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Zhou J, Hou Z, Tian C, Zhu Z, Ye M, Chen S, Yang H, Zhang X, Zhang B. Review of tracer kinetic models in evaluation of gliomas using dynamic contrast-enhanced imaging. Front Oncol 2024; 14:1380793. [PMID: 38947892 PMCID: PMC11211364 DOI: 10.3389/fonc.2024.1380793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
Glioma is the most common type of primary malignant tumor of the central nervous system (CNS), and is characterized by high malignancy, high recurrence rate and poor survival. Conventional imaging techniques only provide information regarding the anatomical location, morphological characteristics, and enhancement patterns. In contrast, advanced imaging techniques such as dynamic contrast-enhanced (DCE) MRI or DCE CT can reflect tissue microcirculation, including tumor vascular hyperplasia and vessel permeability. Although several studies have used DCE imaging to evaluate gliomas, the results of data analysis using conventional tracer kinetic models (TKMs) such as Tofts or extended-Tofts model (ETM) have been ambiguous. More advanced models such as Brix's conventional two-compartment model (Brix), tissue homogeneity model (TH) and distributed parameter (DP) model have been developed, but their application in clinical trials has been limited. This review attempts to appraise issues on glioma studies using conventional TKMs, such as Tofts or ETM model, highlight advancement of DCE imaging techniques and provides insights on the clinical value of glioma management using more advanced TKMs.
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Affiliation(s)
- Jianan Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zujun Hou
- The Jiangsu Key Laboratory of Medical Optics, Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Chuanshuai Tian
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhengyang Zhu
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Meiping Ye
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Sixuan Chen
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Huiquan Yang
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xin Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Institute of Medical Imaging and Artificial Intelligence, Nanjing University, Nanjing, China
- Medical Imaging Center, Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Alvaro-Heredia JA, Rodríguez-Hernández LA, Rodríguez-Rubio HA, Alvaro-Heredia I, Mondragon-Soto MG, Rodríguez-Hernández IA, Mateo-Nouel EDJ, Villanueva-Castro E, Uribe-Pacheco R, Castro-Martinez E, Gutierrez-Aceves GA, Moreno-Jiménez S, Reyes-Moreno I, Gonzalez-Aguilar A. Diagnostic Algorithm for Intracranial Lesions in the Emergency Department: Effectiveness of the Relative Brain Volume and Hounsfield Unit Value Measured by Perfusion Tomography. Cureus 2024; 16:e61591. [PMID: 38962639 PMCID: PMC11221499 DOI: 10.7759/cureus.61591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 07/05/2024] Open
Abstract
Background Early treatment of intracranial lesions in the emergency department is crucial, but it can be challenging to differentiate between them. This differentiation is essential because the treatment of each type of lesion is different. Cerebral computed tomography perfusion (CTP) imaging can help visualize the vascularity of brain lesions and provide absolute quantification of physiological parameters. Compared to magnetic resonance imaging, CTP has several advantages, such as simplicity, wide availability, and reproducibility. Purpose This study aimed to assess the effectiveness of Hounsfield units (HU) in measuring the density of hypercellular lesions and the ability of CTP to quantify hemodynamics in distinguishing intracranial space-occupying lesions. Methods A retrospective study was conducted from March 2016 to March 2022. All patients underwent CTP and CT scans, and relative cerebral blood volume (rCBV) and HU were obtained for intracranial lesions. Results We included a total of 244 patients in our study. This group consisted of 87 (35.7%) individuals with glioblastomas (GBs), 48 (19.7%) with primary central nervous system lymphoma (PCNSL), 45 (18.4%) with metastases (METs), and 64 (26.2) with abscesses. Our study showed that the HUs for METs were higher than those for GB (S 57.4% and E 88.5%). In addition, rCBV values for PCNSL and abscesses were lower than those for GB and METs. The HU in PCNSL was higher than those in abscesses (S 94.1% and E 96.6%). Conclusion PCT parameters provide valuable information for diagnosing brain lesions. A comprehensive assessment improves accuracy. Combining rCBV and HU enhances diagnostic accuracy, making it a valuable tool for distinguishing between lesions. PCT's widespread availability allows for the use of both anatomical and functional information with high spatial resolution for diagnosing and managing brain tumor patients.
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Affiliation(s)
- Juan Antonio Alvaro-Heredia
- Neurological Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
- Spine Surgery, National Institute of Rehabilitation, Mexico City, MEX
| | | | | | - Isidro Alvaro-Heredia
- Emergency Medicine, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | | | | | | | | | - Rodrigo Uribe-Pacheco
- Neurological Surgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | | | | | - Sergio Moreno-Jiménez
- Neurosurgery-Radiosurgery, The American British Cowdray (ABC) Medical Center, Mexico City, MEX
- Radiosurgery, National Institute of Neurology and Neurosurgery, Mexico City, MEX
| | - Ignacio Reyes-Moreno
- Neuro-Oncology, The American British Cowdray (ABC) Medical Center, Mexico City, MEX
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Chen X, Xu J, Guo S, Zhang S, Wang H, Shen P, Shang Y, Tan M, Geng Y. Blood-brain barrier permeability by CT perfusion predicts parenchymal hematoma after recanalization with thrombectomy. J Neuroimaging 2024; 34:241-248. [PMID: 38018876 DOI: 10.1111/jon.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/13/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Parenchymal hematoma is a dreaded complication of mechanical thrombectomy after acute ischemic stroke. This study evaluated whether blood-brain barrier permeability measurements based on CT perfusion could be used as predictors of parenchymal hematoma after successful recanalization and compared the predictive value of various permeability parameters in patients with acute ischemic stroke. METHODS We enrolled 53 patients with acute ischemic stroke who underwent mechanical thrombectomy and achieved successful recanalization. Each patient underwent CT, CT angiography, and CT perfusion imaging before treatment. We used relative volume transfer constant (rKtrans ) values, relative permeability-surface area product (rP·S), and relative extraction fraction (rE) to evaluate preoperative blood-brain barrier permeability in the delayed perfusion area. RESULTS Overall, 22 patients (37.7%) developed hemorrhagic transformation after surgery, including 10 patients (16.9%) with hemorrhagic infarction and 11 patients (20.8%) with parenchymal hematoma. The rP·S, rKtrans , and rE of the hypoperfusion area in the parenchymal hematoma group were significantly higher than those in the hemorrhagic infarction and no-hemorrhage transformation groups (p < .01). We found that rE and rP·S were superior to rKtrans in predicting parenchymal hematoma transformation after thrombectomy (P·S area under the curve [AUC] .844 vs. rKtrans AUC .753, z = 2.064, p = .039; rE AUC .907 vs. rKtrans AUC .753, z = 2.399, p = .017). CONCLUSIONS Patients with parenchymal hematoma after mechanical thrombectomy had higher blood-brain barrier permeability in hypoperfusion areas. Among blood-brain barrier permeability measurement parameters, rP·S and rE showed better accuracy for parenchymal hematoma prediction.
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Affiliation(s)
- Xinyi Chen
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie Xu
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shunyuan Guo
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Huiyuan Wang
- Department of Clinical Medicine, Bengbu Medical College, Bengbu, China
| | - Panpan Shen
- Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yafei Shang
- Department of Clinical Medicine, Bengbu Medical College, Bengbu, China
| | - Mingming Tan
- Zhejiang Provincial People's Hospital, Department of Quality Management, Hangzhou, China
| | - Yu Geng
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
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Agrawal I, Bano S, Chaudhary A, Ahuja A. Role of Permeability Surface Area Product in Grading of Brain Gliomas using CT Perfusion. Asian J Neurosurg 2023; 18:751-760. [PMID: 38161609 PMCID: PMC10756843 DOI: 10.1055/s-0043-1774820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Purpose The aim of this study was to evaluate the role of permeability surface area product in grading brain gliomas using computed tomography (CT) perfusion Materials and Methods CT perfusion was performed on 33 patients with brain glioma diagnosed on magnetic resonance imaging. Of these, 19 had high-grade glioma and 14 had low-grade glioma on histopathological follow-up. CT perfusion values were obtained and first compared between the tumor region and normal brain parenchyma. Then the relative values of perfusion parameters were compared between high- and low-grade gliomas. Cut-off values, sensitivity, specificity, and strength of agreement for each parameter were calculated and compared subsequently. A conjoint factor (permeability surface area product + cerebral blood volume) was also evaluated since permeability surface area product and cerebral blood volume are considered complimentary factors for tumor vascularity. Results All five perfusion parameters namely permeability surface area product, cerebral blood volume, cerebral blood flow, mean transit time, and time to peak were found significantly higher in the tumor region than normal brain parenchyma. Among these perfusion parameters, only relative permeability surface area product and relative cerebral blood volume were found significant in differentiating high- and low-grade glioma. Moreover, relative permeability surface area product was significantly better than all other perfusion parameters with highest sensitivity and specificity (97.74 and 100%, respectively, at a cut-off of 9.0065). Relative permeability surface area product had a very good agreement with the histopathology grade. The conjoint factor did not yield any significant diagnostic advantage over permeability surface area product. Conclusion Relative permeability surface area product and relative cerebral blood volume were helpful in differentiating high- and low-grade glioma; however, relative permeability surface area product was significantly better than all other perfusion parameters. Grading brain gliomas using relative permeability surface area product can add crucial value in their management and prognostication; hence, it should be evaluated in the routine CT perfusion imaging protocol.
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Affiliation(s)
- Ira Agrawal
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Shahina Bano
- Department of Radiodiagnosis, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Ajay Chaudhary
- Department of Neurosurgery, PGIMER, Dr. RML Hospital, New Delhi, India
| | - Arvind Ahuja
- Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India
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Chiu FY, Yen Y. Imaging biomarkers for clinical applications in neuro-oncology: current status and future perspectives. Biomark Res 2023; 11:35. [PMID: 36991494 DOI: 10.1186/s40364-023-00476-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
Biomarker discovery and development are popular for detecting the subtle diseases. However, biomarkers are needed to be validated and approved, and even fewer are ever used clinically. Imaging biomarkers have a crucial role in the treatment of cancer patients because they provide objective information on tumor biology, the tumor's habitat, and the tumor's signature in the environment. Tumor changes in response to an intervention complement molecular and genomic translational diagnosis as well as quantitative information. Neuro-oncology has become more prominent in diagnostics and targeted therapies. The classification of tumors has been actively updated, and drug discovery, and delivery in nanoimmunotherapies are advancing in the field of target therapy research. It is important that biomarkers and diagnostic implements be developed and used to assess the prognosis or late effects of long-term survivors. An improved realization of cancer biology has transformed its management with an increasing emphasis on a personalized approach in precision medicine. In the first part, we discuss the biomarker categories in relation to the courses of a disease and specific clinical contexts, including that patients and specimens should both directly reflect the target population and intended use. In the second part, we present the CT perfusion approach that provides quantitative and qualitative data that has been successfully applied to the clinical diagnosis, treatment and application. Furthermore, the novel and promising multiparametric MR imageing approach will provide deeper insights regarding the tumor microenvironment in the immune response. Additionally, we briefly remark new tactics based on MRI and PET for converging on imaging biomarkers combined with applications of bioinformatics in artificial intelligence. In the third part, we briefly address new approaches based on theranostics in precision medicine. These sophisticated techniques merge achievable standardizations into an applicatory apparatus for primarily a diagnostic implementation and tracking radioactive drugs to identify and to deliver therapies in an individualized medicine paradigm. In this article, we describe the critical principles for imaging biomarker characterization and discuss the current status of CT, MRI and PET in finiding imaging biomarkers of early disease.
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Affiliation(s)
- Fang-Ying Chiu
- Center for Cancer Translational Research, Tzu Chi University, Hualien City, 970374, Taiwan.
- Center for Brain and Neurobiology Research, Tzu Chi University, Hualien City, 970374, Taiwan.
- Teaching and Research Headquarters for Sustainable Development Goals, Tzu Chi University, Hualien City, 970374, Taiwan.
| | - Yun Yen
- Center for Cancer Translational Research, Tzu Chi University, Hualien City, 970374, Taiwan.
- Ph.D. Program for Cancer Biology and Drug Discovery, Taipei Medical University, Taipei City, 110301, Taiwan.
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei City, 110301, Taiwan.
- TMU Research Center of Cancer Translational Medicine, Taipei Medical University, Taipei City, 110301, Taiwan.
- Cancer Center, Taipei Municipal WanFang Hospital, Taipei City, 116081, Taiwan.
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The Utility of Conventional CT, CT Perfusion and Quantitative Diffusion-Weighted Imaging in Predicting the Risk Level of Gastrointestinal Stromal Tumors of the Stomach: A Prospective Comparison of Classical CT Features, CT Perfusion Values, Apparent Diffusion Coefficient and Intravoxel Incoherent Motion-Derived Parameters. Diagnostics (Basel) 2022; 12:diagnostics12112841. [PMID: 36428901 PMCID: PMC9689886 DOI: 10.3390/diagnostics12112841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/01/2022] [Accepted: 11/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background: The role of advanced functional imaging techniques in prediction of pathological risk categories of gastrointestinal stromal tumors (GIST) is still unknown. The purpose of this study was to evaluate classical CT features, CT-perfusion and magnetic-resonance-diffusion-weighted-imaging (MR-DWI)-related parameters in predicting the metastatic risk of gastric GIST. Patients and methods: Sixty-two patients with histologically proven GIST who underwent CT perfusion and MR-DWI using multiple b-values were prospectively included. Morphological CT characteristics and CT-perfusion parameters of tumor were comparatively analyzed in the high-risk (HR) and low-risk (LR) GIST groups. Apparent diffusion coefficient (ADC) and intravoxel-incoherent-motion (IVIM)-related parameters were also analyzed in 45 and 34 patients, respectively. Results: Binary logistic regression analysis revealed that greater tumor diameter (p < 0.001), cystic structure (p < 0.001), irregular margins (p = 0.007), irregular shape (p < 0.001), disrupted mucosa (p < 0.001) and visible EFDV (p < 0.001), as well as less ADC value (p = 0.001) and shorter time-to-peak (p = 0.006), were significant predictors of HR GIST. Multivariate analysis extracted irregular shape (p = 0.006) and enlarged feeding or draining vessels (EFDV) (p = 0.017) as independent predictors of HR GIST (area under curve (AUC) of predicting model 0.869). Conclusion: Although certain classical CT imaging features remain most valuable, some functional imaging parameters may add the diagnostic value in preoperative prediction of HR gastric GIST.
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Suero Molina E, Black D, Kaneko S, Müther M, Stummer W. Double dose of 5-aminolevulinic acid and its effect on protoporphyrin IX accumulation in low-grade glioma. J Neurosurg 2022; 137:943-952. [PMID: 35213830 DOI: 10.3171/2021.12.jns211724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/20/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Administration of 5-aminolevulinic acid (5-ALA) does not regularly elicit fluorescence in low-grade glioma (LGG) at currently established doses and timing of administration. One explanation may be differences in blood-brain barrier (BBB) integrity compared to high-grade glioma. The authors hypothesized that for a BBB semipermeable to 5-ALA there might be a relationship between plasma 5-ALA concentration and its movement into the brain. A higher dose would elicit more 5-ALA conversion into protoporphyrin IX (PPIX). The authors present a case series of patients harboring LGG who received higher doses of 5-ALA. METHODS Patients undergoing surgery for indeterminate glioma later diagnosed as LGG were included in this study. 5-ALA was administered at a standard dose of 20 mg/kg body weight (bw) 4 hours prior to induction of anesthesia. A subgroup of patients received a higher dose of 40 mg/kg bw. Fluorescence was evaluated visually and PPIX concentration (cPPIX) was determined ex vivo by hyperspectral measurements in freshly extracted tissue. All adverse events were recorded. RESULTS A total of 23 patients harboring diffuse low-grade astrocytomas (n = 19) and oligodendrogliomas (n = 4) were analyzed. Thirteen patients received 20 mg/kg bw, and 10 patients received 40 mg/kg bw of 5-ALA. In the 20 mg/kg group, 30.8% (4 of 13) of tumors harbored areas of visible fluorescence, compared to 60% of cases (n = 6 of 10) with 40 mg/kg bw. The threshold to visibility was 1 μg/ml in both groups. Measured over all biopsies, the mean cPPIX was significantly higher in the double-dose group (1.8 vs 0.45 μg/ml; p < 0.001). In non-visibly fluorescent tissue the mean cPPIX was 0.146 μg/ml in the 20 mg/kg and 0.347 μg/ml in the 40 mg/kg group, indicating an increase of 138% (p < 0.001). CONCLUSIONS These observations demonstrate different regions with different levels of PPIX accumulation in LGG. With higher 5-ALA doses cPPIX increases, leading to more regions surpassing the visibility threshold of 1 μg/ml. These observations can be explained by the fact that the BBB in LGG is semipermeable to 5-ALA. Higher 5-ALA doses result in more PPIX conversion, an observation with implications for future dosing in LGG.
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Affiliation(s)
| | - David Black
- 2Carl Zeiss Meditec AG, Oberkochen, Germany
- 3Department of Physics and Astronomy, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Sadahiro Kaneko
- 1Department of Neurosurgery, University Hospital of Münster
- 4Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michael Müther
- 1Department of Neurosurgery, University Hospital of Münster
| | - Walter Stummer
- 1Department of Neurosurgery, University Hospital of Münster
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Diagnostic Performance of Dynamic Susceptibility Contrast-Enhanced Perfusion-Weighted Imaging in Differentiating Recurrence From Radiation Injury in Postoperative Glioma: A Meta-analysis. J Comput Assist Tomogr 2022; 46:938-944. [PMID: 35969866 DOI: 10.1097/rct.0000000000001356] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE It is important to differentiate between radiation injury (RI) and tumor recurrence (TR) in patients with glioma after surgery and radiotherapy. Our objective was to evaluate the use of dynamic susceptibility contrast-enhanced perfusion-weighted imaging to distinguish between TR and RI in patients with glioma. METHODS Relevant studies published until October 2021 were identified in the PubMed, Embase, and Cochrane Library databases. Stata v12.0 and RevMan 5.3 were used for meta-analysis. RESULTS In total, the meta-analysis incorporated 13 retrospective studies that included 513 patients with 522 lesions. Among the 522 lesions, 329 lesions were TRs and 193 lesions were RIs. The pooled relative cerebral blood volume value was significantly greater in the TR group (P < 0.00001) with significant heterogeneity (I2 = 88%). The pooled sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were 83% (95 confidence interval [CI], 77%-88%), 85% (95 CI, 77%-91%), 5.60 (95 CI, 3.61-8.70), and 0.20 (95% CI, 0.14-0.27), respectively. The heterogeneity of sensitivity (I2 = 33.18%), specificity (I2 = 24.01%), PLR (I2 = 0.00%), and NLR (I2 = 6.68%) is not significant. The area under the receiver operating characteristic curve was 0.91 (95% CI, 0.88-0.93). The 3.0 T magnetic resonance imaging, high-grade glioma, and Europe/America patient subgroups showed PLR greater than 5 and NLR less than 0.2. There was no significant indication of publication bias in the analysis (P = 0.496). CONCLUSIONS It is concluded that dynamic susceptibility contrast-enhanced perfusion-weighted imaging is effective for the diagnostic differentiation between TR and RI in patients with glioma.
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Blee JA, Liu X, Harland AJ, Fatania K, Currie S, Kurian KM, Hauert S. Liquid biopsies for early diagnosis of brain tumours: in silico mathematical biomarker modelling. J R Soc Interface 2022; 19:20220180. [PMID: 35919979 PMCID: PMC9346349 DOI: 10.1098/rsif.2022.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/07/2022] [Indexed: 11/12/2022] Open
Abstract
Brain tumours are the biggest cancer killer in those under 40 and reduce life expectancy more than any other cancer. Blood-based liquid biopsies may aid early diagnosis, prediction and prognosis for brain tumours. It remains unclear whether known blood-based biomarkers, such as glial fibrillary acidic protein (GFAP), have the required sensitivity and selectivity. We have developed a novel in silico model which can be used to assess and compare blood-based liquid biopsies. We focused on GFAP, a putative biomarker for astrocytic tumours and glioblastoma multi-formes (GBMs). In silico modelling was paired with experimental measurement of cell GFAP concentrations and used to predict the tumour volumes and identify key parameters which limit detection. The average GBM volumes of 449 patients at Leeds Teaching Hospitals NHS Trust were also measured and used as a benchmark. Our model predicts that the currently proposed GFAP threshold of 0.12 ng ml-1 may not be suitable for early detection of GBMs, but that lower thresholds may be used. We found that the levels of GFAP in the blood are related to tumour characteristics, such as vasculature damage and rate of necrosis, which are biological markers of tumour aggressiveness. We also demonstrate how these models could be used to provide clinical insight.
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Affiliation(s)
- Johanna A. Blee
- Department of Engineering Mathematics, University of Bristol, Ada Lovelace Building, Bristol BS8 1TW, UK
| | - Xia Liu
- Brain Tumour Research Centre, Bristol Medical School, Bristol BS2 8DZ, UK
| | - Abigail J. Harland
- Brain Tumour Research Centre, Bristol Medical School, Bristol BS2 8DZ, UK
| | - Kavi Fatania
- Department of Radiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | - Stuart Currie
- Department of Radiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
| | | | - Sabine Hauert
- Department of Engineering Mathematics, University of Bristol, Ada Lovelace Building, Bristol BS8 1TW, UK
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Wang K, Li Y, Cheng H, Li S, Xiang W, Ming Y, Chen L, Zhou J. Perfusion CT detects alterations in local cerebral flow of glioma related to IDH, MGMT and TERT status. BMC Neurol 2021; 21:460. [PMID: 34814870 PMCID: PMC8611974 DOI: 10.1186/s12883-021-02490-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between tumor biology and values of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), time to peak (TTP), permeability surface (PS) of tumor in patients with glioma. METHODS Forty-six patients with glioma were involved in the study. Histopathologic and molecular pathology diagnoses were obtained by tumor resection, and all patients accepted perfusion computed tomography (PCT) before operation. Regions of interests were placed manually at tumor and contralateral normal-appearing thalamus. The parameters of tumor were divided by those of contralateral normal-appearing thalamus to normalize at tumor (relative [r] CBV, rCBF, rMTT, rTTP, rPS). The relationships of the parameters, world health organization (WHO) grade, molecular pathological findings were analysed. RESULTS The rCBV, rMTT and rPS of patients are positively related to the pathological classification (P < 0.05). The values of rCBV and rPS in IDH mutated patients were lower than those IDH wild-type. The values of rCBF in patients with MGMT methylation were lower than those MGMT unmethylation (P < 0.05). The MVD of TERT wild-type group was lower than TERT mutated group (P < 0.05). The values of rCBV were significant difference in the four molecular groups divided by the combined IDH/TERT classification (P < 0.05). The progression free survival (PFS) and overall survival (OS) were significant difference in the four molecular groups divided by the combined IDH/TERT classification (P < 0.05). CONCLUSIONS Our study introduces and supports the changes of glioma flow perfusion may be closely related to its biological characteristics.
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Affiliation(s)
- Ke Wang
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Department of Neurosurgery, The General Hospital of Western Theater Command PLA, Chengdu, China
| | - Yeming Li
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | | | - Shenjie Li
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Wei Xiang
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Yang Ming
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Ligang Chen
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China.,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China.,Neurological Diseases and Brain Function Laboratory, Luzhou, China
| | - Jie Zhou
- Department of Neurosurgery, Affliated Hospital of Southwest Medical University, Luzhou, China. .,Neurosurgery Clinical Medical Research Center of Sichuan Province, Lu Zhou, China. .,Neurological Diseases and Brain Function Laboratory, Luzhou, China.
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11
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Chakrabarti R, Gupta V, Vyas S, Gupta K, Singh V. Correlation of dual energy computed tomography electron density measurements with cerebral glioma grade. Neuroradiol J 2021; 35:352-362. [PMID: 34605334 DOI: 10.1177/19714009211047455] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To correlate dual energy computed tomography electron density measurements with histopathological cerebral glioma grading to determine whether it can be used as a non-invasive predictor of cerebral glioma grade. MATERIALS AND METHODS Fifty patients with suspected cerebral gliomas on imaging scheduled to undergo resection were included. We tested our hypothesis that with increasing glioma grade, increased tumor cellularity should translate into increased electron density and if a statistically significant difference between electron density of low-grade gliomas and high-grade gliomas is seen, we may have a clinical use of dual energy computed tomography as a non-invasive tool to predict cerebral glioma grade.A pre-operative dual energy computed tomography scan of the brain was performed, and electron density measurements calculated from the solid part of the tumor. Obtaining a ratio with electron density of contralateral normal brain parenchyma normalized these values. The minimum, maximum and mean electron density and their normalized values recorded between high-grade gliomas and low-grade gliomas were compared for presence of statistical significance. RESULTS A statistically significant difference was found between all six parameters recorded (minimum electron density and normalized values, mean electron density and normalized values, maximum electron density and normalized values) between low-grade gliomas and high-grade gliomas. The predictivity ranged from 75% (for minimum electron density and maximum normalized values) to 81.25% (for mean normalized values). All six parameters were found to have statistically significant positive correlation with Ki-67 index. CONCLUSION Dual energy computed tomography electron density measurements in cerebral gliomas are predictive of pre-operative differentiation of low-grade gliomas from high-grade gliomas and show a linear, statistically significant positive correlation with Ki-67 index.
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Affiliation(s)
| | - Vivek Gupta
- Department of Interventional Neuroradiology, Paras Hospitals, India
| | - Sameer Vyas
- Department of Radiodiagnosis and Imaging, PGIMER, India
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12
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Sprowls SA, Saralkar P, Arsiwala T, Adkins CE, Blethen KE, Pizzuti VJ, Shah N, Fladeland R, Lockman PR. A Review of Mathematics Determining Solute Uptake at the Blood-Brain Barrier in Normal and Pathological Conditions. Pharmaceutics 2021; 13:pharmaceutics13050756. [PMID: 34069733 PMCID: PMC8160855 DOI: 10.3390/pharmaceutics13050756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
The blood-brain barrier (BBB) limits movement of solutes from the lumen of the brain microvascular capillary system into the parenchyma. The unidirectional transfer constant, Kin, is the rate at which transport across the BBB occurs for individual molecules. Single and multiple uptake experiments are available for the determination of Kin for new drug candidates using both intravenous and in situ protocols. Additionally, the single uptake method can be used to determine Kin in heterogeneous pathophysiological conditions such as stroke, brain cancers, and Alzheimer's disease. In this review, we briefly cover the anatomy and physiology of the BBB, discuss the impact of efflux transporters on solute uptake, and provide an overview of the single-timepoint method for determination of Kin values. Lastly, we compare preclinical Kin experimental results with human parallels.
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Affiliation(s)
- Samuel A. Sprowls
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
| | - Pushkar Saralkar
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
| | - Tasneem Arsiwala
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
| | | | - Kathryn E. Blethen
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
| | - Vincenzo J. Pizzuti
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
| | - Neal Shah
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Department of Dermatology, School of Medicine, West Virginia University, Morgantown, WV 26506, USA
| | - Ross Fladeland
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
| | - Paul R. Lockman
- Health Sciences Center, West Virginia University, Morgantown, WV 26506, USA;
- Basic Pharmaceutical Sciences, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA; (S.A.S.); (P.S.); (T.A.); (K.E.B.); (V.J.P.); (R.F.)
- Correspondence: ; Tel.: +1-304-293-0944
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13
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Bivard A, Kleinig T, Churilov L, Levi C, Lin L, Cheng X, Chen C, Aviv R, Choi PMC, Spratt NJ, Butcher K, Dong Q, Parsons M. Permeability Measures Predict Hemorrhagic Transformation after Ischemic Stroke. Ann Neurol 2020; 88:466-476. [PMID: 32418242 PMCID: PMC7496077 DOI: 10.1002/ana.25785] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We sought to examine the diagnostic utility of existing predictors of any hemorrhagic transformation (HT) and compare them with new perfusion imaging permeability measures in ischemic stroke patients receiving alteplase only. METHODS A pixel-based analysis of pretreatment CT perfusion (CTP) was undertaken to define the optimal CTP permeability thresholds to predict the likelihood of HT. We then compared previously proposed predictors of HT using regression analyses and receiver operating characteristic curve analysis to produce an area under the curve (AUC). We compared AUCs using χ2 analysis. RESULTS From 5 centers, 1,407 patients were included in this study; of these, 282 had HT. The cohort was split into a derivation cohort (1,025, 70% patients) and a validation cohort (382 patients or 30%). The extraction fraction (E) permeability map at a threshold of 30% relative to contralateral had the highest AUC at predicting any HT (derivation AUC 0.85, 95% confidence interval [CI], 0.79-0.91; validation AUC 0.84, 95% CI 0.77-0.91). The AUC improved when permeability was assessed within the acute perfusion lesion for the E maps at a threshold of 30% (derivation AUC 0.91, 95% CI 0.86-0.95; validation AUC 0.89, 95% CI 0.86-0.95). Previously proposed associations with HT and parenchymal hematoma showed lower AUC values than the permeability measure. INTERPRETATION In this large multicenter study, we have validated a highly accurate measure of HT prediction. This measure might be useful in clinical practice to predict hemorrhagic transformation in ischemic stroke patients before receiving alteplase alone. ANN NEUROL 2020;88:466-476.
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Affiliation(s)
- Andrew Bivard
- Departments of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Christopher Levi
- Melbourne Medical School, University of Melbourne, Victoria, Australia
| | - Longting Lin
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chushuang Chen
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Richard Aviv
- Department of Radiology, Neuroradiology section, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Philip M C Choi
- Department of Neuroscience, Eastern Health. Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Neil J Spratt
- Departments of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kenneth Butcher
- Department of Neurology, Department of Medicine, University of New South Wales, Kensington, New South Wales, Australia
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Mark Parsons
- Departments of Neurology, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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14
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Dogra P, Butner JD, Nizzero S, Ruiz Ramírez J, Noureddine A, Peláez MJ, Elganainy D, Yang Z, Le AD, Goel S, Leong HS, Koay EJ, Brinker CJ, Cristini V, Wang Z. Image-guided mathematical modeling for pharmacological evaluation of nanomaterials and monoclonal antibodies. WILEY INTERDISCIPLINARY REVIEWS-NANOMEDICINE AND NANOBIOTECHNOLOGY 2020; 12:e1628. [PMID: 32314552 PMCID: PMC7507140 DOI: 10.1002/wnan.1628] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/06/2020] [Accepted: 02/15/2020] [Indexed: 12/13/2022]
Abstract
While plasma concentration kinetics has traditionally been the predictor of drug pharmacological effects, it can occasionally fail to represent kinetics at the site of action, particularly for solid tumors. This is especially true in the case of delivery of therapeutic macromolecules (drug-loaded nanomaterials or monoclonal antibodies), which can experience challenges to effective delivery due to particle size-dependent diffusion barriers at the target site. As a result, disparity between therapeutic plasma kinetics and kinetics at the site of action may exist, highlighting the importance of target site concentration kinetics in determining the pharmacodynamic effects of macromolecular therapeutic agents. Assessment of concentration kinetics at the target site has been facilitated by non-invasive in vivo imaging modalities. This allows for visualization and quantification of the whole-body disposition behavior of therapeutics that is essential for a comprehensive understanding of their pharmacokinetics and pharmacodynamics. Quantitative non-invasive imaging can also help guide the development and parameterization of mathematical models for descriptive and predictive purposes. Here, we present a review of the application of state-of-the-art imaging modalities for quantitative pharmacological evaluation of therapeutic nanoparticles and monoclonal antibodies, with a focus on their integration with mathematical models, and identify challenges and opportunities. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease Diagnostic Tools > in vivo Nanodiagnostics and Imaging Nanotechnology Approaches to Biology > Nanoscale Systems in Biology.
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Affiliation(s)
- Prashant Dogra
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Joseph D Butner
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Sara Nizzero
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Javier Ruiz Ramírez
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Achraf Noureddine
- Department of Chemical and Biological Engineering, University of New Mexico, Albuquerque, New Mexico, USA
| | - María J Peláez
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA.,Applied Physics Graduate Program, Rice University, Houston, Texas, USA
| | - Dalia Elganainy
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Zhen Yang
- Center for Bioenergetics, Houston Methodist Research Institute, Houston, Texas, USA
| | - Anh-Dung Le
- Nanoscience and Microsystems Engineering, University of New Mexico, Albuquerque, New Mexico, USA
| | - Shreya Goel
- Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hon S Leong
- Biological Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Eugene J Koay
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - C Jeffrey Brinker
- Department of Chemical and Biological Engineering and UNM Comprehensive Cancer Center, University of New Mexico, Albuquerque, New Mexico, USA
| | - Vittorio Cristini
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Zhihui Wang
- Mathematics in Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
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15
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In Silico Studies on Triterpenoid Saponins Permeation through the Blood-Brain Barrier Combined with Postmortem Research on the Brain Tissues of Mice Affected by Astragaloside IV Administration. Int J Mol Sci 2020; 21:ijms21072534. [PMID: 32260588 PMCID: PMC7177733 DOI: 10.3390/ijms21072534] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 02/06/2023] Open
Abstract
As the number of central nervous system (CNS) drug candidates is constantly growing, there is a strong need for precise a priori prediction of whether an administered compound is able to cross the blood–brain barrier (BBB). The aim of this study was to evaluate the ability to cross the BBB of triterpenoid saponins occurring in Astragalus mongholicus roots. The research was carried out using in silico methods combined with postmortem studies on the brain tissues of mice treated with isolated astragaloside IV (AIV). Firstly, to estimate the ability to cross the BBB by the tested saponins, new quantitative structure–activity relationship (QSAR) models were established. The reliability and predictability of the model based on the values of the blood–brain barrier penetration descriptor (logBB), the difference between the n-octanol/water and cyclohexane/water logP (ΔlogP), the logarithm of n-octanol/water partition coefficient (logPow), and the excess molar refraction (E) were both confirmed using the applicability domain (AD). The critical leverage value h* was found to be 0.128. The relationships between the standardized residuals and the leverages were investigated here. The application of an in vitro acetylcholinesterase-inhibition test showed that AIV can be recognized as the strongest inhibitor among the tested compounds. Therefore, it was isolated for the postmortem studies on brain tissues and blood using semi-preparative HPLC with the mobile phase composed of water, methanol, and ethyl acetate (1.7:2.1:16.2 v/v/v). The results of the postmortem studies on the brain tissues show a regular dependence of the final concentration of AIV in the analyzed brain samples of animals treated with 12.5 and 25 mg/kg b.w. of AIV (0.00012299 and 0.0002306 mg, respectively, per one brain). Moreover, the AIV logBB value was experimentally determined and found to be equal to 0.49 ± 0.03.
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16
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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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17
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MR imaging phenotype correlates with extent of genome-wide copy number abundance in IDH mutant gliomas. Neuroradiology 2019; 61:1023-1031. [PMID: 31134296 DOI: 10.1007/s00234-019-02219-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE There is variability in survival within IDH mutant gliomas determined by chromosomal events. Copy number variation (CNV) abundance associated with survival in low-grade and IDH mutant astrocytoma has been reported. Our purpose was to correlate the extent of genome-wide CNV abundance in IDH mutant astrocytomas with MRI features. METHODS Presurgical MRI and CNV plots derived from Illumina 850k EPIC DNA methylation arrays of 18 cases of WHO grade II-IV IDH mutant astrocytomas were reviewed. IDH mutant astrocytomas were divided into CNV stable group (CNV-S) with ≤ 3 chromosomal gains or losses and lack of focal gene amplifications and CNV unstable group (CNV-U) with > 3 large chromosomal gains/losses and/or focal amplifications. The associations between MR features, relative cerebral blood volume (rCBV), CNV abundance, and time to progression were assessed. Tumor rCBV estimates were obtained using DSC T2* perfusion analysis. RESULTS There were nine (50%) CNV-S and nine (50%) CNV-U IDH mutant astrocytomas. CNV-U tumors showed larger mean tumor size (P = 0.004) and maximum diameter on FLAIR (P = 0.004) and also demonstrated significantly higher median rCBV than CNV-S tumors (2.62 vs 0.78, P = 0.019). CNV-U tumors tended to have shorter time to progression although without statistical significance (P = 0.393). CONCLUSIONS Larger size/diameter and higher rCBVs were seen associated CNV-U astrocytomas, suggesting a correlation of aggressive imaging phenotype with unstable and aggressive genotype in IDH mutant astrocytomas.
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18
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Orr SE, Gokulan K, Boudreau M, Cerniglia CE, Khare S. Alteration in the mRNA expression of genes associated with gastrointestinal permeability and ileal TNF-α secretion due to the exposure of silver nanoparticles in Sprague-Dawley rats. J Nanobiotechnology 2019; 17:63. [PMID: 31084603 PMCID: PMC6513523 DOI: 10.1186/s12951-019-0499-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/04/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Silver ions from silver nanoparticles (AgNP) or AgNPs themselves itself that are ingested from consumer health care products or indirectly from absorbed food contact material can interact with the gastrointestinal tract (GIT). The permeability of the GIT is strictly regulated to maintain barrier function and proper nutrient absorption. The single layer intestinal epithelium adheres and communicates actively to neighboring cells and the extracellular matrix through different cell junctions. In the current study, we hypothesized that oral exposure to AgNPs may alter the intestinal permeability and expression of genes controlling cell junctions. Changes in cell junction gene expression in the ileum of male and female rats administered different sizes of AgNP for 13-weeks were assessed using qPCR. RESULTS The results of this study indicate that AgNPs have an altering effect on cell junctions that are known to dictate intestinal permeability. mRNA expression of genes representing tight junction (Cldn1, Cldn5, Cldn6, Cldn10 and Pecam1), focal adhesion (Cav1, Cav2, and Itgb2), adherens junction (Pvrl1, Notch1, and Notch2), and hemidesmosome (Dst) groups were upregulated significantly in females treated with 10 nm AgNP, while no change or downregulation of same genes was detected in male animals. In addition, a higher concentration of pro-inflammatory cytokine, TNF-α, was noticed in AgNP-treated female animals as compared to controls. CONCLUSIONS This study proposes that interaction of silver with GIT could potentially initiate an inflammatory process that could lead to changes in the gastrointestinal permeability and/or nutrient deficiencies in sex-specific manner. Fully understanding the mechanistic consequences of oral AgNP exposure may lead to stricter regulation for the commercial usage of AgNPs and/or improved clinical therapy in the future.
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Affiliation(s)
- Sarah E Orr
- Division of Microbiology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72029, USA
| | - Kuppan Gokulan
- Division of Microbiology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72029, USA
| | - Mary Boudreau
- Division of Biochemical Toxicology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72029, USA
| | - Carl E Cerniglia
- Division of Microbiology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72029, USA
| | - Sangeeta Khare
- Division of Microbiology, National Center for Toxicological Research, US Food and Drug Administration, 3900 NCTR Road, Jefferson, AR, 72029, USA.
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19
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Gonawala S, Aryal M, Ewing JR, deCarvalho AC, Kalkanis S, Ali MM. MRI Monitoring of Cerebral Blood Flow after the Delivery of Nanocombretastatin across the Blood Brain Tumor Barrier. JOURNAL OF NANOMEDICINE & NANOTECHNOLOGY 2019; 9. [PMID: 30656065 PMCID: PMC6333422 DOI: 10.4172/2157-7439.1000516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction of polymeric nanoparticles in cancer therapeutics is widely investigated since nanomedicine often enables the intratumoral delivery of drugs with increased efficacy with minimal side effects. In this study MRI monitoring was employed to study the therapeutic effect of nanocombretastatin (G3-CA4) in an orthotopic glioma model. Water insoluble combretastatin (CA4) was conjugated to a small-sized water soluble G3-succinamic acid PAMAM dendrimer. Nanoconstruct sizes were determined by TEM to be 3 to 5 nm. Intravenous (i.v.) delivery of G3-CA4 in an orthotopic glioma model produced a long-lived ischemia accompanied by necrosis at the core of the tumor but leaving a rim of viable tissue. In contrast, delivery of CA4 alone has no therapeutic effect in an experimental rat model of glioma.
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Affiliation(s)
- Sunalee Gonawala
- Department of Neurosurgery, Cellular and Molecular Imaging Laboratory, Henry Ford Hospital, USA
| | - Madhava Aryal
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - James R Ewing
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Ana C deCarvalho
- Department of Neurosurgery, Cellular and Molecular Imaging Laboratory, Henry Ford Hospital, USA
| | - Steven Kalkanis
- Department of Neurosurgery, Cellular and Molecular Imaging Laboratory, Henry Ford Hospital, USA
| | - Meser M Ali
- Department of Neurosurgery, Cellular and Molecular Imaging Laboratory, Henry Ford Hospital, USA
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20
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Relative Cerebral Blood Transit Time Decline and Neurological Improvement in Patients After Internal Carotid Artery Stenting. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1176:71-80. [PMID: 31098943 DOI: 10.1007/5584_2019_378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this study we hypothesized that the alleviation of neurological symptoms long after internal carotid artery (ICA) stenting may be related to sustained improvement of cerebral perfusion. Thirty-four subjects (F/M; 15/19) with >70% stenosis of a single internal carotid artery and neurological symptoms, who underwent a carotid artery stenting procedure, were studied. Brain computed tomography perfusion (CTP) imaging was performed before and 3 years after ICA stenting. The following relative variables were compared: cerebral blood flow (rCBF), cerebral blood volume (rCBV), mean transit time (rMTT), time to peak (rTTP), and permeability surface area product (rPS). A survey also was conducted to compare the patients' clinical symptoms. Overall, we found that a trend toward rMTT decline was the only persisting change after ICA stenting. We then stratified the patients into the subgroups of <2%, 2-5%, and > 5% rMTT decline and found that those with a rMTT decline >2% reported a prominent reduction in subjective clinical symptoms such as headache, dizziness, tinnitus, blurred vision, transient blindness, a sense of gravity of the head, and pain in the eyeballs. We conclude that a shortened mean rMTT, likely reflecting improved cerebral microcirculation, underlies the improvement of neurological symptoms in patients with ICA stenosis.
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21
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Karegowda LH, Kadavigere R, Shenoy PM, Paruthikunnan SM. First-pass CT-perfusion in differentiating primary extra-axial brain tumours: Added value of MTT and TTP in characterisation beyond CBV and CBF. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Using an orbit shield during volume perfusion CT: is it useful protection or an obstacle? Clin Radiol 2018; 73:834.e1-834.e8. [DOI: 10.1016/j.crad.2018.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/01/2018] [Indexed: 11/22/2022]
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23
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Kaichi Y, Tatsugami F, Nakamura Y, Baba Y, Iida M, Higaki T, Kiguchi M, Tsushima S, Yamasaki F, Amatya VJ, Takeshima Y, Kurisu K, Awai K. Improved differentiation between high- and low-grade gliomas by combining dual-energy CT analysis and perfusion CT. Medicine (Baltimore) 2018; 97:e11670. [PMID: 30095624 PMCID: PMC6133561 DOI: 10.1097/md.0000000000011670] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to investigate the value of the cerebral blood volume (CBV) obtained with perfusion computed tomography (CT) and the electron density (ED) measured by dual-energy CT for differentiating high- from low-grade glioma (HGG, LGG).The CBV and ED were obtained in 9 LGG and 7 HGG patients. The CBV and ED of LGGs and HGGs were compared. Receiver operating characteristic (ROC) curves were generated for CBV, ED, and CBV plus ED. The correlation between CBV, ED, and the MIB-1 labeling index of the tumors was examined. All of these analyses were also performed using relative CBV (rCBV) and ED (rED) (the value of tumors/the value of contralateral white matter).The mean CBV, ED, rCBV, and rED values were significantly higher in HGG than LGG (P < .05). By ROC analysis, the combination of rCBV plus rED as well as CBV plus ED were more accurate than CBV, ED, rCBV, rED alone. There was a significant correlation between ED and MIB-1 (P = .04).ED improved diagnostic accuracy of perfusion CT for differentiating HGG from LGG.
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Affiliation(s)
| | | | | | | | | | | | - Masao Kiguchi
- Department of Radiology, Hiroshima University, Minami-ku, Hiroshima
| | - So Tsushima
- Canon Medical Systems Corporation, Otawara, Tochigi
| | | | - Vishwa Jeet Amatya
- Department of Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical Sciences
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Wright KL, Jiang Y, Ma D, Noll DC, Griswold MA, Gulani V, Hernandez-Garcia L. Estimation of perfusion properties with MR Fingerprinting Arterial Spin Labeling. Magn Reson Imaging 2018; 50:68-77. [PMID: 29545215 DOI: 10.1016/j.mri.2018.03.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 03/10/2018] [Indexed: 12/22/2022]
Abstract
In this study, the acquisition of ASL data and quantification of multiple hemodynamic parameters was explored using a Magnetic Resonance Fingerprinting (MRF) approach. A pseudo-continuous ASL labeling scheme was used with pseudo-randomized timings to acquire the MRF ASL data in a 2.5 min acquisition. A large dictionary of MRF ASL signals was generated by combining a wide range of physical and hemodynamic properties with the pseudo-random MRF ASL sequence and a two-compartment model. The acquired signals were matched to the dictionary to provide simultaneous quantification of cerebral blood flow, tissue time-to-peak, cerebral blood volume, arterial time-to-peak, B1, and T1. A study in seven healthy volunteers resulted in the following values across the population in grey matter (mean ± standard deviation): cerebral blood flow of 69.1 ± 6.1 ml/min/100 g, arterial time-to-peak of 1.5 ± 0.1 s, tissue time-to-peak of 1.5 ± 0.1 s, T1 of 1634 ms, cerebral blood volume of 0.0048 ± 0.0005. The CBF measurements were compared to standard pCASL CBF estimates using a one-compartment model, and a Bland-Altman analysis showed good agreement with a minor bias. Repeatability was tested in five volunteers in the same exam session, and no statistical difference was seen. In addition to this validation, the MRF ASL acquisition's sensitivity to the physical and physiological parameters of interest was studied numerically.
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Affiliation(s)
- Katherine L Wright
- Dept. of Radiology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH, USA.
| | - Yun Jiang
- Dept. of Radiology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH, USA
| | - Dan Ma
- Dept. of Radiology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH, USA
| | - Douglas C Noll
- Dept. of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Mark A Griswold
- Dept. of Radiology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH, USA; Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Gulani
- Dept. of Radiology, Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH, USA; Dept. of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
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Diagnosing Neoplastic Hematoma: Role of MR Perfusion. Clin Neuroradiol 2018; 29:263-268. [PMID: 29417155 DOI: 10.1007/s00062-018-0664-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/10/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND The imaging appearance of neoplastic hematoma can be complicated by the presence of a large hematoma, even on magnetic resonance imaging (MRI). We describe the role of MR perfusion (MRP) in detecting neoplastic hematomas in patients with intraparenchymal hematoma (IPH). MATERIAL AND METHODS A retrospective review was performed for consecutive patients with IPH, where MRP was performed. Routine, post-gadolinium MRI and MRP were analyzed. All patients were either operated on for evacuation of IPH or followed up on imaging. The MRP parameters of cerebral blood volume (CBV) and cerebral blood flow (CBF) and pattern of enhancement (peripheral linear vs. nodular) were recorded. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated for these parameters for diagnosing neoplastic hematoma. RESULTS Of 116 patients with MRP, 16 patients (male 8; mean age-65.5 years) had IPH on their initial MRI. For diagnosing neoplastic hematoma, the sensitivity, specificity, PPV and NPV for increased CBF and CBV were 100%, 88.9%, 87.5%, and 100%; for peripheral linear enhancement were 100%, 28.6%, 50%, 100% and for nodular enhancement were 85.7%, 77.8%, 75% and 12.5%, respectively. The combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV. CONCLUSION In our small series, the combination of peripheral linear enhancement and increased CBF and CBV showed 100% sensitivity, specificity, PPV and NPV for diagnosing a neoplastic hematoma. These findings need to be validated in a larger study.
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26
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Pronin AI, Dolgushin MB, Lyuosev AS, Odzharova AA, Nevzorov DI, Nechipay EA, Gasparyan TG. [Capabilities of 18F-FET PET/CT in a patient with brain glioma (a case report and literature review)]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2018; 82:95-99. [PMID: 29795092 DOI: 10.17116/oftalma201882295-99] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Positron emission tomography combined with computed tomography (PET/CT) enables assessment of not only anatomical and structural but also metabolic changes in tumor mass. 18F-fluoroethyl tyrosine (18F-FET) PET/CT is based on evaluation of transport of 18F-labeled tyrosine in tissues. We present a clinical case of a patient with a newly diagnosed brain tumor, demonstrating the capabilities of 18F-FET PET/CT in assessing the reliable volume and degree of tumor anaplasia, which is important when choosing the treatment approach for a patient.
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Affiliation(s)
- A I Pronin
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
| | - M B Dolgushin
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
| | - A S Lyuosev
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
| | - A A Odzharova
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
| | - D I Nevzorov
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
| | - E A Nechipay
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
| | - T G Gasparyan
- Blokhin Russian Cancer Research Center, Kashirskoe Shosse, 23, Moscow, Russia, 115478
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Saini J, Gupta PK, Sahoo P, Singh A, Patir R, Ahlawat S, Beniwal M, Thennarasu K, Santosh V, Gupta RK. Differentiation of grade II/III and grade IV glioma by combining "T1 contrast-enhanced brain perfusion imaging" and susceptibility-weighted quantitative imaging. Neuroradiology 2017; 60:43-50. [PMID: 29090331 DOI: 10.1007/s00234-017-1942-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/18/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE MRI is a useful method for discriminating low- and high-grade glioma using perfusion MRI and susceptibility-weighted imaging (SWI). The purpose of this study is to evaluate the usefulness of T1-perfusion MRI and SWI in discriminating among grade II, III, and IV gliomas. METHODS T1-perfusion MRI was used to measure relative cerebral blood volume (rCBV) in 129 patients with glioma (70 grade IV, 33 grade III, and 26 grade II tumors). SWI was also used to measure the intratumoral susceptibility signal intensity (ITSS) scores for each tumor in these patients. rCBV and ITSS values were compared to seek differences between grade II vs. grade III, grade III vs. grade IV, and grade III+II vs. grade IV tumors. RESULTS Significant differences in rCBV values of the three grades of the tumors were noted and pairwise comparisons showed significantly higher rCBV values in grade IV tumors as compared to grade III tumors, and similarly increased rCBV was seen in the grade III tumors as compared to grade II tumors (p < 0.001). Grade IV gliomas showed significantly higher ITSS scores on SWI as compared to grade III tumors (p < 0.001) whereas insignificant difference was seen on comparing ITSS scores of grade III with grade II tumors. Combining the rCBV and ITSS resulted in significant improvement in the discrimination of grade III from grade IV tumors. CONCLUSION The combination of rCBV values derived from T1-perfusion MRI and SWI derived ITSS scores improves the diagnostic accuracy for discrimination of grade III from grade IV gliomas.
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Affiliation(s)
- Jitender Saini
- Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pradeep Kumar Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurugram, India
| | - Prativa Sahoo
- Philips Health System, Philips India Limited, Bangalore, India.,Beckman Research Institute, Mathematical Oncology, bldg-74, Duarte, CA, USA
| | - Anup Singh
- Center for Biomedical Engineering, Indian Institute of Technology Delhi, Delhi, India
| | - Rana Patir
- Department of Neurosurgery, Fortis Memorial Research Institute, Gurugram, India
| | - Suneeta Ahlawat
- SRL Diagnostics, Fortis Memorial Research Institute, Gurugram, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - K Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Rakesh Kumar Gupta
- Department of Radiology and Imaging, Fortis Memorial Research Institute, Gurugram, India.
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Jo J, Lee CH, Kopelman R, Wang X. In vivo quantitative imaging of tumor pH by nanosonophore assisted multispectral photoacoustic imaging. Nat Commun 2017; 8:471. [PMID: 28883396 PMCID: PMC5589864 DOI: 10.1038/s41467-017-00598-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 07/12/2017] [Indexed: 02/04/2023] Open
Abstract
Changes of physiological pH are correlated with several pathologies, therefore the development of more effective medical pH imaging methods is of paramount importance. Here, we report on an in vivo pH mapping nanotechnology. This subsurface chemical imaging is based on tumor-targeted, pH sensing nanoprobes and multi-wavelength photoacoustic imaging (PAI). The nanotechnology consists of an optical pH indicator, SNARF-5F, 5-(and-6)-Carboxylic Acid, encapsulated into polyacrylamide nanoparticles with surface modification for tumor targeting. Facilitated by multi-wavelength PAI plus a spectral unmixing technique, the accuracy of pH measurement inside the biological environment is not susceptible to the background optical absorption of biomolecules, i.e., hemoglobins. As a result, both the pH levels and the hemodynamic properties across the entire tumor can be quantitatively evaluated with high sensitivity and high spatial resolution in in vivo cancer models. The imaging technology reported here holds the potential for both research on and clinical management of a variety of cancers. Background optical absorption of several biomolecules impedes an effective in vivo pH imaging in tumors. Here, the authors developed a visible light-based in vivo pH mapping method by coupling photoacoustic imaging and pH-responsive modified nanoparticles that selectively target tumor cells.
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Affiliation(s)
- Janggun Jo
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Chang H Lee
- Department of Chemistry, University of Michigan, Ann Arbor, Michigan, 48109, USA
| | - Raoul Kopelman
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA. .,Department of Chemistry, University of Michigan, Ann Arbor, Michigan, 48109, USA.
| | - Xueding Wang
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, 48109, USA. .,Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan, 48109, USA.
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29
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Reproducibility and relative stability in magnetic resonance imaging indices of tumor vascular physiology over a period of 24h in a rat 9L gliosarcoma model. Magn Reson Imaging 2017; 44:131-139. [PMID: 28887206 DOI: 10.1016/j.mri.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/03/2017] [Accepted: 09/01/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE The objective was to study temporal changes in tumor vascular physiological indices in a period of 24h in a 9L gliosarcoma rat model. METHODS Fischer-344 rats (N=14) were orthotopically implanted with 9L cells. At 2weeks post-implantation, they were imaged twice in a 24h interval using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI). Data-driven model-selection-based analysis was used to segment tumor regions with varying vascular permeability characteristics. The region with the maximum number of estimable parameters of vascular kinetics was chosen for comparison across the two time points. It provided estimates of three parameters for an MR contrast agent (MRCA): i) plasma volume (vp), ii) forward volumetric transfer constant (Ktrans) and interstitial volume fraction (ve, ratio of Ktrans to reverse transfer constant, kep). In addition, MRCA extracellular distribution volume (VD) was estimated in the tumor and its borders, along with tumor blood flow (TBF) and peritumoral MRCA flux. Descriptors of parametric distributions were compared between the two times. Tumor extent was examined by hematoxylin and eosin (H&E) staining. Picrosirus red staining of secreted collagen was performed as an additional index for 9L cells. RESULTS Test-retest differences between population summaries for any parameter were not significant (paired t and Wilcoxon signed rank tests). Bland-Altman plots showed no apparent trends between the differences and averages of the test-retest measures for all indices. The intraclass correlation coefficients showed moderate to almost perfect reproducibility for all of the parameters, except vp. H&E staining showed tumor infiltration in parenchyma, perivascular space and white matter tracts. Collagen staining was observed along the outer edges of main tumor mass. CONCLUSION The data suggest the relative stability of these MR indices of tumor microenvironment over a 24h duration in this gliosarcoma model.
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30
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Li Z, Zhou Q, Li Y, Yan S, Fu J, Huang X, Shen L. Mean cerebral blood volume is an effective diagnostic index of recurrent and radiation injury in glioma patients: A meta-analysis of diagnostic test. Oncotarget 2017; 8:15642-15650. [PMID: 28152505 PMCID: PMC5362512 DOI: 10.18632/oncotarget.14922] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/15/2016] [Indexed: 11/25/2022] Open
Abstract
We conducted a meta-analysis to evaluate the diagnostic values of mean cerebral blood volume for recurrent and radiation injury in glioma patients. We performed systematic electronic searches for eligible study up to August 8, 2016. Bivariate mixed effects models were used to estimate the combined sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, diagnostic odds ratios and their 95% confidence intervals (CIs). Fifteen studies with a total number of 576 participants were enrolled. The pooled sensitivity and specificity of diagnostic were 0.88 (95%CI: 0.82-0.92) and 0.85 (95%CI: 0.68-0.93). The pooled positive likelihood ratio is 5.73 (95%CI: 2.56-12.81), negative likelihood ratio is 0.15 (95%CI: 0.10-0.22), and the diagnostic odds ratio is 39.34 (95%CI:13.96-110.84). The summary receiver operator characteristic is 0.91 (95%CI: 0.88-0.93). However, the Deek's plot suggested publication bias may exist (t=2.30, P=0.039). Mean cerebral blood volume measurement methods seems to be very sensitive and highly specific to differentiate recurrent and radiation injury in glioma patients. The results should be interpreted with caution because of the potential bias.
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Affiliation(s)
- Zhanzhan Li
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Qin Zhou
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Yanyan Li
- Office of Cancer Prevent and Control, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Shipeng Yan
- Office of Cancer Prevent and Control, Hunan Provincial Tumor Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013 China
| | - Jun Fu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Xinqiong Huang
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
| | - Liangfang Shen
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan Province 410008, China
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Griffith B, Jain R. Perfusion Imaging in Neuro-Oncology: Basic Techniques and Clinical Applications. Magn Reson Imaging Clin N Am 2017; 24:765-779. [PMID: 27742116 DOI: 10.1016/j.mric.2016.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Perfusion imaging is a method for assessing the flow of blood occurring at the tissue level and can be accomplished by both CT and MR perfusion techniques. The use of perfusion imaging has increased substantially in the past decade, particularly in neuro-oncologic imaging, where it is has been used for brain tumor grading and directing biopsies or targeted therapy, as well as for the evaluation of treatment response and disease progression. This article discusses the basic principles and techniques of perfusion imaging, as well as its applications in neuro-oncology.
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Affiliation(s)
- Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA.
| | - Rajan Jain
- NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
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Abstract
Dendritic polymers or dendrimers present an alternate template for the development of nanoparticulate-based drug delivery and imaging systems. The smaller size (~7-12 nm) of dendrimers have the advantage over the other particles, because its smaller size can possibly improve tumor penetration and the inclusion of tumor specific drug release mechanisms. A Paramagnetic Chemical Exchange Saturation Transfer (PARACEST) MRI contrast agent, Eu-DOTA-Gly4 or a clinical relevant Gd-DOTA was conjugated on the surface of a G5 PAMAM dendrimer. To create a dual mode MRI-optical imaging nanoparticle, Dylight680 was also incorporated on the amines surface of a G5 dendrimer. The particle was detected with in vivo MRI in preclinical glioma animal model. Furthermore, noninvasive imaging results were validated with in vivo and ex-vivo optical imaging.
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Affiliation(s)
| | - Meser M Ali
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA.,Department of Chemical Engineering and Material Science, Wayne State University, Detroit, MI, USA
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Szarmach A, Halena G, Kaszubowski M, Piskunowicz M, Studniarek M, Lass P, Szurowska E, Winklewski PJ. Carotid Artery Stenting and Blood-Brain Barrier Permeability in Subjects with Chronic Carotid Artery Stenosis. Int J Mol Sci 2017; 18:ijms18051008. [PMID: 28481312 PMCID: PMC5454921 DOI: 10.3390/ijms18051008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/23/2017] [Accepted: 05/03/2017] [Indexed: 01/28/2023] Open
Abstract
Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population. Forty subjects (23 males) with stenosis of >70% within a single internal carotid artery and neurological symptoms who underwent a carotid artery stenting procedure were investigated. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after surgery: global cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material. In all baseline cases, the CBF and CBV values were low, while MTT and TTP were high on both the ipsi- and contralateral sides compared to reference values. PS was approximately twice the normal value. CBF was higher (+6.14%), while MTT was lower (−9.34%) on the contralateral than on the ipsilateral side. All perfusion parameters improved after stenting on both the ipsilateral (CBF +22.66%; CBV +18.98%; MTT −16.09%, TTP −7.62%) and contralateral (CBF +22.27%, CBV +19.72%, MTT −14.65%, TTP −7.46%) sides. PS decreased by almost half: ipsilateral −48.11%, contralateral −45.19%. The decline in BBB permeability was symmetrical on the ipsi- and contralateral sides to the stenosis. Augmented BBB permeability can be controlled by surgical intervention in humans.
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Affiliation(s)
- Arkadiusz Szarmach
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Grzegorz Halena
- Department of Cardiovascular Surgery, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Mariusz Kaszubowski
- Department of Economic Sciences, Faculty of Management and Economics, Gdansk University of Technology, Gdansk 80-210, Poland.
| | - Maciej Piskunowicz
- 1st Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Michal Studniarek
- 1st Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
- Department of Diagnostic Imaging, Medical University of Warsaw, Warsaw 03-242, Poland.
| | - Piotr Lass
- Department of Nuclear Medicine, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, Gdansk 80-210, Poland.
| | - Pawel J Winklewski
- Institute of Human Physiology, Medical University of Gdansk, Gdansk 80-210, Poland.
- Department of Clinical Sciences, Institute of Health Sciences, Pomeranian University of Slupsk, Slupsk 76-200, Poland.
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Karegowda LH, Kadavigere R, Shenoy PM, Paruthikunnan SM. Efficacy of Perfusion Computed Tomography (PCT) in Differentiating High-Grade Gliomas from Low Grade Gliomas, Lymphomas, Metastases and Abscess. J Clin Diagn Res 2017; 11:TC28-TC33. [PMID: 28658875 DOI: 10.7860/jcdr/2017/24835.9917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/01/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tumoural angioneogenesis and its quantification are important in predicting the tumour grade and in the management with respect to the treatment available and to assess the response to treatment and the prognosis. It also plays major role in the growth and spread of tumours. Hence, a need arises for non-invasive in vivo methods to assess tumour angioneogenesis and tumour grade at the time of presentation and for monitoring the response during treatment and follow up. In this regard Perfusion Computed Tomography (PCT) can be easily added into routine CT studies to obtain such information on lesion physiology along with its morphology. AIM Prospective evaluation of the efficacy of PCT in differentiating high grade gliomas from low grade glioma lymphomas, metastases and abscess. MATERIALS AND METHODS Perfusion CT was performed in 68 patients (17 high-grade gliomas, 10 low-grade gliomas, 7 lymphomas, 27 metastases and 7 abscess). Perfusion parameters which include Cerebral Blood Volume (CBV), Cerebral Blood Flow (CBF), Mean Transit Time (MTT) and Time To Peak (TTP) were derived both from the lesion and the normal parenchyma and were Normalized (n) by obtaining the ratio. Statistical analysis for high grade versus low-grade gliomas, high grade gliomas versus lymphomas, metastases and abscess was performed. RESULTS Difference in the mean nCBV and nCBF in high grade gliomas were statistically significant from low grade gliomas with cut off of > 3.07 for nCBV and > 2.08 for nCBF yielding good sensitivity and specificity. Difference in the mean nCBV and nMTT in the lymphomas were statistically significant from high grade gliomas (p<0.05) with cut off of <3.40 for nCBV and >1.83 for nMTT yielding good sensitivity and specificity. Difference in the mean nCBV and nMTT in the metastases were statistically significant from high grade gliomas (p<0.05) with cut off of >4.95 for nCBV and >1.88 for nMTT yielding a fair sensitivity and specificity. No statistical significant difference seen among the parameters in differentiating high grade gliomas and abscess. CONCLUSION Cerebral PCT greatly adds to the diagnostic accuracy when the diagnosis of a common intra-axial lesion based on morphological characters becomes uncertain.
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Affiliation(s)
| | - Rajagopal Kadavigere
- Professor, Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, Karnataka, India
| | - Poonam Mohan Shenoy
- Speciality Doctor, Department of Radiology, Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Croesnewydd Road, LL13 7TD, Wrexham, United Kingdom
| | - Samir Mustaffa Paruthikunnan
- Assistant Professor, Department of Radiodiagnosis and Imaging, Kasturba Medical College and Hospital, Manipal, Karnataka, India
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Vucicevic J, Popovic M, Nikolic K, Filipic S, Obradovic D, Agbaba D. Use of biopartitioning micellar chromatography and RP-HPLC for the determination of blood-brain barrier penetration of α-adrenergic/imidazoline receptor ligands, and QSPR analysis. SAR AND QSAR IN ENVIRONMENTAL RESEARCH 2017; 28:235-252. [PMID: 28332439 DOI: 10.1080/1062936x.2017.1302506] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 02/28/2017] [Indexed: 06/06/2023]
Abstract
For this study, 31 compounds, including 16 imidazoline/α-adrenergic receptor (IRs/α-ARs) ligands and 15 central nervous system (CNS) drugs, were characterized in terms of the retention factors (k) obtained using biopartitioning micellar and classical reversed phase chromatography (log kBMC and log kwRP, respectively). Based on the retention factor (log kwRP) and slope of the linear curve (S) the isocratic parameter (φ0) was calculated. Obtained retention factors were correlated with experimental log BB values for the group of examined compounds. High correlations were obtained between logarithm of biopartitioning micellar chromatography (BMC) retention factor and effective permeability (r(log kBMC/log BB): 0.77), while for RP-HPLC system the correlations were lower (r(log kwRP/log BB): 0.58; r(S/log BB): -0.50; r(φ0/Pe): 0.61). Based on the log kBMC retention data and calculated molecular parameters of the examined compounds, quantitative structure-permeability relationship (QSPR) models were developed using partial least squares, stepwise multiple linear regression, support vector machine and artificial neural network methodologies. A high degree of structural diversity of the analysed IRs/α-ARs ligands and CNS drugs provides wide applicability domain of the QSPR models for estimation of blood-brain barrier penetration of the related compounds.
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Affiliation(s)
- J Vucicevic
- a Department of Pharmaceutical Chemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - M Popovic
- a Department of Pharmaceutical Chemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - K Nikolic
- a Department of Pharmaceutical Chemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - S Filipic
- a Department of Pharmaceutical Chemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - D Obradovic
- a Department of Pharmaceutical Chemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
| | - D Agbaba
- a Department of Pharmaceutical Chemistry, Faculty of Pharmacy , University of Belgrade , Belgrade , Serbia
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Belliveau JG, Bauman G, Macdonald DR. Detecting tumor progression in glioma: current standards and new techniques. Expert Rev Anticancer Ther 2016; 16:1177-1188. [PMID: 27661768 DOI: 10.1080/14737140.2016.1240621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-treatment monitoring of glioma patients remains an area of active research and development. Conventional imaging with MRI is a highly sensitive modality for detecting and monitoring primary and secondary brain tumors and includes multi-parametric sequences to better characterize the disease. Standardized schemes for measuring response to treatment are in wide clinical use; however, the introduction of new therapeutics have introduced new patterns of response that can confound interpretation of conventional MRI and can cause uncertainty in the proper management following therapy. Areas covered: A summary of current and evolving techniques for assessing glioma response in this era of new therapies that address these challenges are presented in this review. While this review focuses more on clinical and early clinical methodologies for MRI and nuclear medicine techniques some promising pre-clinical techniques are also presented. Expert commentary: While successful single institution results have been widely reported in the literature, any new methodologies must be undertaken in multi-center settings. Additionally, the need for standardization of protocols in quantitative measured are an important area that must be addressed for new and promising techniques to be implemented to a wide array of patients.
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Affiliation(s)
- Jean-Guy Belliveau
- a Department of Medical Biophysics , University of Western Ontario , London , ON , Canada
| | - Glenn Bauman
- b Department of Medical Biophysics and Oncology , University of Western Ontario , London , ON , Canada
| | - David R Macdonald
- c Department of Oncology , University of Western Ontario , London , ON , Canada
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Saito T, Sugiyama K, Ikawa F, Yamasaki F, Ishifuro M, Takayasu T, Nosaka R, Nishibuchi I, Muragaki Y, Kawamata T, Kurisu K. Permeability Surface Area Product Using Perfusion Computed Tomography Is a Valuable Prognostic Factor in Glioblastomas Treated with Radiotherapy Plus Concomitant and Adjuvant Temozolomide. World Neurosurg 2016; 97:21-26. [PMID: 27693246 DOI: 10.1016/j.wneu.2016.09.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/14/2016] [Accepted: 09/16/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The current standard treatment protocol for patients with newly diagnosed glioblastoma (GBM) includes surgery, radiotherapy, and concomitant and adjuvant temozolomide (TMZ). We hypothesized that the permeability surface area product (PS) from a perfusion computed tomography (PCT) study is associated with sensitivity to TMZ. The aim of this study was to determine whether PS values were correlated with prognosis of GBM patients who received the standard treatment protocol. METHODS This study included 36 patients with GBM that were newly diagnosed between October 2005 and September 2014 and who underwent preoperative PCT study and the standard treatment protocol. We measured the maximum value of relative cerebral blood volume (rCBVmax) and the maximum PS value (PSmax). We statistically examined the relationship between PSmax and prognosis using survival analysis, including other clinicopathologic factors (age, Karnofsky performance status [KPS], extent of resection, O6-methylguanine-DNA methyltransferase [MGMT] status, second-line use of bevacizumab, and rCBVmax). RESULTS Log-rank tests revealed that age, KPS, MGMT status, and PSmax were significantly correlated with overall survival. Multivariate analysis using the Cox regression model showed that PSmax was the most significant prognostic factor. Receiver operating characteristic curve analysis showed that PSmax had the highest accuracy in differentiating longtime survivors (LTSs) (surviving more than 2 years) from non-LTSs. At a cutoff point of 8.26 mL/100 g/min, sensitivity and specificity were 90% and 70%, respectively. CONCLUSIONS PSmax from PCT study can help predict survival time in patients with GBM receiving the standard treatment protocol. Survival may be related to sensitivity to TMZ.
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Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan.
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology and Neuro-oncology Program, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Minoru Ishifuro
- Department of Diagnostic Imaging, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Ryo Nosaka
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Hiroshima University Hospital, Minami-ku, Hiroshima, Japan
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Minami-ku, Hiroshima, Japan
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Xue Z, Peng D, Sun Z, Wu C, Xu B, Wang F, Zhou D, Dong T. Intraoperative Perfusion Computed Tomography in Carotid Endarterectomy: Initial Experience in 16 Cases. Med Sci Monit 2016; 22:3362-3369. [PMID: 27657307 PMCID: PMC5036379 DOI: 10.12659/msm.897356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the changes in perfusion computed tomography (PCT) parameters in carotid endarterectomy (CEA), and to discuss the use of intraoperative PCT in CEA. MATERIAL AND METHODS Sixteen patients with carotid stenosis who also underwent CEA with intraoperative CT were recruited in this study. We calculated quantitative data on cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and the relative parameter values, including relative CBF (rCBF), relative CBV (rCBV), and relative TTP (rTTP). The role of PCT was assessed and compared to conventional monitoring methods. RESULTS There were no significant differences in any of the parameters in the anterior cerebral artery (ACA) territory (P>0.05). In the middle cerebral artery (MCA) territory, the CBF and CBV increased and TTP decreased in the operated side during CEA; the rCBF and rCBV increased and the rTTP decreased significantly (P<0.05). In 16 patients, CT parameters were improved, SSEP was normal, and MDU was abnormal. In 3 patients, CBF increased by more than 70% during CEA. Relative PCT parameters are sensitive indicators for detecting early cerebral hemodynamic changes during CEA. Cerebral hemodynamics changed significantly in the MCA territory during CEA. CONCLUSIONS Intraoperative PCT could be an important adjuvant monitoring method in CEA.
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Affiliation(s)
- Zhe Xue
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Dingwei Peng
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Zhenghui Sun
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Chen Wu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Fuyu Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Dingbiao Zhou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Tianxiang Dong
- Department of Radiology, Chinese PLA General Hospital, Beijing, China (mainland)
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Karki K, Ewing JR, Ali MM. Targeting Glioma with a Dual Mode Optical and Paramagnetic Nanoprobe across the Blood-brain Tumor Barrier. ACTA ACUST UNITED AC 2016; 7. [PMID: 27695645 PMCID: PMC5042151 DOI: 10.4172/2157-7439.1000395] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In brain tumors, delivering nanoparticles across the blood-tumor barrier presents major hurdles. A clinically relevant MRI contrast agent, GdDOTA and a near-infrared (NIR) fluorescent dye, DL680 were conjugated to a G5 PAMAM dendrimer, thus producing a dual-mode MRI and NIR imaging agent. Systemic delivery of the subsequent nano-sized agent demonstrated glioma-specific accumulation, probably due to the enhanced permeability and retention effect. In vivo MRI detected the agent in glioma tissue, but not in normal contralateral tissue; this observation was validated with in vivo and ex vivo fluorescence imaging. A biodistribution study showed the agent to have accumulated in the glioma tumor and the liver, the latter being the excretion path for a G5 dendrimer-based agent.
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Affiliation(s)
- Kishor Karki
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - James R Ewing
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
| | - Meser M Ali
- Department of Neurology, Henry Ford Hospital, Detroit, MI 48202, USA
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Lv P, Liu J, Yan X, Chai Y, Chen Y, Gao J, Pan Y, Li S, Guo H, Zhou Y. CT spectral imaging for monitoring the therapeutic efficacy of VEGF receptor kinase inhibitor AG-013736 in rabbit VX2 liver tumours. Eur Radiol 2016; 27:918-926. [PMID: 27287476 DOI: 10.1007/s00330-016-4458-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/21/2016] [Accepted: 05/30/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate the value of computed tomography (CT) spectral imaging in assessing the therapeutic efficacy of a vascular endothelial growth factor (VEGF) receptor inhibitor AG-013736 in rabbit VX2 liver tumours. METHODS Twenty-three VX2 liver tumour-bearing rabbits were scanned with CT in spectral imaging mode during the arterial phase (AP) and portal phase (PP). The iodine concentrations(ICs)of tumours normalized to aorta (nICs) at different time points (baseline, 2, 4, 7, 10, and 14 days after treatment) were compared within the treated group (n = 17) as well as between the control (n = 6) and treated groups. Correlations between the tumour size, necrotic fraction (NF), microvessel density (MVD), and nICs were analysed. RESULTS The change of nICs relative to baseline in the treated group was lower compared to the control group. A greater decrease in the nIC of a tumour at 2 days was positively correlated with a smaller increase in tumour size at 14 days (P < 0.05 for both). The tumour nIC values in AP and PP had correlations with MVD (r = 0.71 and 0.52) and NF (r = -0.54 and -0.51) (P < 0.05 for all). CONCLUSIONS CT spectral imaging allows for the evaluation and early prediction of tumour response to AG-013736. KEY POINTS • AG-013736 treatment response was evaluated by CT in a rabbit tumour model. • CT spectral imaging allows for the early treatment monitoring of targeted anti-tumour therapies. • Spectral CT findings correlated with vascular changes after anti-tumour therapies. • Spectral CT is a promising method for assessing clinical treatment response.
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Affiliation(s)
- Peijie Lv
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Jie Liu
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Xiaopeng Yan
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Yaru Chai
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Yan Chen
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Jianbo Gao
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052.
| | - Yuanwei Pan
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Shuai Li
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Hua Guo
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
| | - Yue Zhou
- The Department of Radiology, The First Affiliated Hospital of Zhengzhou University, No.1, East Jianshe Road, Zhengzhou, Henan Province, China, 450052
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Zwingenberger AL, Pollard RE, Taylor SL, Chen RX, Nunley J, Kent MS. Perfusion and Volume Response of Canine Brain Tumors to Stereotactic Radiosurgery and Radiotherapy. J Vet Intern Med 2016; 30:827-35. [PMID: 27149650 PMCID: PMC4867273 DOI: 10.1111/jvim.13945] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/03/2016] [Accepted: 03/10/2016] [Indexed: 12/26/2022] Open
Abstract
Background Stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) are highly conformal, high‐dose radiation treatment techniques used to treat people and dogs with brain tumors. Objectives To evaluate the response to SRS‐ and SRT‐treated tumors using volume and perfusion variables and to measure the survival times of affected dogs. Animals Prospective study of 34 dogs with evidence of brain tumors undergoing stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT). Methods Computed tomography and MRI imaging were used to calculate tumor volume and perfusion at baseline, and at 3 months and 6 months after treatment. Survival analysis was performed to evaluate treatment efficacy. Results Mean tumor volume significantly declined from baseline to the first recheck by −0.826 cm3 (95% CI: −1.165, −0.487) (P < .001); this reduction was maintained at the second recheck. Blood flow and blood volume declined significantly in the tumor after treatment. Median survival was 324 days (95% CI: 292.8, 419.4), and 4 dogs survived longer than 650 days. Neither actual tumor volume (hazard ratio = 1.21, P = .19) nor the change in tumor volume from the baseline (hazard ratio = 1.38, P = .12) significantly affected the hazard of death because of the tumor. Conclusions and Clinical Importance Stereotactic radiosurgery and SRT are effective treatments for reducing tumor volume, blood flow, and blood volume. Treated dogs surviving for more than 1 year are more likely to die from other causes than of their primary brain tumor. SRS and SRT should be considered for noninvasive treatment of intracranial brain tumors.
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Affiliation(s)
- A L Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA
| | - R E Pollard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA
| | - S L Taylor
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA
| | - R X Chen
- Department of Public Health Sciences, School of Medicine, University of California, Davis, Sacramento, CA
| | - J Nunley
- William R. Pritchard Veterinary Teaching Hospital, School of Veterinary Medicine, University of California, Davis, CA
| | - M S Kent
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA
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Evaluation of glioblastomas and lymphomas with whole-brain CT perfusion: Comparison between a delay-invariant singular-value decomposition algorithm and a Patlak plot. J Neuroradiol 2016; 43:266-72. [PMID: 26947963 DOI: 10.1016/j.neurad.2016.01.147] [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: 08/01/2015] [Revised: 12/26/2015] [Accepted: 01/23/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Correction of contrast leakage is recommended when enhancing lesions during perfusion analysis. The purpose of this study was to assess the diagnostic performance of computed tomography perfusion (CTP) with a delay-invariant singular-value decomposition algorithm (SVD+) and a Patlak plot in differentiating glioblastomas from lymphomas. MATERIALS AND METHODS This prospective study included 17 adult patients (12 men and 5 women) with pathologically proven glioblastomas (n=10) and lymphomas (n=7). CTP data were analyzed using SVD+ and a Patlak plot. The relative tumor blood volume and flow compared to contralateral normal-appearing gray matter (rCBV and rCBF derived from SVD+, and rBV and rFlow derived from the Patlak plot) were used to differentiate between glioblastomas and lymphomas. The Mann-Whitney U test and receiver operating characteristic (ROC) analyses were used for statistical analysis. RESULTS Glioblastomas showed significantly higher rFlow (3.05±0.49, mean±standard deviation) than lymphomas (1.56±0.53; P<0.05). There were no statistically significant differences between glioblastomas and lymphomas in rBV (2.52±1.57 vs. 1.03±0.51; P>0.05), rCBF (1.38±0.41 vs. 1.29±0.47; P>0.05), or rCBV (1.78±0.47 vs. 1.87±0.66; P>0.05). ROC analysis showed the best diagnostic performance with rFlow (Az=0.871), followed by rBV (Az=0.771), rCBF (Az=0.614), and rCBV (Az=0.529). CONCLUSION CTP analysis with a Patlak plot was helpful in differentiating between glioblastomas and lymphomas, but CTP analysis with SVD+ was not.
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Kim SM, Haider MA, Jaffray DA, Yeung IWT. Improved accuracy of quantitative parameter estimates in dynamic contrast-enhanced CT study with low temporal resolution. Med Phys 2016; 43:388. [PMID: 26745932 DOI: 10.1118/1.4937600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE A previously proposed method to reduce radiation dose to patient in dynamic contrast-enhanced (DCE) CT is enhanced by principal component analysis (PCA) filtering which improves the signal-to-noise ratio (SNR) of time-concentration curves in the DCE-CT study. The efficacy of the combined method to maintain the accuracy of kinetic parameter estimates at low temporal resolution is investigated with pixel-by-pixel kinetic analysis of DCE-CT data. METHODS The method is based on DCE-CT scanning performed with low temporal resolution to reduce the radiation dose to the patient. The arterial input function (AIF) with high temporal resolution can be generated with a coarsely sampled AIF through a previously published method of AIF estimation. To increase the SNR of time-concentration curves (tissue curves), first, a region-of-interest is segmented into squares composed of 3 × 3 pixels in size. Subsequently, the PCA filtering combined with a fraction of residual information criterion is applied to all the segmented squares for further improvement of their SNRs. The proposed method was applied to each DCE-CT data set of a cohort of 14 patients at varying levels of down-sampling. The kinetic analyses using the modified Tofts' model and singular value decomposition method, then, were carried out for each of the down-sampling schemes between the intervals from 2 to 15 s. The results were compared with analyses done with the measured data in high temporal resolution (i.e., original scanning frequency) as the reference. RESULTS The patients' AIFs were estimated to high accuracy based on the 11 orthonormal bases of arterial impulse responses established in the previous paper. In addition, noise in the images was effectively reduced by using five principal components of the tissue curves for filtering. Kinetic analyses using the proposed method showed superior results compared to those with down-sampling alone; they were able to maintain the accuracy in the quantitative histogram parameters of volume transfer constant [standard deviation (SD), 98th percentile, and range], rate constant (SD), blood volume fraction (mean, SD, 98th percentile, and range), and blood flow (mean, SD, median, 98th percentile, and range) for sampling intervals between 10 and 15 s. CONCLUSIONS The proposed method of PCA filtering combined with the AIF estimation technique allows low frequency scanning for DCE-CT study to reduce patient radiation dose. The results indicate that the method is useful in pixel-by-pixel kinetic analysis of DCE-CT data for patients with cervical cancer.
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Affiliation(s)
- Sun Mo Kim
- Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, Ontario M5G 2M9, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario M4N 3M5, Canada and Department of Medical Imaging, University of Toronto, Toronto, Ontario M5G 2M9, Canada
| | - David A Jaffray
- Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, Ontario M5G 2M9, Canada and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9, Canada
| | - Ivan W T Yeung
- Radiation Medicine Program, Princess Margaret Hospital/University Health Network, Toronto, Ontario M5G 2M9, Canada; Department of Medical Physics, Stronach Regional Cancer Centre, Southlake Regional Health Centre, Newmarket, Ontario L3Y 2P9, Canada; and Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5G 2M9, Canada
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Maarouf R, Sakr H. A potential role of CT perfusion parameters in grading of brain gliomas. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Xu Y, Sun H, Song A, Yang Q, Lu X, Wang W. Predictive Significance of Tumor Grade Using 256-Slice CT Whole-Tumor Perfusion Imaging in Colorectal Adenocarcinoma. Acad Radiol 2015; 22:1529-35. [PMID: 26421473 DOI: 10.1016/j.acra.2015.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 08/27/2015] [Accepted: 08/31/2015] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES The preoperative assessment of tumor grade has important clinical implications for the treatment and prognosis of patients with colorectal adenocarcinomas. The purpose of this study is to investigate the predictive significance of colorectal adenocarcinoma grade using 256-slice whole-tumor computed tomography (CT) perfusion. MATERIALS AND METHODS Fifty-three patients with proven colorectal adenocarcinomas were enrolled. All of them underwent 256-slice whole-tumor CT perfusion. They were divided into two different subgroups according to postoperative pathological results: low grade and high grade. The Kruskal-Wallis test or one-way analysis of variance was used for comparison of CT perfusion parameters between different tumor grades. Multivariant correlation between pathologic tumor stage, histologic tumor differentiation, and whole-tumor CT perfusion parameters was evaluated by Spearman rank correlation coefficient. According to receiver operating characteristic (ROC) curves, perfusion parameters including blood flow (BF), peak enhancement index (PEI), blood volume (BV), and time to peak (TTP) of 53 patients were analyzed, and the sensitivity, specificity, and accuracy of these parameters in predicting tumor grade were calculated. RESULTS There were significant differences in BF and TTP between low-grade and high-grade tumors. According to the ROC curve, BF and TTP were of diagnostic significance, with the area under the curve values of 0.828 and 0.736, respectively. The diagnostic threshold of BF was 32.12 mL/min/100 g and that of TTP was 18.10 seconds. CONCLUSIONS The CT perfusion parameters (BF, TTP) of first-pass 256-slice whole-tumor CT perfusion imaging can reflect tumor grade in colorectal adenocarcinoma.
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Dynamic perfusion CT in brain tumors. Eur J Radiol 2015; 84:2386-92. [DOI: 10.1016/j.ejrad.2015.02.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/15/2015] [Indexed: 11/22/2022]
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Ewing JR, Nagaraja TN, Aryal MP, Keenan KA, Elmghirbi R, Bagher-Ebadian H, Panda S, Lu M, Mikkelsen T, Cabral G, Brown SL. Peritumoral tissue compression is predictive of exudate flux in a rat model of cerebral tumor: an MRI study in an embedded tumor. NMR IN BIOMEDICINE 2015; 28:1557-69. [PMID: 26423316 PMCID: PMC4656050 DOI: 10.1002/nbm.3418] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 08/18/2015] [Accepted: 08/27/2015] [Indexed: 05/22/2023]
Abstract
MRI estimates of extracellular volume and tumor exudate flux in peritumoral tissue are demonstrated in an experimental model of cerebral tumor. Peritumoral extracellular volume predicted the tumor exudate flux. Eighteen RNU athymic rats were inoculated intracerebrally with U251MG tumor cells and studied with dynamic contrast enhanced MRI (DCE-MRI) approximately 18 days post implantation. Using a model selection paradigm and a novel application of Patlak and Logan plots to DCE-MRI data, the distribution volume (i.e. tissue porosity) in the leaky rim of the tumor and that in the tissue external to the rim (the outer rim) were estimated, as was the tumor exudate flow from the inner rim of the tumor through the outer rim. Distribution volume in the outer rim was approximately half that of the inner adjacent region (p < 1 × 10(-4)). The distribution volume of the outer ring was significantly correlated (R(2) = 0.9) with tumor exudate flow from the inner rim. Thus, peritumoral extracellular volume predicted the rate of tumor exudate flux. One explanation for these data is that perfusion, i.e. the delivery of blood to the tumor, was regulated by the compression of the mostly normal tissue of the tumor rim, and that the tumor exudate flow was limited by tumor perfusion.
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Affiliation(s)
- James R. Ewing
- Dept. of Neurology, Henry Ford Hospital, Detroit, MI
- Dept. of Neurology, Wayne State University, Detroit, MI
- Dept. of Physics, Oakland University, Rochester, MI
- Corresponding Author: James R. Ewing;
| | | | - Madhava P. Aryal
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI
| | | | - Rasha Elmghirbi
- Dept. of Neurology, Henry Ford Hospital, Detroit, MI
- Dept. of Physics, Oakland University, Rochester, MI
| | - Hassan Bagher-Ebadian
- Dept. of Neurology, Henry Ford Hospital, Detroit, MI
- Dept. of Physics, Oakland University, Rochester, MI
| | | | - Mei Lu
- Dept. of Public Health Sciences, Henry Ford Hospital, Detroit, MI
| | - Tom Mikkelsen
- Dept. of Neurology, Henry Ford Hospital, Detroit, MI
- Dept. of Neurosurgery, Henry Ford Hospital, Detroit, MI
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Granata F, Morabito R, Alafaci C, Barresi V, Tomasello F, Vinci S, Mormina E, Calamuneri A, Grasso G, Salpietro FM, Longo M. Perfusion computed tomography of intracranial meningiomas: In vivo correlation of cerebral blood volume and vascular permeability. Neuroradiol J 2015; 28:303-9. [PMID: 26246100 DOI: 10.1177/1971400915592551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A noninvasive method to predict the grade of a meningioma would be desirable since it would anticipate information about tumour nature, recurrence and improve tumour management and outcomes. The aim of the present study was to assess the ability of perfusion computed tomography (PCT) technique in predicting the meningioma grade before surgery. Data from PCT, such as cerebral blood volume (CBV) and permeability surface (PS), were correlated with immunohistolopathological information. METHODS Twenty-three patients with a diagnosis of intracranial meningioma underwent PCT for pre-surgical evaluation of CBV and PS. During surgery, samples from the centre and periphery of the tumour were obtained. Two correspondent regions of interest (ROIs) were drawn on CBV and PS maps. Central and peripheral CBV and PS mean values were calculated. PCT parameters were correlated to CD-34 and endoglin. RESULTS There was a positive correlation between PS and CD-34. No correlation was found between PS values and endoglin, CBV values and CD-34 and endoglin values. CONCLUSION Our findings suggest that PCT may support conventional morphological imaging in predicting meningioma grading before surgery.
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Affiliation(s)
- Francesca Granata
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy
| | - Rosa Morabito
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy
| | | | | | | | - Sergio Vinci
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy
| | - Enricomaria Mormina
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy
| | | | - Giovanni Grasso
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Italy
| | | | - Marcello Longo
- Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Italy
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49
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Jain R, Griffith B, Alotaibi F, Zagzag D, Fine H, Golfinos J, Schultz L. Glioma Angiogenesis and Perfusion Imaging: Understanding the Relationship between Tumor Blood Volume and Leakiness with Increasing Glioma Grade. AJNR Am J Neuroradiol 2015. [PMID: 26206809 DOI: 10.3174/ajnr.a4405] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate imaging correlates to the changes occurring during angiogenesis in gliomas. This was accomplished through in vivo assessment of vascular parameters (relative CBV and permeability surface-area product) and their changing relationship with increasing glioma grade. MATERIALS AND METHODS Seventy-six patients with gliomas underwent preoperative perfusion CT and assessment of relative CBV and permeability surface-area product. Regression analyses were performed to assess the rate of change between relative CBV and permeability surface-area product and to test whether these differed for distinct glioma grades. The ratio of relative CBV to permeability surface-area product was also computed and compared among glioma grades by using analysis of variance methods. RESULTS The rate of change in relative CBV with respect to permeability surface-area product was highest for grade II gliomas followed by grade III and then grade IV (1.64 versus 0.91 versus 0.27, respectively). The difference in the rate of change was significant between grade III and IV (P = .003) and showed a trend for grades II and IV (P = .098). Relative CBV/permeability surface-area product ratios were the highest for grade II and lowest for grade IV. The pair-wise difference among all 3 groups was significant (P < .001). CONCLUSIONS There is an increase in relative CBV more than permeability surface-area product in lower grade gliomas, whereas in grade III and especially grade IV gliomas, permeability surface-area product increases much more than relative CBV. The rate of change of relative CBV with respect to permeability surface-area product and relative CBV/permeability surface-area product ratio can serve as an imaging correlate to changes occurring at the tumor microvasculature level.
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Affiliation(s)
- R Jain
- From the Departments of Radiology (R.J.)
| | | | | | - D Zagzag
- Pathology (F.A., D.Z.) Neurosurgery (D.Z., J.G.)
| | - H Fine
- Medicine (H.F.), New York University School of Medicine, New York, New York
| | | | - L Schultz
- Public Health Sciences (L.S.), Henry Ford Hospital, Detroit, Michigan
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50
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Griffith B, Jain R. Perfusion imaging in neuro-oncology: basic techniques and clinical applications. Radiol Clin North Am 2015; 53:497-511. [PMID: 25953286 DOI: 10.1016/j.rcl.2015.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Perfusion imaging is a method for assessing the flow of blood occurring at the tissue level and can be accomplished by both CT and MR perfusion techniques. The use of perfusion imaging has increased substantially in the past decade, particularly in neuro-oncologic imaging, where it is has been used for brain tumor grading and directing biopsies or targeted therapy, as well as for the evaluation of treatment response and disease progression. This article discusses the basic principles and techniques of perfusion imaging, as well as its applications in neuro-oncology.
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Affiliation(s)
- Brent Griffith
- Department of Radiology, Henry Ford Health System, Detroit, MI, USA.
| | - Rajan Jain
- NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA
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