assessment in the posttherapy setting remains challenging. We believe that the integration of additional information from advanced neuroimaging techniques can further improve the diagnostic accuracy of conventional MRI. In this article, we review the utility of advanced neuroimaging techniques such as diffusion-weighted imaging, diffusion tensor imaging, perfusion-weighted imaging, proton magnetic resonance spectroscopy, and chemical exchange saturation transfer in characterizing and evaluating treatment response in patients with glioblastoma. We will also discuss the existing challenges and limitations of using these techniques in clinical settings and possible solutions to avoiding pitfalls in study design, data acquisition, and analysis for future studies. LEVEL OF EVIDENCE: 2 TECHNICAL EFFICACY STAGE: 3 J. Magn. Reson. Imaging 2020;52:978-997.
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Affiliation(s)
| | - Sanjeev Chawla
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Suyash Mohan
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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10
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Zhao SS, Feng XL, Hu YC, Han Y, Tian Q, Sun YZ, Zhang J, Ge XW, Cheng SC, Li XL, Mao L, Shen SN, Yan LF, Cui GB, Wang W. Better efficacy in differentiating WHO grade II from III oligodendrogliomas with machine-learning than radiologist's reading from conventional T1 contrast-enhanced and fluid attenuated inversion recovery images. BMC Neurol 2020; 20:48. [PMID: 32033580 PMCID: PMC7007642 DOI: 10.1186/s12883-020-1613-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 01/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background The medical imaging to differentiate World Health Organization (WHO) grade II (ODG2) from III (ODG3) oligodendrogliomas still remains a challenge. We investigated whether combination of machine leaning with radiomics from conventional T1 contrast-enhanced (T1 CE) and fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) offered superior efficacy. Methods Thirty-six patients with histologically confirmed ODGs underwent T1 CE and 33 of them underwent FLAIR MR examination before any intervention from January 2015 to July 2017 were retrospectively recruited in the current study. The volume of interest (VOI) covering the whole tumor enhancement were manually drawn on the T1 CE and FLAIR slice by slice using ITK-SNAP and a total of 1072 features were extracted from the VOI using 3-D slicer software. Random forest (RF) algorithm was applied to differentiate ODG2 from ODG3 and the efficacy was tested with 5-fold cross validation. The diagnostic efficacy of radiomics-based machine learning and radiologist’s assessment were also compared. Results Nineteen ODG2 and 17 ODG3 were included in this study and ODG3 tended to present with prominent necrosis and nodular/ring-like enhancement (P < 0.05). The AUC, ACC, sensitivity, and specificity of radiomics were 0.798, 0.735, 0.672, 0.789 for T1 CE, 0.774, 0.689, 0.700, 0.683 for FLAIR, as well as 0.861, 0.781, 0.778, 0.783 for the combination, respectively. The AUCs of radiologists 1, 2 and 3 were 0.700, 0.687, and 0.714, respectively. The efficacy of machine learning based on radiomics was superior to the radiologists’ assessment. Conclusions Machine-learning based on radiomics of T1 CE and FLAIR offered superior efficacy to that of radiologists in differentiating ODG2 from ODG3.
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Affiliation(s)
- Sha-Sha Zhao
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Xiu-Long Feng
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Yu Han
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Qiang Tian
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Ying-Zhi Sun
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Jie Zhang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Xiang-Wei Ge
- Student Brigade, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Si-Chao Cheng
- Student Brigade, Air Force Medical University, Xi'an, 710032, Shaanxi, China
| | - Xiu-Li Li
- Deepwise AI Lab, Deepwise Inc, No.8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Li Mao
- Deepwise AI Lab, Deepwise Inc, No.8 Haidian avenue, Sinosteel International Plaza, Beijing, 100080, China
| | - Shu-Ning Shen
- Department of Stomatology, PLA 984 Hospital, Beijing, China
| | - Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Air Force Medical University, 569 Xinsi Road, Xi'an, 710038, Shaanxi, People's Republic of China.
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11
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Pseudo-continuous arterial spin labelling shows high diagnostic performance in the detection of postoperative residual lesion in hyper-vascularised adult brain tumours. Eur Radiol 2020; 30:2809-2820. [PMID: 31965259 DOI: 10.1007/s00330-019-06474-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/26/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Our aim was to evaluate the contribution of pseudo-continuous arterial spin labelling (pCASL) in the detection of a postoperative residual lesion in adult brain tumours. METHODS Seventy-five patients were prospectively included. Following the results of preoperative DSC-PWI assessment, intra-axial lesions, including high-grade gliomas (n = 43) and certain metastases (n = 14), were classified as hyper-vascular (HV+ group, n = 57); other lesions, including low-grade gliomas and certain metastases, were classified as non-hyper-vascular (HV- group, n = 18). To confirm the absence/presence of a residual lesion or disease progression, postoperative MRI including pCASL sequence and follow-up-MRI were performed within 72 h and 1-6 months after the resection, respectively. Two raters evaluated the images. Mean and maximal ASL cerebral blood flow (CBF) values were measured in the perioperative region and normalised to the contralateral tissue. The pCASL-CBF maps and post-contrast T1WI were visually assessed for residual lesion. Quantitative data were analysed with unpaired Student t and Mann-Whitney U tests and the visual diagnostic performance with the McNemar test. RESULTS In the HV+ group, the mean normalised CBF was 1.97 ± 0.59 and 0.97 ± 0.29 (p < 0.0001, AUC = 0.964, cut-off = 1.27) for patients with or without residual tumours, respectively. The mean normalised CBF was not discriminative for assessing residual tumours in the HV- group (p = 0.454). Visual CBF evaluation allowed 92.98% patients belonging to the HV+ group to be correctly classified (sensitivity 93.02%, specificity 92.86%, p < 0.001). Visual evaluation was correlated with contrast enhancement evaluation and with the mean normalised CBF values (r = 0.505, p < 0.0001 and 0.838, p < 0.0001, respectively). CONCLUSION Qualitative and quantitative ASL evaluation shows high diagnostic performance in postoperative assessment of hyper-perfused tumours. In this case, postoperative pCASL may be useful, especially if contrast injection cannot be performed or when contrast enhancement is doubtful. KEY POINTS • Evaluation of postoperative residual lesion in the case of brain tumours is an imaging challenge. • This prospective monocentric study showed that increased normalised cerebral blood flow assessed by pseudo-continuous arterial spin labelling (pCASL) correlates well with the presence of a residual tumour in the case of hyper-vascular tumour diagnosed on preoperative MRI. • Qualitative and quantitative pCASL is an informative sequence for hyper-vascular residual tumour, especially if acquired more than 48 h after brain tumour surgery, when contrast enhancement can give ambiguous results due to blood-brain barrier disruption.
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12
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Aydin S, Fatihoğlu E, Koşar PN, Ergün E. Perfusion and permeability MRI in glioma grading. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-019-0127-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
MRI is successful in showing the anatomy of probable pathologies of the central nervous system. Although it may not be sufficient to reveal physiological and metabolic changes, advanced MRI techniques, such as perfusion and permeability MRI, are the key to overcoming these limitations. The aim of this study was to detect the efficacy of permeability and perfusion MRI techniques.
Results
The study included 38 patients with a pathology result of primary brain glioma. The permeability MRI (Ktrans, Ve), perfusion MRI values (CBV, CBF), and pathology results were evaluated. The high-grade group included 22 patients, and the low-grade group, 16 patients. Mean CBV and CBF, median Ktrans, and Ve values were higher in the high-grade group. All parameters tended to elevate with grade and had a positive correlation. CBV > 2.25, with sensitivity and specificity of 100%, CBF > 2.02, with sensitivity and specificity of 100%, Ktrans > 0.043, with sensitivity of 81.82% and specificity of 100%, and Ve > 0.255, with sensitivity and specificity of 100%, can predict high grade.
Conclusion
Perfusion and permeability MRI can be used safely for the differentiation of high- and low-grade gliomas and for the prediction of glioma grades.
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13
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Natarajan SK, Venneti S. Glutamine Metabolism in Brain Tumors. Cancers (Basel) 2019; 11:E1628. [PMID: 31652923 PMCID: PMC6893651 DOI: 10.3390/cancers11111628] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/18/2019] [Accepted: 10/19/2019] [Indexed: 12/14/2022] Open
Abstract
Altered metabolism is a hallmark of cancer cells. Tumor cells rewire their metabolism to support their uncontrolled proliferation by taking up nutrients from the microenvironment. The amino acid glutamine is a key nutrient that fuels biosynthetic processes including ATP generation, redox homeostasis, nucleotide, protein, and lipid synthesis. Glutamine as a precursor for the neurotransmitter glutamate, and plays a critical role in the normal functioning of the brain. Brain tumors that grow in this glutamine/glutamate rich microenvironment can make synaptic connections with glutamatergic neurons and reprogram glutamine metabolism to enable their growth. In this review, we examine the functions of glutamate/glutamine in the brain and how brain tumor cells reprogram glutamine metabolism. Altered glutamine metabolism can be leveraged to develop non-invasive imaging strategies and we review these imaging modalities. Finally, we examine if targeting glutamine metabolism could serve as a therapeutic strategy in brain tumors.
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Affiliation(s)
- Siva Kumar Natarajan
- Laboratory of Brain Tumor Metabolism and Epigenetics, Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - Sriram Venneti
- Laboratory of Brain Tumor Metabolism and Epigenetics, Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
- Department of Pathology, University of Michigan 3520E MSRB 1, 1150 West Medical Center Drive, Ann Arbor, MI 41804, USA.
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Chawla S, Lee SC, Mohan S, Wang S, Nasrallah M, Vossough A, Krejza J, Melhem ER, Nabavizadeh SA. Lack of choline elevation on proton magnetic resonance spectroscopy in grade I-III gliomas. Neuroradiol J 2019; 32:250-258. [PMID: 31050313 DOI: 10.1177/1971400919846509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Elevated levels of choline are generally emphasized as marker of increased cellularity and cell membrane turnover in gliomas. In this study, we investigated the incidence rate of lack of choline/creatine and choline/water elevation in a population of grade I-III gliomas. A cohort of 41 patients with histopathologically confirmed gliomas underwent multi-voxel proton magnetic resonance spectroscopy on a 3 T magnetic resonance system prior to treatment. Peak areas for choline and myoinositol were measured from all voxels that exhibited hyperintensity on fluid-attenuated inversion recovery images and were normalized to creatine and unsuppressed water from each voxel. The average metabolite/creatine and metabolite/water ratios from these voxels were then computed. Similarly, average metabolite ratios were computed from normal brain parenchyma. Gliomas were considered for lack of choline elevation when choline/creatine and choline/water ratios from neoplastic regions were less than those from normal brain parenchyma regions. Six of 41 (14.6%) grade I-III gliomas showed lack of elevation for choline/creatine and choline/water ratios compared to normal brain parenchyma. Four of these six gliomas also demonstrated elevated levels of myoinositol/creatine ratio. All other gliomas (n = 35) had elevated choline levels from neoplastic regions relative to normal parenchyma. The sensitivity of choline/creatine or choline/water in determining a grade I-III glioma was 85.4%. These findings suggest that a lack of choline/creatine or choline/water elevation may be seen in some gliomas and low choline levels should not prevent us from considering the possibility of a grade I-III glioma.
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Affiliation(s)
- Sanjeev Chawla
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Seung-Cheol Lee
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Suyash Mohan
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Sumei Wang
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
| | - MacLean Nasrallah
- 2 Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, USA
| | - Arastoo Vossough
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA.,3 Department of Radiology, Children's Hospital of Philadelphia, USA
| | - Jaroslaw Krejza
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA.,4 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, USA
| | - Elias R Melhem
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA.,4 Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, USA
| | - S Ali Nabavizadeh
- 1 Departments of Radiology, Perelman School of Medicine at the University of Pennsylvania, USA
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15
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Alsaedi A, Doniselli F, Jäger HR, Panovska-Griffiths J, Rojas-Garcia A, Golay X, Bisdas S. The value of arterial spin labelling in adults glioma grading: systematic review and meta-analysis. Oncotarget 2019; 10:1589-1601. [PMID: 30899427 PMCID: PMC6422184 DOI: 10.18632/oncotarget.26674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 02/01/2019] [Indexed: 12/20/2022] Open
Abstract
This study aimed to evaluate the diagnostic performance of arterial spin labelling (ASL) in grading of adult gliomas. Eighteen studies matched the inclusion criteria and were included after systematic searches through EMBASE and MEDLINE databases. The quality of the included studies was assessed utilizing Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The quantitative values were extracted and a meta-analysis was subsequently based on a random-effect model with forest plot and joint sensitivity and specificity modelling. Hierarchical summary receiver operating characteristic (HROC) curve analysis was also conducted. The absolute tumour blood flow (TBF) values can differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) and grade II from grade IV tumours. However, it lacked the capacity to differentiate grade II from grade III tumours and grade III from grade IV tumours. In contrast, the relative TBF (rTBF) is effective in differentiating HGG from LGG and in glioma grading. The maximum rTBF (rTBFmax) demonstrated the best results in glioma grading. These results were also reflected in the sensitivity/specificity analysis in which the rTBFmax showed the highest discrimination performance in glioma grading. The estimated effect size for the rTBF was approximately similar between HGGs and LGGs, and grade II and grade III tumours, (-1.46 (-2.00, -0.91), p-value < 0.001), (-1.39 (-1.89, -0.89), p-value < 0.001), respectively; while it exhibited smaller effect size between grade III and grade IV (-1.05 (-1.82, -0.27)), p < 0.05). Sensitivity and specificity analysis replicate these results as well. This meta-analysis suggests that ASL is useful for glioma grading, especially when considering the rTBFmax parameter.
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Affiliation(s)
- Amirah Alsaedi
- Department of Radiology Technology, Taibah University, Medina, KSA.,Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK
| | - Fabio Doniselli
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.,PhD Course in Clinical Research, Università degli Studi di Milano, Milan, Italy
| | - Hans Rolf Jäger
- Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
| | | | | | - Xavier Golay
- Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK
| | - Sotirios Bisdas
- Department of Brain Repair & Rehabilitation, Queen Square Institute of Neurology, University College London, London, UK.,Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Trust, London, UK
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16
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Verma G, Chawla S, Mohan S, Wang S, Nasrallah M, Sheriff S, Desai A, Brem S, O'Rourke DM, Wolf RL, Maudsley AA, Poptani H. Three-dimensional echo planar spectroscopic imaging for differentiation of true progression from pseudoprogression in patients with glioblastoma. NMR IN BIOMEDICINE 2019; 32:e4042. [PMID: 30556932 PMCID: PMC6519064 DOI: 10.1002/nbm.4042] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 05/20/2023]
Abstract
Accurate differentiation of true progression (TP) from pseudoprogression (PsP) in patients with glioblastomas (GBMs) is essential for planning adequate treatment and for estimating clinical outcome measures and future prognosis. The purpose of this study was to investigate the utility of three-dimensional echo planar spectroscopic imaging (3D-EPSI) in distinguishing TP from PsP in GBM patients. For this institutional review board approved and HIPAA compliant retrospective study, 27 patients with GBM demonstrating enhancing lesions within six months of completion of concurrent chemo-radiation therapy were included. Of these, 18 were subsequently classified as TP and 9 as PsP based on histological features or follow-up MRI studies. Parametric maps of choline/creatine (Cho/Cr) and choline/N-acetylaspartate (Cho/NAA) were computed and co-registered with post-contrast T1 -weighted and FLAIR images. All lesions were segmented into contrast enhancing (CER), immediate peritumoral (IPR), and distal peritumoral (DPR) regions. For each region, Cho/Cr and Cho/NAA ratios were normalized to corresponding metabolite ratios from contralateral normal parenchyma and compared between TP and PsP groups. Logistic regression analyses were performed to obtain the best model to distinguish TP from PsP. Significantly higher Cho/NAA was observed from CER (2.69 ± 1.00 versus 1.56 ± 0.51, p = 0.003), IPR (2.31 ± 0.92 versus 1.53 ± 0.56, p = 0.030), and DPR (1.80 ± 0.68 versus 1.19 ± 0.28, p = 0.035) regions in TP patients compared with those with PsP. Additionally, significantly elevated Cho/Cr (1.74 ± 0.44 versus 1.34 ± 0.26, p = 0.023) from CER was observed in TP compared with PsP. When these parameters were incorporated in multivariate regression analyses, a discriminatory model with a sensitivity of 94% and a specificity of 87% was observed in distinguishing TP from PsP. These results indicate the utility of 3D-EPSI in differentiating TP from PsP with high sensitivity and specificity.
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Affiliation(s)
- Gaurav Verma
- Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Sanjeev Chawla
- Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Suyash Mohan
- Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Sumei Wang
- Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - MacLean Nasrallah
- Department of Pathology and Lab MedicinePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | | | - Arati Desai
- Department of Hematology‐OncologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Steven Brem
- Department of NeurosurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Donald M. O'Rourke
- Department of NeurosurgeryPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | - Ronald L. Wolf
- Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
| | | | - Harish Poptani
- Department of RadiologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPAUSA
- Department of Cellular and Molecular PhysiologyUniversity of LiverpoolLiverpoolUK
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17
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Neal A, Moffat BA, Stein JM, Nanga RPR, Desmond P, Shinohara RT, Hariharan H, Glarin R, Drummond K, Morokoff A, Kwan P, Reddy R, O'Brien TJ, Davis KA. Glutamate weighted imaging contrast in gliomas with 7 Tesla magnetic resonance imaging. NEUROIMAGE-CLINICAL 2019; 22:101694. [PMID: 30822716 PMCID: PMC6396013 DOI: 10.1016/j.nicl.2019.101694] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/10/2019] [Accepted: 01/27/2019] [Indexed: 01/04/2023]
Abstract
Introduction Diffuse gliomas are incurable malignancies, which undergo inevitable progression and are associated with seizure in 50–90% of cases. Glutamate has the potential to be an important glioma biomarker of survival and local epileptogenicity if it can be accurately quantified noninvasively. Methods We applied the glutamate-weighted imaging method GluCEST (glutamate chemical exchange saturation transfer) and single voxel MRS (magnetic resonance spectroscopy) at 7 Telsa (7 T) to patients with gliomas. GluCEST contrast and MRS metabolite concentrations were quantified within the tumour region and peritumoural rim. Clinical variables of tumour aggressiveness (prior adjuvant therapy and previous radiological progression) and epilepsy (any prior seizures, seizure in last month and drug refractory epilepsy) were correlated with respective glutamate concentrations. Images were separated into post-hoc determined patterns and clinical variables were compared across patterns. Results Ten adult patients with a histo-molecular (n = 9) or radiological (n = 1) diagnosis of grade II-III diffuse glioma were recruited, 40.3 +/− 12.3 years. Increased tumour GluCEST contrast was associated with prior adjuvant therapy (p = .001), and increased peritumoural GluCEST contrast was associated with both recent seizures (p = .038) and drug refractory epilepsy (p = .029). We distinguished two unique GluCEST contrast patterns with distinct clinical and radiological features. MRS glutamate correlated with GluCEST contrast within the peritumoural voxel (R = 0.89, p = .003) and a positive trend existed in the tumour voxel (R = 0.65, p = .113). Conclusion This study supports the role of glutamate in diffuse glioma biology. It further implicates elevated peritumoural glutamate in epileptogenesis and altered tumour glutamate homeostasis in glioma aggressiveness. Given the ability to non-invasively visualise and quantify glutamate, our findings raise the prospect of 7 T GluCEST selecting patients for individualised therapies directed at the glutamate pathway. Larger studies with prospective follow-up are required. 7 T GluCEST glioma imaging is feasible, producing high quality quantifiable images. Increased peritumoural GluCEST contrast correlates with drug resistant epilepsy. Increased tumour GluCEST contrast is associated with prior adjuvant therapy. Two GluCEST patterns were identified with distinct clinico-radiological features. GluCEST contrast correlates with MRS glutamate in peritumoural regions.
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Affiliation(s)
- Andrew Neal
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia.
| | - Bradford A Moffat
- Melbourne Node of the National Imaging Facility, Department of Radiology, University of Melbourne, Australia
| | - Joel M Stein
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - Ravi Prakash Reddy Nanga
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Patricia Desmond
- Department of Radiology, Royal Melbourne Hospital, Australia; Department of Radiology and Medicine, University of Melbourne, Australia
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, PA, United States
| | - Hari Hariharan
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Rebecca Glarin
- Department of Radiology, Royal Melbourne Hospital, Australia; Department of Radiology and Medicine, University of Melbourne, Australia
| | - Katharine Drummond
- Department of Neurosurgery, Royal Melbourne Hospital, Australia; Department of Surgery, University of Melbourne, Australia; Melbourne Brain Centre, The Royal Melbourne Hospital, Australia
| | - Andrew Morokoff
- Department of Neurosurgery, Royal Melbourne Hospital, Australia; Department of Surgery, University of Melbourne, Australia
| | - Patrick Kwan
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Neurology, The Alfred Hospital Monash University, Australia
| | - Ravinder Reddy
- Center for Magnetic Resonance & Optical Imaging, Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States
| | - Terence J O'Brien
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Royal Melbourne Hospital, Australia; Department of Neuroscience, Central Clinical School, Monash University, Australia; Department of Neurology, The Alfred Hospital Monash University, Australia
| | - Kathryn A Davis
- Penn Epilepsy Center, Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
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Su C, Jiang J, Zhang S, Shi J, Xu K, Shen N, Zhang J, Li L, Zhao L, Zhang J, Qin Y, Liu Y, Zhu W. Radiomics based on multicontrast MRI can precisely differentiate among glioma subtypes and predict tumour-proliferative behaviour. Eur Radiol 2018; 29:1986-1996. [PMID: 30315419 DOI: 10.1007/s00330-018-5704-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore the feasibility and diagnostic performance of radiomics based on anatomical, diffusion and perfusion MRI in differentiating among glioma subtypes and predicting tumour proliferation. METHODS 220 pathology-confirmed gliomas and ten contrasts were included in the retrospective analysis. After being registered to T2FLAIR images and resampling to 1 mm3 isotropically, 431 radiomics features were extracted from each contrast map within a semi-automatic defined tumour volume. For single-contrast and the combination of all contrasts, correlations between the radiomics features and pathological biomarkers were revealed by partial correlation analysis, and multivariate models were built to identify the best predictive models with adjusted 0.632+ bootstrap AUC. RESULTS In univariate analysis, both non-wavelet and wavelet radiomics features were correlated significantly with tumour grade and the Ki-67 labelling index. The max R was 0.557 (p = 2.04E-14) in T1C for tumour grade and 0.395 (p = 2.33E-07) in ADC for Ki-67. In the multivariate analysis, the combination of all-contrast radiomics features had the highest AUCs in both differentiating among glioma subtypes and predicting proliferation compared with those in single-contrast images. For low-/high-grade gliomas, the best AUC was 0.911. In differentiating among glioma subtypes, the best AUC was 0.896 for grades II-III, 0.997 for grades II-IV, and 0.881 for grades III-IV. In predicting proliferation levels, multicontrast features led to an AUC of 0.936. CONCLUSION Multicontrast radiomics supplies complementary information on both geometric characters and molecular biological traits, which correlated significantly with tumour grade and proliferation. Combining all-contrast radiomics models might precisely predict glioma biological behaviour, which may be attributed to presurgical personal diagnosis. KEY POINTS • Multicontrast MRI radiomics features are significantly correlated with tumour grade and Ki-67 LI. • Multimodality MRI provides independent but supplemental information in assessing glioma pathological behaviour. • Combined multicontrast MRI radiomics can precisely predict glioma subtypes and proliferation levels.
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Affiliation(s)
- Changliang Su
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Jingjing Jiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Jingjing Shi
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Kaibin Xu
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Nanxi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Jiaxuan Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Li Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Lingyun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Ju Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Yuanyuan Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China
| | - Yong Liu
- Brainnetome Center and National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, China. .,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China. .,Center for Excellence in Brain Science and Intelligence Technology, Institute of Automation, Chinese Academy of Sciences, Beijing, China.
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, JieFang Avenue, Wuhan, Hubei, China.
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Pantel AR, Ackerman D, Lee SC, Mankoff DA, Gade TP. Imaging Cancer Metabolism: Underlying Biology and Emerging Strategies. J Nucl Med 2018; 59:1340-1349. [PMID: 30042161 PMCID: PMC6126440 DOI: 10.2967/jnumed.117.199869] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 06/18/2018] [Indexed: 12/22/2022] Open
Abstract
Dysregulated cellular metabolism is a characteristic feature of malignancy that has been exploited for both imaging and targeted therapy. With regard to imaging, deranged glucose metabolism has been leveraged using 18F-FDG PET. Metabolic imaging with 18F-FDG, however, probes only the early steps of glycolysis; the complexities of metabolism beyond these early steps in this single pathway are not directly captured. New imaging technologies-both PET with novel radiotracers and MR-based methods-provide unique opportunities to investigate other aspects of cellular metabolism and expand the metabolic imaging armamentarium. This review will discuss the underlying biology of metabolic dysregulation in cancer, focusing on glucose, glutamine, and acetate metabolism. Novel imaging strategies will be discussed within this biologic framework, highlighting particular strengths and limitations of each technique. Emphasis is placed on the role that combining modalities will play in enabling multiparametric imaging to fully characterize tumor biology to better inform treatment.
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Affiliation(s)
- Austin R Pantel
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel Ackerman
- Penn Image-Guided Interventions Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Seung-Cheol Lee
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - David A Mankoff
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Terence P Gade
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
- Penn Image-Guided Interventions Laboratory, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania; and
- Department of Cancer Biology, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Delgado AF, De Luca F, Hanagandi P, van Westen D, Delgado AF. Arterial Spin-Labeling in Children with Brain Tumor: A Meta-Analysis. AJNR Am J Neuroradiol 2018; 39:1536-1542. [PMID: 30072368 PMCID: PMC7410530 DOI: 10.3174/ajnr.a5727] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The value of arterial spin-labeling in a pediatric population has not been assessed in a meta-analysis. PURPOSE Our aim was to assess the diagnostic accuracy of arterial spin-labeling-derived cerebral blood flow to discriminate low- and high-grade tumors. DATA SOURCES MEDLINE, EMBASE, the Web of Science Core Collection, and the Cochrane Library were used. STUDY SELECTION Pediatric patients with arterial spin-labeling MR imaging with verified neuropathologic diagnoses were included. DATA ANALYSIS Relative CBF and absolute CBF and tumor grade were extracted, including sequence-specific information. Mean differences in CBF between low- and high-grade tumors were calculated. Study quality was assessed. DATA SYNTHESIS Data were aggregated using the bivariate summary receiver operating characteristic curve model. Heterogeneity was explored with meta-regression and subgroup analyses. The study protocol was published at PROSPERO (CRD42017075055). Eight studies encompassing 286 pediatric patients were included. The mean differences in absolute CBF were 29.62 mL/min/100 g (95% CI, 10.43-48.82 mL/min/100 g), I2 = 74, P = .002, and 1.34 mL/min/100 g (95% CI, 0.95-1.74 mL/min/100 g), P < .001, I2 = 38 for relative CBF. Pooled sensitivity for relative CBF ranged from 0.75 to 0.90, and specificity, from 0.77 to 0.92 with an area under curve = 0.92. Meta-regression showed no moderating effect of sequence parameters TE, TR, acquisition time, or ROI method. LIMITATIONS Included tumor types, analysis method, and original data varied among included studies. CONCLUSIONS Arterial spin-labeling-derived CBF measures showed high diagnostic accuracy for discriminating low- and high-grade tumors in pediatric patients with brain tumors. The relative CBF showed less variation among studies than the absolute CBF.
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Affiliation(s)
- A F Delgado
- From the Departments of Clinical Neuroscience (Anna F.D.)
| | - F De Luca
- Faculty of Medicine and Surgery (F.D.L.), School of Medicine and Health Sciences, University "G. d'Annunzio," Chieti, Italy
| | - P Hanagandi
- Neuroradiology (P.H.), Karolinska Institute, Stockholm, Sweden
| | - D van Westen
- Faculty of Medicine (D.v.W.), Clinical Sciences, Lund University, Sweden
| | - A F Delgado
- Department of Surgical Sciences (Alberto F.D.), Uppsala University, Uppsala, Sweden
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21
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Naveed MA, Goyal P, Malhotra A, Liu X, Gupta S, Mangla M, Mangla R. Grading of oligodendroglial tumors of the brain with apparent diffusion coefficient, magnetic resonance spectroscopy, and dynamic susceptibility contrast imaging. Neuroradiol J 2018; 31:379-385. [PMID: 29469659 DOI: 10.1177/1971400918757217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose We explored whether advanced magnetic resonance (MR) imaging techniques could grade oligodendrogliomas. Methods Forty patients (age 9-61 years) with oligodendroglial tumors were selected. There were 23 patients with World Health Organization grade II (group 1) and 17 patients with grade III (group 2) tumors. Apparent diffusion coefficient (ADC) maps were calculated by b values of 0 and 1000 s/mm2. Dynamic susceptibility contrast (DSC) images were obtained during the first pass of a bolus of gadolinium-based contrast. These data were post-processed and cerebral blood volume (CBV) maps and permeability (PS) were calculated. MR spectroscopy was acquired after drawing a region of interest on the tumor using two-dimensional chemical shift imaging. Statistical analysis was performed using SPSS software. Results When the rPSmax was combined with the rCBVmax, there was a significant difference between the two groups ( p ≤ 0.03) with area under the curve of 0.742 (95% CI: 0.412-0.904). rCBV, rADC, choline/creatine, and choline/NAA alone were able to differentiate between the two groups; however, they did not show any statistical difference with p values of ≤ 0.121, ≤ 0.722, and ≤ 0.582, respectively. A CBV PS product threshold of 0.53 provided a sensitivity of 80% and a specificity of 83.3% in detection of grade III tumors. Conclusion Combined rCBVmax and rPSmax can be utilized to grade oligodendrogliomas. ADC values, relative cerebral blood volume (rCBV), and MR spectroscopy alone can be utilized to differentiate between the two groups of oligodendrogliomas but without statistical significance.
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Affiliation(s)
| | - Pradeep Goyal
- 2 Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | - Xiang Liu
- 4 Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Sonali Gupta
- 5 Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | - Rajiv Mangla
- 1 Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
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22
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Batalov AI, Zakharova NE, Pogosbekyan EL, Fadeeva LM, Goryaynov SA, Baev AA, Shul'ts EI, Chelushkin DM, Potapov AA, Pronin IN. [Non-contrast ASL perfusion in preoperative diagnosis of supratentorial gliomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2018; 82:15-22. [PMID: 30721213 DOI: 10.17116/neiro20188206115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to investigate the potential of pseudocontinuous arterial spin labeling perfusion (pCASL) in assessing the degree of malignancy of brain gliomas at the preoperative stage. MATERIAL AND METHODS: The study included 126 patients aged 12-75 years with supratentorial gliomas of different malignancy (35 low-grade gliomas and 91 high-grade gliomas). The maximum tumor blood flow (TBF) was measured, and the normalized tumor blood flow (nTBF) was calculated relative to the intact semiovale white matter of the contralateral hemisphere. The TBF and nTBF indicators differed significantly between low-grade and high-grade glioma groups (p<0.001). When using TBF and nTBF in the differential diagnosis of low-grade and high-grade gliomas, the area under the ROC curve was 0.96 in both cases. Our findings suggest that 3D pCASL perfusion is an effective technique for preoperative differential diagnosis of low-grade and high-grade gliomas. The study was supported by the Russian Foundation for Basic Research (grant #18-315-00384).
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Affiliation(s)
- A I Batalov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - L M Fadeeva
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Baev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E I Shul'ts
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Institute, Moscow, Russia
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23
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Zeng Q, Jiang B, Shi F, Ling C, Dong F, Zhang J. 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in the Preoperative Evaluation of Gliomas. AJNR Am J Neuroradiol 2017; 38:1876-1883. [PMID: 28729293 PMCID: PMC7963629 DOI: 10.3174/ajnr.a5299] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/22/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies showed conflicting results concerning the value of CBF maps obtained from arterial spin-labeling MR imaging in grading gliomas. This study was performed to investigate the effectiveness of CBF maps derived from 3D pseudocontinuous arterial spin-labeling in preoperatively assessing the grade, cellular proliferation, and prognosis of gliomas. MATERIALS AND METHODS Fifty-eight patients with pathologically confirmed gliomas underwent preoperative 3D pseudocontinuous arterial spin-labeling. The receiver operating characteristic curves for parameters to distinguish high-grade gliomas from low-grade gliomas were generated. Pearson correlation analysis was used to assess the correlation among parameters. Survival analysis was conducted with Cox regression. RESULTS Both maximum CBF and maximum relative CBF were significantly higher in high-grade gliomas than in low-grade gliomas (P < .001). The areas under the curve for maximum CBF and maximum relative CBF in distinguishing high-grade gliomas from low-grade gliomas were 0.828 and 0.863, respectively. Both maximum CBF and maximum relative CBF had no correlation with the Ki-67 index in all subjects and had a moderate negative correlation with the Ki-67 index in glioblastomas (r = -0.475, -0.534, respectively). After adjustment for age, a higher maximum CBF (P = .008) and higher maximum relative CBF (P = .005) were associated with worse progression-free survival in gliomas, while a higher maximum relative CBF (P = .033) was associated with better overall survival in glioblastomas. CONCLUSIONS 3D pseudocontinuous arterial spin-labeling-derived CBF maps are effective in preoperative evaluation of gliomas. Although gliomas with a higher blood flow are more malignant, glioblastomas with a lower blood flow are likely to be more aggressive.
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Affiliation(s)
- Q Zeng
- From the Departments of Neurosurgery (Q.Z., C.L., J.Z.)
| | | | - F Shi
- Neurology (F.S.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - C Ling
- From the Departments of Neurosurgery (Q.Z., C.L., J.Z.)
| | | | - J Zhang
- From the Departments of Neurosurgery (Q.Z., C.L., J.Z.)
- Brain Research Institute (J.Z.)
- Collaborative Innovation Center for Brain Science (J.Z.), Zhejiang University, Hangzhou, Zhejiang, China
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Brandão LA, Castillo M. Adult Brain Tumors: Clinical Applications of Magnetic Resonance Spectroscopy. Magn Reson Imaging Clin N Am 2017; 24:781-809. [PMID: 27742117 DOI: 10.1016/j.mric.2016.07.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Proton magnetic resonance spectroscopy (H-MRS) may be helpful in suggesting tumor histology and tumor grade and may better define tumor extension and the ideal site for biopsy compared with conventional magnetic resonance (MR) imaging. A multifunctional approach with diffusion-weighted imaging, perfusion-weighted imaging, and permeability maps, along with H-MRS, may enhance the accuracy of the diagnosis and characterization of brain tumors and estimation of therapeutic response. Integration of advanced imaging techniques with conventional MR imaging and the clinical history help to improve the accuracy, sensitivity, and specificity in differentiating tumors and nonneoplastic lesions.
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Affiliation(s)
- Lara A Brandão
- Clínica Felippe Mattoso, Av. Das Américas 700, sala 320, Barra da Tijuca, Rio de Janeiro 30112011, Brazil; Clínica IRM- Ressonância Magnética, Rua Capitão Salomão 44 Humaitá, Rio de Janeiro 22271040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
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25
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Affiliation(s)
- Lifeng Yang
- Laboratory for Systems Biology of Human Diseases, Rice University, Houston, Texas 77005
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, Texas 77005
| | - Sriram Venneti
- Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109
| | - Deepak Nagrath
- Laboratory for Systems Biology of Human Diseases, Rice University, Houston, Texas 77005
- Department of Chemical and Biomolecular Engineering, Rice University, Houston, Texas 77005
- Department of Bioengineering, Rice University, Houston, Texas 77005
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan 48109
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan 48109
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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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27
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Xu W, Wang Q, Shao A, Xu B, Zhang J. The performance of MR perfusion-weighted imaging for the differentiation of high-grade glioma from primary central nervous system lymphoma: A systematic review and meta-analysis. PLoS One 2017; 12:e0173430. [PMID: 28301491 PMCID: PMC5354292 DOI: 10.1371/journal.pone.0173430] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/19/2017] [Indexed: 12/16/2022] Open
Abstract
It is always a great challenge to distinguish high-grade glioma (HGG) from primary central nervous system lymphoma (PCNSL). We conducted a meta-analysis to assess the performance of MR perfusion-weighted imaging (PWI) in differentiating HGG from PCNSL. The heterogeneity and threshold effect were evaluated, and the sensitivity (SEN), specificity (SPE) and areas under summary receiver operating characteristic curve (SROC) were calculated. Fourteen studies with a total of 598 participants were included in this meta-analysis. The results indicated that PWI had a high level of accuracy (area under the curve (AUC) = 0.9415) for differentiating HGG from PCNSL by using the best parameter from each study. The dynamic susceptibility-contrast (DSC) technique might be an optimal index for distinguishing HGGs from PCNSLs (AUC = 0.9812). Furthermore, the DSC had the best sensitivity 0.963 (95%CI: 0.924, 0.986), whereas the arterial spin-labeling (ASL) displayed the best specificity 0.896 (95% CI: 0.781, 0.963) among those techniques. However, the variability of the optimal thresholds from the included studies suggests that further evaluation and standardization are needed before the techniques can be extensively clinically used.
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Affiliation(s)
- Weilin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qun Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Anwen Shao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Haidian District, Beijing, China
- * E-mail: (JZ); (BX)
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
- Brain Research Institute, Zhejiang University, Hangzhou, Zhejiang, China
- Collaborative Innovation Center for Brain Science, Zhejiang University, Hangzhou, Zhejiang, China
- * E-mail: (JZ); (BX)
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28
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García-Figueiras R, Baleato-González S, Padhani AR, Oleaga L, Vilanova JC, Luna A, Cobas Gómez JC. Proton magnetic resonance spectroscopy in oncology: the fingerprints of cancer? Diagn Interv Radiol 2017; 22:75-89. [PMID: 26712681 DOI: 10.5152/dir.2015.15009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Abnormal metabolism is a key tumor hallmark. Proton magnetic resonance spectroscopy (1H-MRS) allows measurement of metabolite concentration that can be utilized to characterize tumor metabolic changes. 1H-MRS measurements of specific metabolites have been implemented in the clinic. This article performs a systematic review of image acquisition and interpretation of 1H-MRS for cancer evaluation, evaluates its strengths and limitations, and correlates metabolite peaks at 1H-MRS with diagnostic and prognostic parameters of cancer in different tumor types.
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Affiliation(s)
- Roberto García-Figueiras
- Department of Radiology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
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Kong L, Chen H, Yang Y, Chen L. A meta-analysis of arterial spin labelling perfusion values for the prediction of glioma grade. Clin Radiol 2016; 72:255-261. [PMID: 27932251 DOI: 10.1016/j.crad.2016.10.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 07/23/2016] [Accepted: 10/25/2016] [Indexed: 12/16/2022]
Abstract
AIM To investigate the ability of arterial spin labelling (ASL) perfusion parameters to distinguish high-grade from low-grade gliomas. MATERIALS AND METHODS The PubMed and EMBASE databases were systematically searched for relevant articles published up to September 2015. Studies that evaluated both high- and low-grade gliomas using ASL were included. The random effect model was used to calculate the standardised mean difference (SMD) of maximum mean absolute tumour blood flow values (aTBFmax, aTBFmean) and maximum mean relative tumour blood flow (rTBFmax, rTBFmean) between high- and low-grade gliomas. RESULTS Nine studies encompassing 305 patients with high- and low-grade gliomas, met all inclusion and exclusion criteria and were included in the study. Compared with low-grade gliomas, high-grade gliomas had a significant increase in all ASL perfusion values: aTBFmax (SMD=0.70, 95% confidence interval [CI]: 0.22-1.19, p=0.0046); aTBFmean (SMD=0.86, 95% CI: 0.2-1.52, p=0.01); rTBFmax (SMD=1.08, 95% CI: 0.54-1.63, p=0.0001) and rTBFmean (SMD=0.88, 95% CI: 0.35-1.4, p=0.0011). CONCLUSIONS The current study results indicate that tumour blood flow from ASL differs significantly with respect to the glioma grade. Despite some limitations, there is evidence that ASL may be useful to distinguish high- and low-grade gliomas. Further larger-scale studies are necessary to examine the utility of ASL to distinguish tumour grade.
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Affiliation(s)
- L Kong
- Department of Anesthesiology, Anhui Provincial Cancer Hospital, Hefei 230031, China
| | - H Chen
- Department of Anesthesiology, Nanjing General Hospital of Nanjing Military Command, Nanjing 210002, China
| | - Y Yang
- Department of Anesthesiology, Anhui Provincial Cancer Hospital, Hefei 230031, China
| | - L Chen
- Department of Anesthesiology, Anhui Provincial Cancer Hospital, Hefei 230031, China.
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Abstract
The revolution in cancer genomics has uncovered a variety of clinically relevant mutations in primary brain tumours, creating an urgent need to develop non-invasive imaging biomarkers to assess and integrate this genetic information into the clinical management of patients. Metabolic reprogramming is a central hallmark of cancer, including brain tumours; indeed, many of the molecular pathways implicated in the pathogenesis of brain tumours result in reprogramming of metabolism. This relationship provides the opportunity to devise in vivo metabolic imaging modalities to improve diagnosis, patient stratification, and monitoring of treatment response. Metabolic phenomena, such as the Warburg effect and altered mitochondrial metabolism, can be leveraged to image brain tumours using techniques including PET and MRI. Moreover, genetic alterations, such as mutations affecting isocitrate dehydrogenase, are associated with unique metabolic signatures that can be detected using magnetic resonance spectroscopy. The need to translate our understanding of the molecular features of brain tumours into imaging modalities with clinical utility is growing; metabolic imaging provides a unique platform to achieve this objective. In this Review, we examine the molecular basis for metabolic reprogramming in brain tumours, and examine current non-invasive metabolic imaging strategies that can be used to interrogate these molecular characteristics with the ultimate goal of guiding and improving patient care.
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31
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Ata ES, Turgut M, Eraslan C, Dayanır YÖ. Comparison between dynamic susceptibility contrast magnetic resonance imaging and arterial spin labeling techniques in distinguishing malignant from benign brain tumors. Eur J Radiol 2016; 85:1545-53. [PMID: 27501887 DOI: 10.1016/j.ejrad.2016.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 04/30/2016] [Accepted: 05/24/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this study was to preliminarily compare unenhanced arterial spin-labeled (ASL) imaging, dynamic susceptibility contrast-enhanced cerebral blood volume (DSCE-CBV) magnetic resonance imaging (MRI) for evaluation of tumor perfusion in patients with brain tumors. MATERIALS AND METHODS A total of 27 patients with brain tumors were examined in 1,5T MRI. Single phase and multiphase ASL, DSCE-CBV examinations were assessed by both qualitative and quantitative analysis for the detection of malignancy. Imaging results were correlated with a histopathology or follow-up. RESULTS Based on 31 studies in 27 patients with brain tumors, the visual inspection sensitivities for ASL and dynamic DSC perfusion imaging were 88% and 94%, respectively, with 100% specificity for both. On qualitative evaluation, sensitivities for ASL and DSC perfusion imaging perfusions were 88% and 94%, respectively, with 100% specificity for both. The highest sensitivity values for quantitative ASL imaging were obtained using a normalized cut-off ratio of 1.65, resulting in sensitivity of 94% for ASL imaging and cut-off ratio of 1.95 and sensitivity 94% for DSCE-CBV imaging. CONCLUSION The present study revealed similar sensitivity and specificity for both multhiphase ASL and DSC MRI. Thus, we suggest that ASL perfusion can be used in daily clinical practice.
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Affiliation(s)
- Emine Sevcan Ata
- Department of Radiology, Adnan Menderes University Faculty of Medicine, 09010, Aydın, Turkey; Department of Radiology, Usak State Hospital, 33940, Uşak, Turkey.
| | - Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University Faculty of Medicine, 09010, Aydın, Turkey.
| | - Cenk Eraslan
- Department of Radiology, Adnan Menderes University Faculty of Medicine, 09010, Aydın, Turkey; Department of Radiology, Ege University Faculty of Medicine, 35100, Bornova, Izmir, Turkey.
| | - Yelda Özsunar Dayanır
- Department of Radiology, Adnan Menderes University Faculty of Medicine, 09010, Aydın, Turkey.
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32
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Kim ES, Satter M, Reed M, Fadell R, Kardan A. A novel, integrated PET-guided MRS technique resulting in more accurate initial diagnosis of high-grade glioma. Neuroradiol J 2016; 29:193-7. [PMID: 27122050 DOI: 10.1177/1971400916639962] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and lethal malignant glioma in adults. Currently, the modality of choice for diagnosing brain tumor is high-resolution magnetic resonance imaging (MRI) with contrast, which provides anatomic detail and localization. Studies have demonstrated, however, that MRI may have limited utility in delineating the full tumor extent precisely. Studies suggest that MR spectroscopy (MRS) can also be used to distinguish high-grade from low-grade gliomas. However, due to operator dependent variables and the heterogeneous nature of gliomas, the potential for error in diagnostic accuracy with MRS is a concern. Positron emission tomography (PET) imaging with (11)C-methionine (MET) and (18)F-fluorodeoxyglucose (FDG) has been shown to add additional information with respect to tumor grade, extent, and prognosis based on the premise of biochemical changes preceding anatomic changes. Combined PET/MRS is a technique that integrates information from PET in guiding the location for the most accurate metabolic characterization of a lesion via MRS. We describe a case of glioblastoma multiforme in which MRS was initially non-diagnostic for malignancy, but when MRS was repeated with PET guidance, demonstrated elevated choline/N-acetylaspartate (Cho/NAA) ratio in the right parietal mass consistent with a high-grade malignancy. Stereotactic biopsy, followed by PET image-guided resection, confirmed the diagnosis of grade IV GBM. To our knowledge, this is the first reported case of an integrated PET/MRS technique for the voxel placement of MRS. Our findings suggest that integrated PET/MRS may potentially improve diagnostic accuracy in high-grade gliomas.
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Affiliation(s)
- Ellen S Kim
- Department of Internal Medicine, Kettering Medical Center, USA
| | - Martin Satter
- Department of Nuclear Medicine/PET, Kettering Medical Center, USA
| | - Marilyn Reed
- Department of Neuro Sciences Service Line, Kettering Medical Center, USA
| | - Ronald Fadell
- Department of Radiology, Kettering Medical Center, USA
| | - Arash Kardan
- Department of Nuclear Medicine/PET, Kettering Medical Center, USA Boonshoft School of Medicine, Wright State University, USA
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Ye J, Bhagat SK, Li H, Luo X, Wang B, Liu L, Yang G. Differentiation between recurrent gliomas and radiation necrosis using arterial spin labeling perfusion imaging. Exp Ther Med 2016; 11:2432-2436. [PMID: 27284331 DOI: 10.3892/etm.2016.3225] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 11/25/2015] [Indexed: 12/13/2022] Open
Abstract
Arterial spin labeling (ASL) magnetic resonance (MR) perfusion imaging has been proposed as an effective method to measure brain tumor perfusion. The aim of the present study was to evaluate the utility of this technique in the differentiation of recurrent gliomas from radiation necrosis. Twenty-one patients with surgically treated primary gliomas, including 16 cases of recurrent glioma and 5 of radiation necrosis were examined using 3.0T MR imaging (MRI). ASL and dynamic susceptibility contrast-weighted (DSC) perfusion MRI scans were performed. Maps of normalized cerebral blood flow (CBF) in ASL imaging and cerebral blood volume (CBV) in DSC imaging were computed and analyzed in the regions of interest. In cases of glioma recurrence, the normalized ASL-CBF ratio (4.45±2.72) was higher than that in cases of radiation injury (1.22±0.61) (P<0.01). The normalized DSC-relative CBV ratio was also significantly higher in glioma recurrence (3.38±2.08) than it was in radiation injury (1.09±0.55) (P<0.05). A close linear correlation was found between the ASL and DSC MRI techniques (linear regression coefficient, R=0.85; P=0.005) in the differentiation of recurrent glioma from radiation injury. The results indicate that ASL perfusion is an accurate method of distinguishing between glioma recurrence and radiation necrosis.
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Affiliation(s)
- Jing Ye
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Santosh Kumar Bhagat
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Hongmei Li
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Xianfu Luo
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Buhai Wang
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Liqin Liu
- Department of Oncology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
| | - Guomei Yang
- Department of Radiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu 225001, P.R. China
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Maumet C, Maurel P, Ferré JC, Barillot C. An a contrario approach for the detection of patient-specific brain perfusion abnormalities with arterial spin labelling. Neuroimage 2016; 134:424-433. [PMID: 27039702 DOI: 10.1016/j.neuroimage.2016.03.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
In this paper, we introduce a new locally multivariate procedure to quantitatively extract voxel-wise patterns of abnormal perfusion in individual patients. This a contrario approach uses a multivariate metric from the computer vision community that is suitable to detect abnormalities even in the presence of closeby hypo- and hyper-perfusions. This method takes into account local information without applying Gaussian smoothing to the data. Furthermore, to improve on the standard a contrario approach, which assumes white noise, we introduce an updated a contrario approach that takes into account the spatial coherency of the noise in the probability estimation. Validation is undertaken on a dataset of 25 patients diagnosed with brain tumours and 61 healthy volunteers. We show how the a contrario approach outperforms the massively univariate general linear model usually employed for this type of analysis.
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Affiliation(s)
- Camille Maumet
- University of Rennes 1, Faculty of Medicine, F-35043 Rennes, France; INSERM, U746, F-35042 Rennes, France; CNRS, IRISA, UMR 6074, F-35042 Rennes, France; INRIA, VisAGeS Project Team, F-35042 Rennes, France; Warwick Manufacturing Group, University of Warwick, CV4 7AL Coventry, United Kingdom.
| | - Pierre Maurel
- University of Rennes 1, Faculty of Medicine, F-35043 Rennes, France; INSERM, U746, F-35042 Rennes, France; CNRS, IRISA, UMR 6074, F-35042 Rennes, France; INRIA, VisAGeS Project Team, F-35042 Rennes, France
| | - Jean-Christophe Ferré
- University of Rennes 1, Faculty of Medicine, F-35043 Rennes, France; INSERM, U746, F-35042 Rennes, France; CNRS, IRISA, UMR 6074, F-35042 Rennes, France; INRIA, VisAGeS Project Team, F-35042 Rennes, France; CHU Rennes, Department of Neuroradiology, F-35033 Rennes, France
| | - Christian Barillot
- University of Rennes 1, Faculty of Medicine, F-35043 Rennes, France; INSERM, U746, F-35042 Rennes, France; CNRS, IRISA, UMR 6074, F-35042 Rennes, France; INRIA, VisAGeS Project Team, F-35042 Rennes, France
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Glioblastoma Induces Vascular Dysregulation in Nonenhancing Peritumoral Regions in Humans. AJR Am J Roentgenol 2016; 206:1073-81. [PMID: 27007449 DOI: 10.2214/ajr.15.14529] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Glioblastoma is an invasive primary brain malignancy that typically infiltrates the surrounding tissue with malignant cells. It disrupts cerebral blood flow through a variety of biomechanical and biochemical mechanisms. Thus, neuroimaging focused on identifying regions of vascular dysregulation may reveal a marker of tumor spread. The purpose of this study was to use blood oxygenation level-dependent (BOLD) functional MRI (fMRI) to compare the temporal dynamics of the enhancing portion of a tumor with those of brain regions without apparent tumors. MATERIALS AND METHODS Patients with pathologically proven glioblastoma underwent preoperative resting-state BOLD fMRI, T1-weighted contrast-enhanced MRI, and FLAIR MRI. The contralesional control hemisphere, contrast-enhancing tumor, and peritu-moral edema were segmented by use of structural images and were used to extract the time series of these respective regions. The parameter estimates (beta values) for the two regressors and resulting z-statistic images were used as a metric to compare the similarity of the tumor dynamics to those of other brain regions. RESULTS The time course of the contrast-enhancing tumor was significantly different from that of the rest of the brain (p < 0.05). Similarly, the control signal intensity was significantly different from the tumor signal intensity (p < 0.05). Notably, the temporal dynamics in the peritumoral edema, which did not contain enhancing tumor, were most similar to the those of enhancing tumor than to those of control regions. CONCLUSION The findings show that the disruption in vascular regulation induced by a glioblastoma can be detected with BOLD fMRI and that the spatial distribution of these disruptions is localized to the immediate vicinity of the tumor and peritumoral edema.
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Abstract
Oligodendroglioma are glial tumours, predominantly occurring in adults. Their hallmark molecular feature is codeletion of the 1p and 19q chromosome arms, which is not only of diagnostic but also of prognostic and predictive relevance. On imaging, these tumours characteristically show calcification, and they have a cortical–subcortical location, most commonly in the frontal lobe. Owing to their superficial location, there may be focal thinning or remodelling of the overlying skull. In contrast to other low-grade gliomas, minimal to moderate enhancement is commonly seen and perfusion may be moderately increased. This complicates differentiation from high-grade, anaplastic oligodendroglioma, in which enhancement and increased perfusion are also common. New enhancement in a previously non-enhancing, untreated tumour, however, is suggestive of malignant transformation, as is high growth rate. MR spectroscopy may further aid in the differentiation between low- and high-grade oligodendroglioma. A relatively common feature of recurrent disease is leptomeningeal dissemination, but extraneural spread is rare. Tumours with the 1p/19q codeletion more commonly show heterogeneous signal intensity, particularly on T2 weighted imaging; calcifications; an indistinct margin; and mildly increased perfusion and metabolism than 1p/19q intact tumours. For the initial diagnosis of oligodendroglioma, MRI and CT are complementary; MRI is superior to CT in assessing tumour extent and cortical involvement, whereas CT is most sensitive to calcification. Advanced and functional imaging techniques may aid in grading and assessing the molecular genotype as well as in differentiating between tumour recurrence and radiation necrosis, but so far no unequivocal method or combination of methods is available.
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Affiliation(s)
- Marion Smits
- Department of Radiology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands
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Lotumolo A, Caivano R, Rabasco P, Iannelli G, Villonio A, D' Antuono F, Gioioso M, Zandolino A, Macarini L, Guglielmi G, Cammarota A. Comparison between magnetic resonance spectroscopy and diffusion weighted imaging in the evaluation of gliomas response after treatment. Eur J Radiol 2015; 84:2597-604. [PMID: 26391231 DOI: 10.1016/j.ejrad.2015.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 08/31/2015] [Accepted: 09/08/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare magnetic resonance spectroscopy (MRS) and diffusion weighted imaging (DWI) in the assessment of progression and regression of brain tumors in order to assess whether there is correlation between MRS and DWI in the monitoring of patients with primary tumors after therapy. METHODS Magnetic resonance imaging (MRI) has been performed in 80 patients, 48 affected by high grade gliomas (HGG) and 32 affected by low grade gliomas (LGG). The variation of apparent diffusion coefficient (ADC) value and metabolite ratios before and after treatment has been used to test DWI sequences and MRS as predictor to response to therapy. Comparison between post contrast-enhancement sequences, MRS and DWI has been done in terms of accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Moreover statistical correlation of ADC deviations with MRS metabolites variations before and after therapy have been studied. RESULTS In the case of HGG, MRS shows better sensitivity, specificity, PPV, NPV and accuracy compared to DWI, especially when considering the Choline/N-acetylaspartate (Cho/NAA) ratio. Regarding the LGG, the technique that better evaluates the response to treatment appears to be the DWI. A moderate correlation between ADC deviations and Cho, Lipide (Lip) and Lactate (Lac) has been found in LGG; while NAA revealed to be weakly correlated to ADC variation. Considering HGG, a weak correlation has been found between ADC deviations and MRS metabolites. CONCLUSION Combination of DWI and MRS can help to characterize different changes related to treatment and to evaluate brain tumor response to treatment.
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A neuroradiologist's guide to arterial spin labeling MRI in clinical practice. Neuroradiology 2015; 57:1181-202. [PMID: 26351201 PMCID: PMC4648972 DOI: 10.1007/s00234-015-1571-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.
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Lasocki A, Tsui A, Tacey MA, Drummond KJ, Field KM, Gaillard F. MRI grading versus histology: predicting survival of World Health Organization grade II-IV astrocytomas. AJNR Am J Neuroradiol 2015; 36:77-83. [PMID: 25104288 DOI: 10.3174/ajnr.a4077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Histologic grading of intracranial astrocytomas is affected by sampling error and substantial inter- and intraobserver variability. We proposed that incorporating MR imaging into grading will predict patient survival more accurately than histopathology alone. MATERIALS AND METHODS Patients with a new diagnosis of World Health Organization grades II-IV astrocytoma or mixed oligoastrocytoma diagnosed between September 2007 and December 2010 were identified. Two hundred forty-five patients met the inclusion criteria. Preoperative MRIs were independently reviewed by 2 readers blinded to the histologic grade, and an MR imaging grade was given. The MR imaging and histopathologic grades were compared with patient survival. RESULTS Patients with grade II or III astrocytomas on histology but evidence of necrosis on MR imaging (consistent with a grade IV tumor) had significantly worse survival than patients with the same histology but no evidence of necrosis on MR imaging (P = .002 for grade II histology and P = .029 for grade III). Their survival was not significantly different from that in patients with grade IV tumors on histology (P = .164 and P = .385, respectively); this outcome suggests that all or most are likely to have truly been grade IV tumors. MR imaging evidence of necrosis was less frequent in grade II and III oligoastrocytomas, preventing adequate subgroup analysis. CONCLUSIONS MR imaging can improve grading of intracranial astrocytomas by identifying patients suspected of being undergraded by histology, with high interobserver agreement. This finding has the potential to optimize patient management, for example, by encouraging more aggressive treatment earlier in the patient's course.
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Affiliation(s)
- A Lasocki
- From the Department of Cancer Imaging (A.L.), Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - A Tsui
- Departments of Pathology (A.T.)
| | - M A Tacey
- Melbourne EpiCentre (M.A.T.), Department of Medicine, The University of Melbourne and The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | | | | | - F Gaillard
- Radiology (F.G.), The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Qiao XJ, Ellingson BM, Kim HJ, Wang DJJ, Salamon N, Linetsky M, Sepahdari AR, Jiang B, Tian JJ, Esswein SR, Cloughesy TF, Lai A, Nghiemphu L, Pope WB. Arterial spin-labeling perfusion MRI stratifies progression-free survival and correlates with epidermal growth factor receptor status in glioblastoma. AJNR Am J Neuroradiol 2014; 36:672-7. [PMID: 25542879 DOI: 10.3174/ajnr.a4196] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/27/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma is a common primary brain tumor with a poor but variable prognosis. Our aim was to investigate the feasibility of MR perfusion imaging by using arterial spin-labeling for determining the prognosis of patients with glioblastoma. MATERIALS AND METHODS Pseudocontinuous arterial spin-labeling with 3D background-suppressed gradient and spin-echo was acquired before surgery on 53 patients subsequently diagnosed with glioblastoma. The calculated CBF color maps were visually evaluated by 3 independent readers blinded to patient history. Pathologic and survival data were correlated with CBF map findings. Arterial spin-labeling values in tumor tissue were also quantified by using manual fixed-size ROIs. RESULTS Two perfusion patterns were characterized by visual evaluation of CBF maps on the basis of either the presence (pattern 1) or absence (pattern 2) of substantial hyperperfused tumor tissue. Evaluation of the perfusion patterns was highly concordant among the 3 readers (κ = 0.898, P < .001). Pattern 1 (versus pattern 2) was associated with significantly shorter progression-free survival by Kaplan-Meier analysis (median progression-free survival of 182 days versus 485 days, P < .01) and trended with shorter overall survival (P = .079). There was a significant association between pattern 1 and epidermal growth factor receptor variant III expression (P < .01). CONCLUSIONS Qualitative evaluation of arterial spin-labeling CBF maps can be used to stratify survival and predict epidermal growth factor receptor variant III expression in patients with glioblastoma.
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Affiliation(s)
- X J Qiao
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - B M Ellingson
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - H J Kim
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - D J J Wang
- Neurology (D.J.J.W., T.F.C., A.L., L.N.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - N Salamon
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - M Linetsky
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - A R Sepahdari
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - B Jiang
- Department of Radiology (B.J.), Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - J J Tian
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - S R Esswein
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
| | - T F Cloughesy
- Neurology (D.J.J.W., T.F.C., A.L., L.N.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - A Lai
- Neurology (D.J.J.W., T.F.C., A.L., L.N.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - L Nghiemphu
- Neurology (D.J.J.W., T.F.C., A.L., L.N.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - W B Pope
- From the Departments of Radiological Sciences (X.J.Q., B.M.E., H.J.K., N.S., M.L., A.R.S., J.J.T., S.R.E., W.B.P.)
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Prognostic value of blood flow estimated by arterial spin labeling and dynamic susceptibility contrast-enhanced MR imaging in high-grade gliomas. J Neurooncol 2014; 120:557-66. [DOI: 10.1007/s11060-014-1586-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022]
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Treister D, Kingston S, Hoque KE, Law M, Shiroishi MS. Multimodal Magnetic Resonance Imaging Evaluation of Primary Brain Tumors. Semin Oncol 2014; 41:478-495. [DOI: 10.1053/j.seminoncol.2014.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Fudaba H, Shimomura T, Abe T, Matsuta H, Momii Y, Sugita K, Ooba H, Kamida T, Hikawa T, Fujiki M. Comparison of multiple parameters obtained on 3T pulsed arterial spin-labeling, diffusion tensor imaging, and MRS and the Ki-67 labeling index in evaluating glioma grading. AJNR Am J Neuroradiol 2014; 35:2091-8. [PMID: 24994829 DOI: 10.3174/ajnr.a4018] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pulsed arterial spin-labeling, DTI, and MR spectroscopy provide useful data for tumor evaluation. We evaluated multiple parameters by using these pulse sequences and the Ki-67 labeling index in newly diagnosed supratentorial gliomas. MATERIALS AND METHODS All 32 patients, with grade II (3 each of diffuse astrocytoma, oligodendroglioma, and oligoastrocytoma), grade III (3 anaplastic astrocytomas, 4 anaplastic oligodendrogliomas, and 1 anaplastic oligoastrocytoma), and grade IV (14 glioblastomas and 1 glioblastoma with an oligodendroglioma component) cases underwent pulsed arterial spin-labeling, DTI, and MR spectroscopy studies by using 3T MR imaging. The following variables were used to compare the tumors: relative cerebral blood flow, fractional anisotropy; ADC tumor/normal ratios; and the Cho/Cr, NAA/Cho, NAA/Cr, and lactate/Cr ratios. A logistic regression and receiver operating characteristic analysis were used to assess parameters with a high sensitivity and specificity to identify the threshold values for separate grading. We compared the Ki-67 index with various MR imaging parameters in tumor specimens. RESULTS Significant correlations were observed between the Ki-67 index and the mean, maximum, and minimum ADC, Cho/Cr, and lactate/Cr ratios. The receiver operating characteristic analysis showed that the combination of the minimum ADC and Cho/Cr ratios could differentiate low-grade and high-grade gliomas, with a sensitivity and specificity of 87.0% and 88.9%, respectively. The mean and maximum relative cerebral blood flow ratios were used to classify glioblastomas from other-grade astrocytomas, with a sensitivity and specificity of 92.9% and 83.3%, respectively. CONCLUSIONS Our findings indicate that pulsed arterial spin-labeling, DTI, and MR spectroscopy are useful for predicting glioma grade. Additionally, the parameters obtained on DTI and MR spectroscopy closely correlated with the proliferative potential of gliomas.
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Affiliation(s)
- H Fudaba
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
| | - T Shimomura
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - T Abe
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - H Matsuta
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Y Momii
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - K Sugita
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - H Ooba
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - T Kamida
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - T Hikawa
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - M Fujiki
- From the Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
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Predicting grade of cerebral gliomas using Myo-inositol/Creatine ratio. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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45
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Ramadan S, Lin A, Stanwell P. Glutamate and glutamine: a review of in vivo MRS in the human brain. NMR IN BIOMEDICINE 2013; 26:1630-46. [PMID: 24123328 PMCID: PMC3849600 DOI: 10.1002/nbm.3045] [Citation(s) in RCA: 182] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 08/08/2013] [Accepted: 09/08/2013] [Indexed: 05/21/2023]
Abstract
Our understanding of the roles that the amino acids glutamate (Glu) and glutamine (Gln) play in the mammalian central nervous system has increased rapidly in recent times. Many conditions are known to exhibit a disturbance in Glu-Gln equilibrium, and the exact relationships between these changed conditions and these amino acids are not fully understood. This has led to increased interest in Glu/Gln quantitation in the human brain in an array of conditions (e.g. mental illness, tumor, neuro-degeneration) as well as in normal brain function. Accordingly, this review has been undertaken to describe the increasing number of in vivo techniques available to study Glu and Gln separately, or pooled as 'Glx'. The present MRS methods used to assess Glu and Gln vary in approach, complexity, and outcome, thus the focus of this review is on a description of MRS acquisition approaches, and an indication of relative utility of each technique rather than brain pathologies associated with Glu and/or Gln perturbation. Consequently, this review focuses particularly on (1) one-dimensional (1)H MRS, (2) two-dimensional (1)H MRS, and (3) one-dimensional (13)C MRS techniques.
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Affiliation(s)
- Saadallah Ramadan
- School of Health Sciences, Faculty of Health, Hunter Building, University of Newcastle, Callaghan NSW 2308, Australia
| | - Alexander Lin
- Alexander Lin: Center for Clinical Spectroscopy, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 4 Blackfan Street, HIM-820, Boston MA 02115
| | - Peter Stanwell
- School of Health Sciences, Faculty of Health, Hunter Building, University of Newcastle, Callaghan NSW 2308, Australia
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Furtner J, Schöpf V, Schewzow K, Kasprian G, Weber M, Woitek R, Asenbaum U, Preusser M, Marosi C, Hainfellner JA, Widhalm G, Wolfsberger S, Prayer D. Arterial spin-labeling assessment of normalized vascular intratumoral signal intensity as a predictor of histologic grade of astrocytic neoplasms. AJNR Am J Neuroradiol 2013; 35:482-9. [PMID: 23945226 DOI: 10.3174/ajnr.a3705] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pulsed arterial spin-labeling is a noninvasive MR imaging perfusion method performed with the use of water in the arterial blood as an endogenous contrast agent. The purpose of this study was to determine the inversion time with the largest difference in normalized intratumoral signal intensity between high-grade and low-grade astrocytomas. MATERIALS AND METHODS Thirty-three patients with gliomas, histologically classified as low-grade (n = 7) or high-grade astrocytomas (n = 26) according to the World Health Organization brain tumor classification, were included. A 3T MR scanner was used to perform pulsed arterial spin-labeling measurements at 8 different inversion times (370 ms, 614 ms, 864 ms, 1114 ms, 1364 ms, 1614 ms, 1864 ms, and 2114 ms). Normalized intratumoral signal intensity was calculated, which was defined by the signal intensity ratio of the tumor and the contralateral normal brain tissue for all fixed inversion times. A 3-way mixed ANOVA was used to reveal potential differences in the normalized vascular intratumoral signal intensity between high-grade and low-grade astrocytomas. RESULTS The difference in normalized vascular intratumoral signal intensity between high-grade and low-grade astrocytomas obtained the most statistically significant results at 370 ms (P = .003, other P values ranged from .012-.955). CONCLUSIONS The inversion time by which to differentiate high-grade and low-grade astrocytomas by use of normalized vascular intratumoral signal intensity was 370 ms in our study. The normalized vascular intratumoral signal intensity values at this inversion time mainly reflect the labeled intra-arterial blood bolus and therefore could be referred to as normalized vascular intratumoral signal intensity. Our data indicate that the use of normalized vascular intratumoral signal intensity values allows differentiation between low-grade and high-grade astrocytomas and thus may serve as a new, noninvasive marker for astrocytoma grading.
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Affiliation(s)
- J Furtner
- From the Department of Biomedical Imaging and Image-Guided Therapy (J.F., V.S., G.K., M.W., R.W., U.A., D.P.)
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Mohammed W, Xunning H, Haibin S, Jingzhi M. Clinical applications of susceptibility-weighted imaging in detecting and grading intracranial gliomas: a review. Cancer Imaging 2013; 13:186-95. [PMID: 23618919 PMCID: PMC3636597 DOI: 10.1102/1470-7330.2013.0020] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Susceptibility-weighted imaging (SWI) is a technique that exploits the susceptibility difference between tissues to provide contrast for different regions of the brain. In essence, it uses the deoxygenated hemoglobin of veins, hemosiderin of hemorrhage, etc. as intrinsic contrast agents, allowing for much better visualization of blood and microvessels even without administration of an external contrast agent. It is a fast-evolving field that is being constantly improved and increasingly implemented with updates in relevant technology. Multiple studies have been done on the role of SWI in the management of various neurologic disorders and it is also being seen as a further step in the neuroradiologist’s goal of being able to noninvasively grade tumors in order to influence therapy. This article briefly reviews the evolution of SWI since its conception and provides the reader with a comprehensive summary of various studies that have been done on its application for detecting and grading intraaxial brain tumors, specifically gliomas. Other useful magnetic resonance techniques that have shown promise in grading gliomas are also discussed.
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Affiliation(s)
- Wasif Mohammed
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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Caivano R, Lotumolo A, Rabasco P, Zandolino A, D'Antuono F, Villonio A, Lancellotti MI, Macarini L, Cammarota A. 3 Tesla magnetic resonance spectroscopy: cerebral gliomas vs. metastatic brain tumors. Our experience and review of the literature. Int J Neurosci 2013; 123:537-43. [PMID: 23390934 DOI: 10.3109/00207454.2013.774395] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the present study is to report about the value of magnetic resonance spectroscopy (MRS) in differentiating brain metastases, primary high-grade gliomas (HGG) and low-grade gliomas (LGG). MRI (magnetic resonance imaging) and MRS were performed in 60 patients with histologically verified brain tumors: 32 patients with HGG (28 glioblastomas multiforme [GBM] and 4 anaplastic astrocytomas), 14 patients with LGG (9 astrocytomas and 5 oligodendrogliomas) and 14 patients with metastatic brain tumors. The Cho/Cr (choline-containing compounds/creatine-phosphocreatine complex), Cho/NAA (N-acetyl aspartate) and NAA/Cr ratios were assessed from spectral maps in the tumoral core and peritumoral edema. The differences in the metabolite ratios between LGG, HGG and metastases were analyzed statistically. Lipids/lactate contents were also analyzed. Significant differences were noted in the tumoral and peritumoral Cho/Cr, Cho/NAA and NAA/Cr ratios between LGG, HGG and metastases. Lipids and lactate content revealed to be useful for discriminating gliomas and metastases. The results of this study demonstrate that MRS can differentiate LGG, HGG and metastases, therefore diagnosis could be allowed even in those patients who cannot undergo biopsy.
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Affiliation(s)
- R Caivano
- Radiology Department, I.R.C.C.S. -C.R.O.B., Rionero in Vulture, Potenza, Italy.
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Chawla S, Krejza J, Vossough A, Zhang Y, Kapoor GS, Wang S, O'Rourke DM, Melhem ER, Poptani H. Differentiation between oligodendroglioma genotypes using dynamic susceptibility contrast perfusion-weighted imaging and proton MR spectroscopy. AJNR Am J Neuroradiol 2013; 34:1542-9. [PMID: 23370479 DOI: 10.3174/ajnr.a3384] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Oligodendrogliomas with 1p/19q chromosome LOH are more sensitive to chemoradiation therapy than those with intact alleles. The usefulness of dynamic susceptibility contrast-PWI-guided ¹H-MRS in differentiating these 2 genotypes was tested in this study. MATERIALS AND METHODS Forty patients with oligodendrogliomas, 1p/19q LOH (n = 23) and intact alleles (n = 17), underwent MR imaging and 2D-¹H-MRS. ¹H-MRS VOI was overlaid on FLAIR images to encompass the hyperintense abnormality on the largest cross-section of the neoplasm and then overlaid on CBV maps to coregister CBV maps with ¹H-MRS VOI. rCBVmax values were obtained by measuring the CBV from each of the selected ¹H-MRS voxels in the neoplasm and were normalized with respect to contralateral white matter. Metabolite ratios with respect to ipsilateral Cr were computed from the voxel corresponding to the rCBVmax value. Logistic regression and receiver operating characteristic analyses were performed to ascertain the best model to discriminate the 2 genotypes of oligodendrogliomas. Qualitative evaluation of conventional MR imaging characteristics (patterns of tumor border, signal intensity, contrast enhancement, and paramagnetic susceptibility effect) was also performed to distinguish the 2 groups of oligodendrogliomas. RESULTS The incorporation of rCBVmax value and metabolite ratios (NAA/Cr, Cho/Cr, Glx/Cr, myo-inositol/Cr, and lipid + lactate/Cr) into the multivariate logistic regression model provided the best discriminatory classification with sensitivity (82.6%), specificity (64.7%), and accuracy (72%) in distinguishing 2 oligodendroglioma genotypes. Oligodendrogliomas with 1p/19q LOH were also more associated with paramagnetic susceptibility effect (P < .05). CONCLUSIONS Our preliminary results indicate the potential of combing PWI and ¹H-MRS to distinguish oligodendroglial genotypes.
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Affiliation(s)
- S Chawla
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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