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Li Z, Wang D, Ooi MB, Choudhary P, Ragunathan S, Karis JP, Pipe JG, Quarles CC, Stokes AM. A 3D dual-echo spiral sequence for simultaneous dynamic susceptibility contrast and dynamic contrast-enhanced MRI with single bolus injection. Magn Reson Med 2024; 92:631-644. [PMID: 38469930 PMCID: PMC11207201 DOI: 10.1002/mrm.30077] [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: 10/27/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Perfusion MRI reveals important tumor physiological and pathophysiologic information, making it a critical component in managing brain tumor patients. This study aimed to develop a dual-echo 3D spiral technique with a single-bolus scheme to simultaneously acquire both dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) data and overcome the limitations of current EPI-based techniques. METHODS A 3D spiral-based technique with dual-echo acquisition was implemented and optimized on a 3T MRI scanner with a spiral staircase trajectory and through-plane SENSE acceleration for improved speed and image quality, in-plane variable-density undersampling combined with a sliding-window acquisition and reconstruction approach for increased speed, and an advanced iterative deblurring algorithm. Four volunteers were scanned and compared with the standard of care (SOC) single-echo EPI and a dual-echo EPI technique. Two patients were scanned with the spiral technique during a preload bolus and compared with the SOC single-echo EPI collected during the second bolus injection. RESULTS Volunteer data demonstrated that the spiral technique achieved high image quality, reduced geometric artifacts, and high temporal SNR compared with both single-echo and dual-echo EPI. Patient perfusion data showed that the spiral acquisition achieved accurate DSC quantification comparable to SOC single-echo dual-dose EPI, with the additional DCE information. CONCLUSION A 3D dual-echo spiral technique was developed to simultaneously acquire both DSC and DCE data in a single-bolus injection with reduced contrast use. Preliminary volunteer and patient data demonstrated increased temporal SNR, reduced geometric artifacts, and accurate perfusion quantification, suggesting a competitive alternative to SOC-EPI techniques for brain perfusion MRI.
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Affiliation(s)
- Zhiqiang Li
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ USA
| | - Dinghui Wang
- Department of Radiology, Mayo Clinic, Rochester, MN USA
| | | | - Poonam Choudhary
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ USA
| | | | - John P Karis
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ USA
| | - James G Pipe
- Department of Radiology, Mayo Clinic, Rochester, MN USA
- Department of Radiology, University of Wisconsin, Madison, WI USA
| | - C Chad Quarles
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ USA
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Ashley M Stokes
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, AZ USA
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Zhang Y, Wang F, Huang Y. PDZK1 is correlated with DCE-MRI perfusion parameters in high-grade glioma. Clinics (Sao Paulo) 2024; 79:100367. [PMID: 38692010 PMCID: PMC11070665 DOI: 10.1016/j.clinsp.2024.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/11/2024] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE This study investigated the relationship between PDZK1 expression and Dynamic Contrast-Enhanced MRI (DCE-MRI) perfusion parameters in High-Grade Glioma (HGG). METHODS Preoperative DCE-MRI scanning was performed on 80 patients with HGG to obtain DCE perfusion transfer coefficient (Ktrans), vascular plasma volume fraction (vp), extracellular volume fraction (ve), and reverse transfer constant (kep). PDZK1 in HGG patients was detected, and its correlation with DCE-MRI perfusion parameters was assessed by the Pearson method. An analysis of Cox regression was performed to determine the risk factors affecting survival, while Kaplan-Meier and log-rank tests to evaluate PDZK1's prognostic significance, and ROC curve analysis to assess its diagnostic value. RESULTS PDZK1 was upregulated in HGG patients and predicted poor overall survival and progression-free survival. Moreover, PDZK1 expression distinguished grade III from grade IV HGG. PDZK1 expression was positively correlated with Ktrans 90, and ve_90, and negatively correlated with kep_max, and kep_90. CONCLUSION PDZK1 is upregulated in HGG, predicts poor survival, and differentiates tumor grading in HGG patients. PDZK1 expression is correlated with DCE-MRI perfusion parameters.
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Affiliation(s)
- Yi Zhang
- Department of Radiology, The First People's Hospital of Shuangliu District, (West China Airport Hospital of Sichuan University), Chengdu City, Sichuan Province, China.
| | - Feng Wang
- Department of Radiology, The First People's Hospital of Shuangliu District, (West China Airport Hospital of Sichuan University), Chengdu City, Sichuan Province, China
| | - YongLi Huang
- Department of Radiology, The First People's Hospital of Shuangliu District, (West China Airport Hospital of Sichuan University), Chengdu City, Sichuan Province, China
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Heidari M, Shokrani P. Imaging Role in Diagnosis, Prognosis, and Treatment Response Prediction Associated with High-grade Glioma. JOURNAL OF MEDICAL SIGNALS & SENSORS 2024; 14:7. [PMID: 38993200 PMCID: PMC11111132 DOI: 10.4103/jmss.jmss_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/31/2022] [Accepted: 03/14/2023] [Indexed: 07/13/2024]
Abstract
Background Glioma is one of the most drug and radiation-resistant tumors. Gliomas suffer from inter- and intratumor heterogeneity which makes the outcome of similar treatment protocols vary from patient to patient. This article is aimed to overview the potential imaging markers for individual diagnosis, prognosis, and treatment response prediction in malignant glioma. Furthermore, the correlation between imaging findings and biological and clinical information of glioma patients is reviewed. Materials and Methods The search strategy in this study is to select related studies from scientific websites such as PubMed, Scopus, Google Scholar, and Web of Science published until 2022. It comprised a combination of keywords such as Biomarkers, Diagnosis, Prognosis, Imaging techniques, and malignant glioma, according to Medical Subject Headings. Results Some imaging parameters that are effective in glioma management include: ADC, FA, Ktrans, regional cerebral blood volume (rCBV), cerebral blood flow (CBF), ve, Cho/NAA and lactate/lipid ratios, intratumoral uptake of 18F-FET (for diagnostic application), RD, ADC, ve, vp, Ktrans, CBFT1, rCBV, tumor blood flow, Cho/NAA, lactate/lipid, MI/Cho, uptakes of 18F-FET, 11C-MET, and 18F-FLT (for prognostic and predictive application). Cerebral blood volume and Ktrans are related to molecular markers such as vascular endothelial growth factor (VEGF). Preoperative ADCmin value of GBM tumors is associated with O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status. 2-hydroxyglutarate metabolite and dynamic 18F-FDOPA positron emission tomography uptake are related to isocitrate dehydrogenase (IDH) mutations. Conclusion Parameters including ADC, RD, FA, rCBV, Ktrans, vp, and uptake of 18F-FET are useful for diagnosis, prognosis, and treatment response prediction in glioma. A significant correlation between molecular markers such as VEGF, MGMT, and IDH mutations with some diffusion and perfusion imaging parameters has been identified.
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Affiliation(s)
- Maryam Heidari
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvaneh Shokrani
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Hemodynamic Imaging in Cerebral Diffuse Glioma-Part A: Concept, Differential Diagnosis and Tumor Grading. Cancers (Basel) 2022; 14:cancers14061432. [PMID: 35326580 PMCID: PMC8946242 DOI: 10.3390/cancers14061432] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/08/2022] [Indexed: 11/17/2022] Open
Abstract
Diffuse gliomas are the most common primary malignant intracranial neoplasms. Aside from the challenges pertaining to their treatment-glioblastomas, in particular, have a dismal prognosis and are currently incurable-their pre-operative assessment using standard neuroimaging has several drawbacks, including broad differentials diagnosis, imprecise characterization of tumor subtype and definition of its infiltration in the surrounding brain parenchyma for accurate resection planning. As the pathophysiological alterations of tumor tissue are tightly linked to an aberrant vascularization, advanced hemodynamic imaging, in addition to other innovative approaches, has attracted considerable interest as a means to improve diffuse glioma characterization. In the present part A of our two-review series, the fundamental concepts, techniques and parameters of hemodynamic imaging are discussed in conjunction with their potential role in the differential diagnosis and grading of diffuse gliomas. In particular, recent evidence on dynamic susceptibility contrast, dynamic contrast-enhanced and arterial spin labeling magnetic resonance imaging are reviewed together with perfusion-computed tomography. While these techniques have provided encouraging results in terms of their sensitivity and specificity, the limitations deriving from a lack of standardized acquisition and processing have prevented their widespread clinical adoption, with current efforts aimed at overcoming the existing barriers.
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Stumpo V, Guida L, Bellomo J, Van Niftrik CHB, Sebök M, Berhouma M, Bink A, Weller M, Kulcsar Z, Regli L, Fierstra J. Hemodynamic Imaging in Cerebral Diffuse Glioma—Part B: Molecular Correlates, Treatment Effect Monitoring, Prognosis, and Future Directions. Cancers (Basel) 2022; 14:cancers14051342. [PMID: 35267650 PMCID: PMC8909110 DOI: 10.3390/cancers14051342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023] Open
Abstract
Gliomas, and glioblastoma in particular, exhibit an extensive intra- and inter-tumoral molecular heterogeneity which represents complex biological features correlating to the efficacy of treatment response and survival. From a neuroimaging point of view, these specific molecular and histopathological features may be used to yield imaging biomarkers as surrogates for distinct tumor genotypes and phenotypes. The development of comprehensive glioma imaging markers has potential for improved glioma characterization that would assist in the clinical work-up of preoperative treatment planning and treatment effect monitoring. In particular, the differentiation of tumor recurrence or true progression from pseudoprogression, pseudoresponse, and radiation-induced necrosis can still not reliably be made through standard neuroimaging only. Given the abundant vascular and hemodynamic alterations present in diffuse glioma, advanced hemodynamic imaging approaches constitute an attractive area of clinical imaging development. In this context, the inclusion of objective measurable glioma imaging features may have the potential to enhance the individualized care of diffuse glioma patients, better informing of standard-of-care treatment efficacy and of novel therapies, such as the immunotherapies that are currently increasingly investigated. In Part B of this two-review series, we assess the available evidence pertaining to hemodynamic imaging for molecular feature prediction, in particular focusing on isocitrate dehydrogenase (IDH) mutation status, MGMT promoter methylation, 1p19q codeletion, and EGFR alterations. The results for the differentiation of tumor progression/recurrence from treatment effects have also been the focus of active research and are presented together with the prognostic correlations identified by advanced hemodynamic imaging studies. Finally, the state-of-the-art concepts and advancements of hemodynamic imaging modalities are reviewed together with the advantages derived from the implementation of radiomics and machine learning analyses pipelines.
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Affiliation(s)
- Vittorio Stumpo
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Correspondence:
| | - Lelio Guida
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Jacopo Bellomo
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Christiaan Hendrik Bas Van Niftrik
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Moncef Berhouma
- Department of Neurosurgical Oncology and Vascular Neurosurgery, Pierre Wertheimer Neurological and Neurosurgical Hospital, Hospices Civils de Lyon, 69500 Lyon, France;
| | - Andrea Bink
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Michael Weller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Zsolt Kulcsar
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
- Department of Neuroradiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, 8091 Zurich, Switzerland; (L.G.); (J.B.); (C.H.B.V.N.); (M.S.); (L.R.); (J.F.)
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8057 Zurich, Switzerland; (A.B.); (M.W.); (Z.K.)
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Albano D, Bruno F, Agostini A, Angileri SA, Benenati M, Bicchierai G, Cellina M, Chianca V, Cozzi D, Danti G, De Muzio F, Di Meglio L, Gentili F, Giacobbe G, Grazzini G, Grazzini I, Guerriero P, Messina C, Micci G, Palumbo P, Rocco MP, Grassi R, Miele V, Barile A. Dynamic contrast-enhanced (DCE) imaging: state of the art and applications in whole-body imaging. Jpn J Radiol 2021; 40:341-366. [PMID: 34951000 DOI: 10.1007/s11604-021-01223-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/17/2021] [Indexed: 12/18/2022]
Abstract
Dynamic contrast-enhanced (DCE) imaging is a non-invasive technique used for the evaluation of tissue vascularity features through imaging series acquisition after contrast medium administration. Over the years, the study technique and protocols have evolved, seeing a growing application of this method across different imaging modalities for the study of almost all body districts. The main and most consolidated current applications concern MRI imaging for the study of tumors, but an increasing number of studies are evaluating the use of this technique also for inflammatory pathologies and functional studies. Furthermore, the recent advent of artificial intelligence techniques is opening up a vast scenario for the analysis of quantitative information deriving from DCE. The purpose of this article is to provide a comprehensive update on the techniques, protocols, and clinical applications - both established and emerging - of DCE in whole-body imaging.
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Affiliation(s)
- Domenico Albano
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Federico Bruno
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy.
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Andrea Agostini
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Clinical, Special and Dental Sciences, Department of Radiology, University Politecnica delle Marche, University Hospital "Ospedali Riuniti Umberto I - G.M. Lancisi - G. Salesi", Ancona, Italy
| | - Salvatore Alessio Angileri
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Benenati
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento di Diagnostica per Immagini, Fondazione Policlinico Universitario A. Gemelli IRCCS, Oncologia ed Ematologia, RadioterapiaRome, Italy
| | - Giulia Bicchierai
- Diagnostic Senology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, Ospedale Fatebenefratelli, Milan, Italy
| | - Vito Chianca
- Ospedale Evangelico Betania, Naples, Italy
- Clinica Di Radiologia, Istituto Imaging Della Svizzera Italiana - Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Diletta Cozzi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Ginevra Danti
- Department of Emergency Radiology, Careggi University Hospital, Florence, Italy
| | - Federica De Muzio
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Letizia Di Meglio
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Francesco Gentili
- Unit of Diagnostic Imaging, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giuliana Giacobbe
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Giulia Grazzini
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Irene Grazzini
- Department of Radiology, Section of Neuroradiology, San Donato Hospital, Arezzo, Italy
| | - Pasquale Guerriero
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Giuseppe Micci
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Dipartimento Di Biomedicina, Neuroscienze E Diagnostica Avanzata, Sezione Di Scienze Radiologiche, Università Degli Studi Di Palermo, via Vetoio 1L'Aquila, 67100, Palermo, Italy
| | - Pierpaolo Palumbo
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Abruzzo Health Unit 1, Department of diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, L'Aquila, Italy
| | - Maria Paola Rocco
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Roberto Grassi
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Vittorio Miele
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Antonio Barile
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Milan, Italy
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Castellano A, Bailo M, Cicone F, Carideo L, Quartuccio N, Mortini P, Falini A, Cascini GL, Minniti G. Advanced Imaging Techniques for Radiotherapy Planning of Gliomas. Cancers (Basel) 2021; 13:cancers13051063. [PMID: 33802292 PMCID: PMC7959155 DOI: 10.3390/cancers13051063] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/07/2023] Open
Abstract
The accuracy of target delineation in radiation treatment (RT) planning of cerebral gliomas is crucial to achieve high tumor control, while minimizing treatment-related toxicity. Conventional magnetic resonance imaging (MRI), including contrast-enhanced T1-weighted and fluid-attenuated inversion recovery (FLAIR) sequences, represents the current standard imaging modality for target volume delineation of gliomas. However, conventional sequences have limited capability to discriminate treatment-related changes from viable tumors, owing to the low specificity of increased blood-brain barrier permeability and peritumoral edema. Advanced physiology-based MRI techniques, such as MR spectroscopy, diffusion MRI and perfusion MRI, have been developed for the biological characterization of gliomas and may circumvent these limitations, providing additional metabolic, structural, and hemodynamic information for treatment planning and monitoring. Radionuclide imaging techniques, such as positron emission tomography (PET) with amino acid radiopharmaceuticals, are also increasingly used in the workup of primary brain tumors, and their integration in RT planning is being evaluated in specialized centers. This review focuses on the basic principles and clinical results of advanced MRI and PET imaging techniques that have promise as a complement to RT planning of gliomas.
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Affiliation(s)
- Antonella Castellano
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Michele Bailo
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Francesco Cicone
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
- Correspondence: ; Tel.: +39-0-961-369-4155
| | - Luciano Carideo
- National Cancer Institute, G. Pascale Foundation, 80131 Naples, Italy;
| | - Natale Quartuccio
- A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90144 Palermo, Italy;
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (M.B.); (P.M.)
| | - Andrea Falini
- Neuroradiology Unit, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (A.C.); (A.F.)
| | - Giuseppe Lucio Cascini
- Department of Experimental and Clinical Medicine, “Magna Graecia” University of Catanzaro, and Nuclear Medicine Unit, University Hospital “Mater Domini”, 88100 Catanzaro, Italy;
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, 53100 Siena, Italy;
- IRCCS Neuromed, 86077 Pozzilli (IS), Italy
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Is quantitative DCE-MRI useful in differentiation of indolent and significant prostate cancers? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.840971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Diffusion and perfusion MRI may predict EGFR amplification and the TERT promoter mutation status of IDH-wildtype lower-grade gliomas. Eur Radiol 2020; 30:6475-6484. [PMID: 32785770 DOI: 10.1007/s00330-020-07090-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/02/2020] [Accepted: 07/20/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Epidermal growth factor receptor (EGFR) amplification and telomerase reverse transcriptase promoter (TERTp) mutation status of isocitrate dehydrogenase-wildtype (IDHwt) lower-grade gliomas (LGGs; grade II/III) are crucial for identifying IDHwt LGG with an aggressive clinical course. The purpose of this study was to assess whether parameters from diffusion tensor imaging, dynamic susceptibility contrast (DSC), and diffusion tensor imaging, dynamic contrast-enhanced imaging can predict the EGFR amplification and TERTp mutation status of IDHwt LGGs. METHODS A total of 49 patients with IDHwt LGGs with either known EGFR amplification (39 non-amplified, 10 amplified) or TERTp mutation (19 wildtype, 21 mutant) statuses underwent MRI. The mean ADC, fractional anisotropy (FA), normalized cerebral blood volume (nCBV), normalized cerebral blood flow (nCBF), volume transfer constant (Ktrans), rate transfer coefficient (Kep), extravascular extracellular volume fraction (Ve), and plasma volume fraction (Vp) values were assessed. Univariate and multivariate logistic regression models were constructed. RESULTS EGFR-amplified tumors showed lower mean ADC values than EGFR-non-amplified tumors (p = 0.019). Mean ADC was an independent predictor of EGFR amplification, with an AUC of 0.75. TERTp mutant tumors showed higher mean nCBV (p = 0.020), higher mean nCBF (p = 0.017), and higher mean Vp (p = 0.002) than TERTp wildtype tumors. With multivariate logistic regression, mean Vp was the independent predictor of TERTp mutation status, with an AUC of 0.85. CONCLUSION This exploratory pilot study shows that lower ADC values may be useful for prediction of EGFR amplification, whereas higher Vp values may be useful for prediction of the TERTp mutation status of IDHwt LGGs. KEY POINTS • EGFR amplification and TERTp mutation are key molecular markers that predict an aggressive clinical course of IDHwt LGGs. • EGFR-amplified tumors showed lower ADC values than EGFR-non-amplified tumors, suggesting higher cellularity. • TERTp mutant tumors showed a higher plasma volume fraction than TERTp wildtype tumors, suggesting higher vascular proliferation and tumor angiogenesis.
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Bulakbaşı N, Paksoy Y. Correction to: Advanced imaging in adult diffusely infiltrating low-grade gliomas. Insights Imaging 2020; 11:57. [PMID: 32323033 PMCID: PMC7176752 DOI: 10.1186/s13244-020-00862-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The original article [1] contains errors in Table 1 in rows ktrans and Ve; the correct version of Table 1 can be viewed in this Correction article.
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Affiliation(s)
- Nail Bulakbaşı
- Medical Faculty, University of Kyrenia, Sehit Yahya Bakır Street, Karakum, Mersin-10, Kyrenia, Turkish Republic of Northern Cyprus, Turkey.
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Larsson C, Groote I, Vardal J, Kleppestø M, Odland A, Brandal P, Due-Tønnessen P, Holme SS, Hope TR, Meling TR, Fosse E, Emblem KE, Bjørnerud A. Prediction of survival and progression in glioblastoma patients using temporal perfusion changes during radiochemotherapy. Magn Reson Imaging 2020; 68:106-112. [PMID: 32004711 DOI: 10.1016/j.mri.2020.01.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 01/10/2020] [Accepted: 01/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of this study was to investigate changes in structural magnetic resonance imaging (MRI) according to the RANO criteria and perfusion- and permeability related metrics derived from dynamic contrast-enhanced MRI (DCE) and dynamic susceptibility contrast MRI (DSC) during radiochemotherapy for prediction of progression and survival in glioblastoma. METHODS Twenty-three glioblastoma patients underwent biweekly structural and perfusion MRI before, during, and two weeks after a six weeks course of radiochemotherapy. Temporal trends of tumor volume and the perfusion-derived parameters cerebral blood volume (CBV) and blood flow (CBF) from DSC and DCE, in addition to contrast agent capillary transfer constant (Ktrans) from DCE, were assessed. The patients were separated in two groups by median survival and differences between the two groups explored. Clinical- and MRI metrics were investigated using univariate and multivariate survival analysis and a predictive survival index was generated. RESULTS Median survival was 19.2 months. A significant decrease in contrast-enhancing tumor size and CBV and CBF in both DCE- and DSC-derived parameters was seen during and two weeks past radiochemotherapy (p < 0.05). A 10%/30% increase in Ktrans/CBF two weeks after finishing radiochemotherapy resulted in significant shorter survival (13.9/16.8 vs. 31.5/33.1 months; p < 0.05). Multivariate analysis revealed an index using change in Ktrans and relative CBV from DSC significantly corresponding with survival time in months (r2 = 0.843; p < 0.001). CONCLUSIONS Significant temporal changes are evident during radiochemotherapy in tumor size (after two weeks) and perfusion-weighted MRI-derived parameters (after four weeks) in glioblastoma patients. While DCE-based metrics showed most promise for early survival prediction, a multiparametric combination of both DCE- and DSC-derived metrics gave additional information.
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Affiliation(s)
- Christopher Larsson
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway.
| | - Inge Groote
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Jonas Vardal
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Magne Kleppestø
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Audun Odland
- Department of Radiology, Stavanger University Hospital, Stavanger, Norway
| | - Petter Brandal
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Paulina Due-Tønnessen
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Sigrun S Holme
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - Tuva R Hope
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Torstein R Meling
- Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Erik Fosse
- Faculty of Medicine, University of Oslo, Oslo, Norway; The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Kyrre E Emblem
- The Intervention Centre, Oslo University Hospital, Oslo, Norway
| | - Atle Bjørnerud
- The Intervention Centre, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
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Kim HS, Kwon SL, Choi SH, Hwang I, Kim TM, Park CK, Park SH, Won JK, Kim IH, Lee ST. Prognostication of anaplastic astrocytoma patients: application of contrast leakage information of dynamic susceptibility contrast-enhanced MRI and dynamic contrast-enhanced MRI. Eur Radiol 2020; 30:2171-2181. [PMID: 31953664 DOI: 10.1007/s00330-019-06598-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/13/2019] [Accepted: 11/19/2019] [Indexed: 12/21/2022]
Abstract
PURPOSE To examine the applicability of contrast leakage information from dynamic susceptibility contrast-enhanced (DSC) MRI and dynamic contrast-enhanced (DCE) MRI to determine which one is the most valuable surrogate imaging biomarker for predicting disease progression in anaplastic astrocytoma (AA) patients. MATERIALS AND METHODS This study was approved by the institutional review board (IRB), which waived informed consent. A total of seventy-three AA patients who had undergone preoperative DCE and DSC MRI and received standard treatment, including partial resection or biopsy followed by radiation therapy, were included in this retrospective study. Based on Response Assessment in Neuro-Oncology (RANO), patients were sorted into progression (n = 21) and non-progression (n = 52) groups. Tumor boundaries were defined as high-signal intensity (SI) lesions on fluid-attenuated inversion recovery (FLAIR) imaging, where we analyzed mean pharmacokinetic parameters (Ktrans, Vp, and Ve) from DCE MRI and contrast leakage information (mean extraction fraction (EF)) from DSC MRI. RESULTS Mean Ve and mean EF were significantly higher in patients with progression-free survival (PFS) < 18 months than in those with PFS ≥ 18 months. For distinguishing the group with PFS < 18 months, AUC values were calculated using the mean Ve value (AUC = 0.716). The Kaplan-Meier survival analysis revealed that mean Ve value was significantly correlated with PFS. In Cox proportional-hazards regression, only the mean Ve value was found to be significantly associated with PFS. CONCLUSION We found that the mean Ve value based on high-SI tumor lesions on FLAIR imaging was capable of predicting outcomes of AA patients as a potential surrogate imaging biomarker. KEY POINTS • Mean Ve(2.152 ± 1.857 vs. 1.173 ± 1.408) was significantly higher in anaplastic astrocytoma patients with PFS < 18 months that in those with PFS ≥ 18 months (p = 0.02). • Cox proportional-hazards regression showed that only mean Ve(p = 0.034) was significantly associated with PFS, regardless of IDH mutation status, in anaplastic astrocytoma patients.
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Affiliation(s)
- Hee Soo Kim
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Se Lee Kwon
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Seung Hong Choi
- Department of Radiology, College of Medicine, Seoul National University, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea.
- Center for Nanoparticle Research, Institute for Basic Science, Seoul, South Korea.
- School of Chemical and Biological Engineering, Seoul National University, Seoul, 151-742, South Korea.
| | - Inpyeong Hwang
- Department of Radiology, College of Medicine, Seoul National University, 28, Yongon-dong, Chongno-gu, Seoul, 110-744, South Korea
- Center for Nanoparticle Research, Institute for Basic Science, Seoul, South Korea
| | - Tae Min Kim
- Department of Internal Medicine, Cancer Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Biomedical Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung-Hye Park
- Department of Pathology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jae-Kyung Won
- Department of Pathology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Il Han Kim
- Department of Radiation Oncology, Cancer Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
| | - Soon Tae Lee
- Department of Neurology, College of Medicine, Seoul National University, Seoul, South Korea
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13
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Bulakbaşı N, Paksoy Y. Advanced imaging in adult diffusely infiltrating low-grade gliomas. Insights Imaging 2019; 10:122. [PMID: 31853670 PMCID: PMC6920302 DOI: 10.1186/s13244-019-0793-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/25/2019] [Indexed: 02/09/2023] Open
Abstract
The adult diffusely infiltrating low-grade gliomas (LGGs) are typically IDH mutant and slow-growing gliomas having moderately increased cellularity generally without mitosis, necrosis, and microvascular proliferation. Supra-total resection of LGG significantly increases the overall survival by delaying malignant transformation compared with a simple debulking so accurate MR diagnosis is crucial for treatment planning. Data from meta-analysis support the addition of diffusion and perfusion-weighted MR imaging and MR spectroscopy in the diagnosis of suspected LGG. Typically, LGG has lower cellularity (ADCmin), angiogenesis (rCBVmax), capillary permeability (Ktrans), and mitotic activity (Cho/Cr ratio) compared to high-grade glioma. The identification of 2-hydroxyglutarate by MR spectroscopy can reflect the IDH status of the tumor. The initial low ADCmin, high rCBVmax, and Ktrans values are consistent with the poor prognosis. The gradual increase in intratumoral Cho/Cr ratio and rCBVmax values are well correlated with tumor progression. Besides MR-based technical artifacts, which are minimized by the voxel-based assessment of data obtained by histogram analysis, the problems derived from the diversity and the analysis of imaging data should be solved by using artificial intelligence techniques. The quantitative multiparametric MR imaging of LGG can either improve the diagnostic accuracy of their differential diagnosis or assess their prognosis.
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Affiliation(s)
- Nail Bulakbaşı
- Medical Faculty, University of Kyrenia, Sehit Yahya Bakır Street, Karakum, Mersin-10, Kyrenia, Turkish Republic of Northern Cyprus, Turkey.
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Yan LF, Sun YZ, Zhao SS, Hu YC, Han Y, Li G, Zhang X, Tian Q, Liu ZC, Yang Y, Nan HY, Yu Y, Sun Q, Zhang J, Chen P, Hu B, Li F, Han TH, Wang W, Cui GB. Perfusion, Diffusion, Or Brain Tumor Barrier Integrity: Which Represents The Glioma Features Best? Cancer Manag Res 2019; 11:9989-10000. [PMID: 31819632 PMCID: PMC6885544 DOI: 10.2147/cmar.s197839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose This study aims to incorporate informative histogram indicator analyses and advanced multimodal MRI parameters to differentiate low-grade gliomas (LGGs) from high-grade gliomas (HGGs) and to explore the features associated with patients’ survival. Patients and methods A total of 120 patients with pathologically confirmed LGGs or HGGs receiving conventional and advanced MRI such as three-dimensional arterial spin labeling (3D-ASL), intravoxel incoherent motion-diffusion weighted imaging (IVIM-DWI), and dynamic contrast-enhanced MRI (DCE-MRI) were included. The mean and histogram indicators from advanced MRI were calculated from the entire tumor. The efficacies of a single indicator or multiple parameters were tested in distinguishing HGGs from LGGs and predicting patients’ survival. Receiver operating characteristic (ROC) curve and multivariable stepwise logistic regression were used to evaluate the diagnostic efficacies. Leave-one-out cross-validation was further used to validate the accuracy of the parameter sets in glioma grading. Log-rank test using the Kaplan–Meier curve was utilized to predict patients’ survival. Results Overall, parameters from DCE-MRI performed better than those from 3D-ASL or IVIM-DWI in both glioma grading and survival prediction. The histogram metrics of Ve were demonstrated to have higher accuracies (the accuracies for Extended Tofts_Vemean and Extended Tofts_Vemedian were 68.33% and 71.67%, respectively, while those for the Incremental_Vemean and Incremental_Ve75th were 68.33% and 72.50%, respectively) in grading LGGs from HGGs. The combination of Tofts_Ve histogram metrics was the one with the highest accuracy (81.67%) and area under ROC curve (AUC = 0.840). On the other hand, Patlak_Ktrans95th (AUC = 0.9265) and Extended Tofts_Ve95th (AUC = 0.9154) performed better than their corresponding means (Patlak_Ktransmean: AUC = 0.9118 and Extended Tofts_Vemean: AUC = 0.9044) in predicting patients’ overall survival (OS) at 18-month follow-up. Conclusion DCE-MRI-derived histogram features from the entire tumor were promising metrics for glioma grading and OS prediction. Combining single modal histogram features improved glioma grading. Trial registration NCT 02622620.
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Affiliation(s)
- Lin-Feng Yan
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Ying-Zhi Sun
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Sha-Sha Zhao
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Yu Han
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Gang Li
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Xin Zhang
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Qiang Tian
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Zhi-Cheng Liu
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Yang Yang
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Ying Yu
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Qian Sun
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Jin Zhang
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Ping Chen
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Bo Hu
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Fei Li
- Student Brigade, Fourth Military Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Teng-Hui Han
- Student Brigade, Fourth Military Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Laboratory of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710038, People's Republic of China
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15
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Qin Y, Yu X, Hou J, Hu Y, Li F, Wen L, Lu Q, Liu S. Prognostic Value of the Pretreatment Primary Lesion Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging for Nasopharyngeal Carcinoma. Acad Radiol 2019; 26:1473-1482. [PMID: 30772137 DOI: 10.1016/j.acra.2019.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/19/2022]
Abstract
RATIONALE AND OBJECTIVES Early identifying the long-term outcome of chemoradiotherapy is helpful for personalized treatment in nasopharyngeal carcinoma (NPC). This study aimed to investigate the prognostic significance of pretreatment quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for NPC. MATERIALS AND METHODS The relationships between the prognosis and pretreatment quantitative DCE-MRI (Ktrans, Kep, Ve, and fpv) values of the primary tumors were analyzed in 134 NPC patients who received chemoradiotherapy. Kaplan-Meier analysis was performed to calculate the local-regional relapse-free survival (LRRFS), local relapse-free survival (LRFS), regional relapse-free survival, distant metastasis-free survival (DMFS), progression-free survival, and overall survival rates. Cox proportional hazards model was used to explore the independent predictors for prognosis. RESULTS The local-failure group had significantly higher Ve (p = 0.033) and fpv values (p = 0.005) than the non-local-failure group. The Ve-high group showed significantly lower LRRFS (p = 0.015) , LRFS (p = 0.013) , DMFS (p = 0.027) and progression-free survival (p = 0.035) rates than the Ve-low group. The fpv-high group exhibited significantly lower LRRFS (p = 0.004) and LRFS (p = 0.005) rates than the fpv-low group. Ve was the independent predictor for LRRFS (p = 0.008), LRFS (p = 0.007), DMFS (p = 0.041), and overall survival (p = 0.022). fpv was the independent indicator for LRRFS (p = 0.003) and LRFS (p = 0.001). CONCLUSION Baseline quantitative DCE-MRI may be valuable in predicting the prognosis for NPC.
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Affiliation(s)
- Yuhui Qin
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China
| | - Xiaoping Yu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China.
| | - Jing Hou
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China
| | - Ying Hu
- Department of Radiotherapy, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
| | - Feiping Li
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China
| | - Lu Wen
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China
| | - Qiang Lu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China
| | - Siye Liu
- Department of Diagnostic Radiology, the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University and Hunan Cancer Hospital, 283 Tongzipo Road, Changsha 410013, Hunan, PR China
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16
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Carceller F, Jerome NP, Fowkes LA, Khabra K, Mackinnon A, Bautista F, Marshall LV, Vaidya S, Mandeville H, Morgan V, Leach MO, Koh DM. Post-radiotherapy apparent diffusion coefficient (ADC) in children and young adults with high-grade gliomas and diffuse intrinsic pontine gliomas. Pediatr Hematol Oncol 2019; 36:103-112. [PMID: 30978130 DOI: 10.1080/08880018.2019.1592267] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 03/05/2019] [Indexed: 01/14/2023]
Abstract
Objectives: Diffusion-weighted magnetic resonance imaging (DW-MRI) offers potential to monitor response and predict survival in high-grade gliomas (HGG) and diffuse intrinsic pontine gliomas (DIPG). We hypothesized that post-radiotherapy DW-MRI may provide prognostic imaging biomarkers in children and young adults with these tumors. Methods: Patients aged ≤21 years diagnosed between 2005 and 2012 were eligible. The tumor median apparent diffusion coefficient (ADC) and its 5th percentile (C5-ADC) were determined at the first post-radiotherapy scan and at the time of radiological progression. DW-MRI parameters were correlated with survival endpoints, temozolomide use and pseudoprogression, when it occurred. Results: Out of 40 patients (20 HGG, 20 DIPG), 23 had evaluable DW-MRI post-radiotherapy and 25 at radiological progression. There were 6 episodes of pseudoprogression. Hazard ratios (95%CI) for progression-free survival were 0.998 (0.993-1.003) for median ADC and 1.003 (0.996-1.010) for C5-ADC. Hazard ratios (95%CI) for overall survival were 1.0009 (0.996-1.006) for median ADC and 0.998 (0.992-1.004) for C5-ADC. Post-radiotherapy median and C5-ADC values were not significantly different between patients treated with radiotherapy alone versus radiotherapy/temozolomide. The median and C5-ADC values were not significantly different at the time of pseudoprogression compared to those at tumor progression. Conclusions: Post-radiotherapy median ADC and C5-ADC were not prognostic, nor able to differentiate radiosensitization with temozolomide or occurrence of pseudoprogression in this cohort of HGG and DIPG patients. Further exploration of alternative DW parameters, study timepoints or data modeling may contribute to the development of prognostic/predictive imaging biomarkers for children and young adults with HGG or DIPG.
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Affiliation(s)
- Fernando Carceller
- a Paediatric Neuro-Oncology and Drug Development Teams, Children & Young People's Unit , The Royal Marsden NHS Foundation Trust , London , UK
- b Division of Clinical Studies and Cancer Therapeutics , The Institute of Cancer Research , London , UK
| | - Neil P Jerome
- c Cancer Research UK Cancer Imaging Centre , The Institute of Cancer Research , London , UK
- d Department of Circulation and Medical Imaging , NTNU - Norwegian University of Science and Technology , Trondheim , Norway
| | - Lucy A Fowkes
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
| | - Komel Khabra
- f The Royal Marsden NHS Foundation Trust , Research Data Management and Statistics Unit , London , UK
- g MRC Clinical Trials Unit, University College London , London , UK
| | - Andrew Mackinnon
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
| | | | - Lynley V Marshall
- a Paediatric Neuro-Oncology and Drug Development Teams, Children & Young People's Unit , The Royal Marsden NHS Foundation Trust , London , UK
- b Division of Clinical Studies and Cancer Therapeutics , The Institute of Cancer Research , London , UK
| | - Sucheta Vaidya
- a Paediatric Neuro-Oncology and Drug Development Teams, Children & Young People's Unit , The Royal Marsden NHS Foundation Trust , London , UK
- b Division of Clinical Studies and Cancer Therapeutics , The Institute of Cancer Research , London , UK
| | - Henry Mandeville
- i Department of Radiotherapy , The Royal Marsden NHS Foundation Trust , London , UK
| | - Veronica Morgan
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
| | - Martin O Leach
- c Cancer Research UK Cancer Imaging Centre , The Institute of Cancer Research , London , UK
| | - Dow-Mu Koh
- e Department of Radiology , The Royal Marsden NHS Foundation Trust , London , UK
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17
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Ivanidze J, Lum M, Pisapia D, Magge R, Ramakrishna R, Kovanlikaya I, Fine HA, Chiang GC. MRI Features Associated with TERT Promoter Mutation Status in Glioblastoma. J Neuroimaging 2019; 29:357-363. [PMID: 30644143 DOI: 10.1111/jon.12596] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Telomerase reverse transcriptase (TERT) promoter mutations are associated with worse prognosis in glioblastoma. The purpose of this study was to evaluate whether TERT mutation status was associated with specific morphologic and quantitative imaging features. METHODS Twenty-nine patients with isocitrate dehydrogenase 1/2-wildtype glioblastoma (13 TERT-wildtype, 16 TERT-mutated), who underwent preoperative magnetic resonance (MR) imaging were included in this retrospective study. Qualitative imaging phenotypes were evaluated using the Visually Accessible Rembrandt Images (VASARIs) feature set. Histogram analysis of apparent diffusion coefficient (ADC) and dynamic contrast-enhanced MR perfusion values were performed on enhancing tumor volumes-of-interest, and differences between TERT-wildtype and TERT-mutated tumors were assessed. RESULTS VASARI analysis demonstrated that the majority of morphologic features were not significantly different between TERT-wildtype and TERT-mutated tumors, although a higher proportion of TERT-wildtype tumors featured nonenhancing tumor crossing midline (P = .014). TERT-mutated tumors demonstrated lower median rate constant kep (.38 vs. .76, P = .03) and lower median volume transfer coefficient Ktrans (.13 vs. .31, P = .02). There was no significant difference in median plasma volume vp (P = .92) or ADC values (P = .66) between the two groups. We further found a significant interaction between median kep and Ktrans and TERT status, respectively, suggesting greater risk of death with increasing blood-brain barrier dysfunction in TERT-mutated but not in TERT-wildtype tumors. CONCLUSION Our study demonstrates evidence of altered permeability metrics associated with TERT mutation in glioblastoma, laying the foundation for future prospective studies assessing implications for therapeutic management and clinical outcomes.
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Affiliation(s)
- Jana Ivanidze
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Mark Lum
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
| | - David Pisapia
- Department of Pathology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Rajiv Magge
- Department of Neurology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Rohan Ramakrishna
- Department of Neurologic Surgery, New York Presbyterian Hospital-Cornell, New York, NY
| | - Ilhami Kovanlikaya
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Howard A Fine
- Department of Neurology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Gloria C Chiang
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
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18
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Probing tumor microenvironment in patients with newly diagnosed glioblastoma during chemoradiation and adjuvant temozolomide with functional MRI. Sci Rep 2018; 8:17062. [PMID: 30459364 PMCID: PMC6244161 DOI: 10.1038/s41598-018-34820-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/24/2018] [Indexed: 12/18/2022] Open
Abstract
Functional MRI may identify critical windows of opportunity for drug delivery and distinguish between early treatment responders and non-responders. Using diffusion-weighted, dynamic contrast-enhanced, and dynamic susceptibility contrast MRI, as well as pro-angiogenic and pro-inflammatory blood markers, we prospectively studied the physiologic tumor-related changes in fourteen newly diagnosed glioblastoma patients during standard therapy. 153 MRI scans and blood collection were performed before chemoradiation (baseline), weekly during chemoradiation (week 1–6), monthly before each cycle of adjuvant temozolomide (pre-C1-C6), and after cycle 6. The apparent diffusion coefficient, volume transfer coefficient (Ktrans), and relative cerebral blood volume (rCBV) and flow (rCBF) were calculated within the tumor and edema regions and compared to baseline. Cox regression analysis was used to assess the effect of clinical variables, imaging, and blood markers on progression-free (PFS) and overall survival (OS). After controlling for additional covariates, high baseline rCBV and rCBF within the edema region were associated with worse PFS (microvessel rCBF: HR = 7.849, p = 0.044; panvessel rCBV: HR = 3.763, p = 0.032; panvessel rCBF: HR = 3.984; p = 0.049). The same applied to high week 5 and pre-C1 Ktrans within the tumor region (week 5 Ktrans: HR = 1.038, p = 0.003; pre-C1 Ktrans: HR = 1.029, p = 0.004). Elevated week 6 VEGF levels were associated with worse OS (HR = 1.034; p = 0.004). Our findings suggest a role for rCBV and rCBF at baseline and Ktrans and VEGF levels during treatment as markers of response. Functional imaging changes can differ substantially between tumor and edema regions, highlighting the variable biologic and vascular state of tumor microenvironment during therapy.
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Hilario A, Hernandez-Lain A, Sepulveda JM, Lagares A, Perez-Nuñez A, Ramos A. Perfusion MRI grading diffuse gliomas: Impact of permeability parameters on molecular biomarkers and survival. Neurocirugia (Astur) 2018; 30:11-18. [PMID: 30143443 DOI: 10.1016/j.neucir.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 05/04/2018] [Accepted: 06/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Our objectives were: (1) compare dynamic susceptibility-weighted (DSC) and dynamic contrast-enhanced (DCE) permeability parameters, (2) evaluate diagnostic accuracy of DSC and DCE discriminating high- and low-grade tumors, (3) analyze relationship of permeability parameters with overall (OS) and progression-free survival (PFS) and (4) assess differences in high-grade tumors classified according to molecular biomarkers. MATERIALS AND METHODS 49 patients with histologically proved diffuse gliomas underwent DSC and DCE imaging. Parametric maps of cerebral blood volume (CBV), CBV-leakage corrected, volume transfer coefficient (Ktrans), fractional volume of the extravascular extracellular space (EES) (Ve), fractional blood plasma volume (Vp) and rate constant between EES and blood plasma (Kep) were calculated. High-grade gliomas were also classified according to isocitrate dehydrogenase (IDH), alpha-thalassemia/mental retardation syndrome X-linked (ATRX) and O6-methylguanine-dna-methyltransferase promoter methylation (MGMT) status. RESULTS There is correlation between parameters leakage, Ktrans and Vp. ROC curve analysis showed significance in both Ktrans and Ve for glioma grading. Threshold value of 0.075 for Ve generated the best combination of sensitivity (80%) and specificity (75%) in tumor gradation. Leakage was the only permeability parameter related to OS (P=0.006) and PFS (0.012); with prolonged survival for leakage values lower than 1.2. IDH-mutated high-grade tumors showed lower leakage and Ktrans values. High-grade tumors with loss of ATRX presented lower leakage and Vp values. CONCLUSIONS Both DSC and DCE permeability parameters serve as non-invasive method for glioma grading. Leakage was the unique permeability parameter related to survival and the best discriminating high-grade gliomas classified according to IDH and ATRX status.
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Affiliation(s)
- Amaya Hilario
- Department of Radiology, Neuroradiology Section, Universitary Hospital 12 de Octubre, Madrid, Spain.
| | | | | | - Alfonso Lagares
- Department of Neurosurgery, Universitary Hospital 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Department of Neurosurgery, Universitary Hospital 12 de Octubre, Madrid, Spain
| | - Ana Ramos
- Department of Radiology, Neuroradiology Section, Universitary Hospital 12 de Octubre, Madrid, Spain
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Ly KI, Gerstner ER. The Role of Advanced Brain Tumor Imaging in the Care of Patients with Central Nervous System Malignancies. Curr Treat Options Oncol 2018; 19:40. [PMID: 29931476 DOI: 10.1007/s11864-018-0558-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OPINION STATEMENT T1-weighted post-contrast and T2-weighted fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) constitute the gold standard for diagnosis and response assessment in neuro-oncologic patients but are limited in their ability to accurately reflect tumor biology and metabolism, particularly over the course of a patient's treatment. Advanced MR imaging methods are sensitized to different biophysical processes in tissue, including blood perfusion, tumor metabolism, and chemical composition of tissue, and provide more specific information on tissue physiology than standard MRI. This review provides an overview of the most common and emerging advanced imaging modalities in the field of brain tumor imaging and their applications in the care of neuro-oncologic patients.
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Affiliation(s)
- K Ina Ly
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA
| | - Elizabeth R Gerstner
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, 55 Fruit Street, Yawkey 9E, Boston, MA, 02114, USA.
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Anzalone N, Castellano A, Cadioli M, Conte GM, Cuccarini V, Bizzi A, Grimaldi M, Costa A, Grillea G, Vitali P, Aquino D, Terreni MR, Torri V, Erickson BJ, Caulo M. Brain Gliomas: Multicenter Standardized Assessment of Dynamic Contrast-enhanced and Dynamic Susceptibility Contrast MR Images. Radiology 2018; 287:933-943. [DOI: 10.1148/radiol.2017170362] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Lee JY, Ahn KJ, Lee YS, Jang JH, Jung SL, Kim BS. Differentiation of grade II and III oligodendrogliomas from grade II and III astrocytomas: a histogram analysis of perfusion parameters derived from dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) MRI. Acta Radiol 2018; 59:723-731. [PMID: 28862024 DOI: 10.1177/0284185117728981] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Since oligodendroglial tumors are sensitive to chemotherapy and have a better prognosis, the differentiation of oligodendroglial tumors (OT) from astrocytic tumors (AT) is important. Purpose To investigate the perfusion and permeability parameters that differentiate grade II and III OT from AT, using dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) magnetic resonance imaging (MRI). Material and Methods We retrospectively reviewed the DCE and DSC MRIs of 39 patients with OT (OTs, n = 19; grade II, n = 12 and grade III, n = 7) and AT (ATs, n = 20; grade II, n = 7 and grade III, n = 13). Glioblastomas were not included. Various histogram parameters of relative cerebral blood volume, volume transfer constant (Ktrans), flux rate constant (Kep), plasma volume fraction (Vp), and extravascular extracellular volume fraction (Ve) from DSC and DCE MRI, were compared between the two groups. Univariable and multivariable logistic regression were used to distinguish OT from AT. Receiver operating characteristic (ROC) curve analysis was performed. Results On the results of DCE MRI, most of the histogram parameters of Ktrans, Kep, and Ve showed tendencies toward higher values in OT than AT. Multivariable logistic regression revealed that the 50th Kep and 95th Ktrans were the most significant parameters predictive of OT, with an odds ratio of 3.7 and 2.5, respectively ( P = 0.004 and 0.03). The area under the curve from the ROC curve analysis for the 50th Kep and the 95th Ktrans were 0.81 and 0.80, respectively. Conclusion The DCE MRI-derived parameters of Ktrans and Kep could facilitate differentiation of OT from AT.
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Affiliation(s)
- Ji Young Lee
- Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kook Jin Ahn
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Youn Soo Lee
- Department of Hospital Pathology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Hee Jang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So Lyung Jung
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bum Soo Kim
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Di N, Cheng W, Jiang X, Liu X, Zhou J, Xie Q, Chu Z, Chen H, Wang B. Can dynamic contrast-enhanced MRI evaluate VEGF expression in brain glioma? An MRI-guided stereotactic biopsy study. J Neuroradiol 2018; 46:186-192. [PMID: 29752976 DOI: 10.1016/j.neurad.2018.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 02/16/2018] [Accepted: 04/21/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate whether pharmacokinetic parameters derived from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to evaluate vascular endothelial growth factor (VEGF) expression in brain glioma based on a point-to-point basis. MATERIALS AND METHODS Forty-seven patients with treatment-naïve glioma received preoperative DCE-MRI before stereotactic biopsy. We histologically quantified VEGF from section of stereotactic biopsies, and co-registered biopsy locations with localized measurements of DCE-MRI parameters including volume transfer coefficient (Ktrans), reverse reflux rate constant (Kep), extracellular extravascular volume fraction (Ve) and blood plasma volume (Vp). The correlations between DCE-MRI parameters (Ktrans, Kep, Ve and Vp) and VEGF were determined using Spearman correlation coefficient. P≤.05 was considered statistically significant. RESULTS Seventy-nine biopsy samples were obtained and graded into 45 high-grade gliomas (HGGs) and 34 low-grade gliomas (LGGs). Ktrans showed a significant positive correlation with VEGF expression in HGGs group (ρ=0.505, P<0.001) and in combined group (LGGs+HGGs) (ρ=0.549, P<0.001), but not in LGGs group (P>0.05). Kep, Ve or Vp was not correlated with VEGF even though a positive trend showed (P>0.05). CONCLUSIONS DCE-MRI is a useful, non-invasive imaging technique for quantitative evaluation of VEGF, and its parameter Ktrans other than Kep, Ve or Vp may be used as a surrogate for VEGF expression in brain gliomas.
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Affiliation(s)
- Ningning Di
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China; Department of Radiology, Huashan Hospital Fudan University, 12, Wulumuqi road Middle, 200040 Shanghai, China.
| | - Wenna Cheng
- Department of Pharmacy, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Xingyue Jiang
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Xinjiang Liu
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Jinliang Zhou
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Qian Xie
- Department of Radiology, Huashan Hospital Fudan University, 12, Wulumuqi road Middle, 200040 Shanghai, China.
| | - Zhihui Chu
- Department of Radiology, Binzhou Medical University Hospital, 661, Huanghe road, 256600 Binzhou, China.
| | - Huacheng Chen
- Department of Radiology, Weifang Traditional Chinese Hospital, 1055, Weizhou road, 256600 Weifang, China.
| | - Bin Wang
- Department of Medical Imaging and Nuclear, Binzhou Medical University, 346, Guanhai road, 264000 Yantai, China.
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Di N, Yao C, Cheng W, Ren Y, Qu J, Wang B, Yao Z. Correlation of dynamic contrast-enhanced MRI derived volume transfer constant with histological angiogenic markers in high-grade gliomas. J Med Imaging Radiat Oncol 2018; 62:464-470. [PMID: 29330968 DOI: 10.1111/1754-9485.12701] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION To ascertain if the volume transfer constant (Ktrans ) derived from T1 dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) correlates with the immunohistological markers of angiogenesis in high-grade gliomas. METHODS Fifty-one image-guided biopsy specimens in 34 patients with newly presenting high-grade gliomas (grade III = 16; grade IV = 18) underwent preoperative imaging (conventional imaging and T1 DCE-MRI). We correlated vascular endothelial growth factor (VEGF) expression and the microvessel density (MVD) of MRI-guided biopsy specimens with the corresponding DCE-derived Ktrans . Histological sections were stained with VEGF and CD34, and examined under light microscopy. These histological and molecular markers of angiogenesis were correlated with the Ktrans of the region of interest corresponding to the biopsy specimen. RESULTS The Ktrans showed a significant positive correlation with VEGF expression (ρ = 0.582, P = 0.001) but not with MVD stained with CD34 antibody (ρ = 0.328, P = 0.072). CONCLUSION The Ktrans derived from DCE-MRI can reflect the VEGF expression of high-grade gliomas but not the MVD.
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Affiliation(s)
- Ningning Di
- Department of Radiology, Binzhou Medical University Hospital, Binzhou, China
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | - Chenjun Yao
- Department of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China
| | - Wenna Cheng
- Department of Pharmacy, Binzhou Medical University Affiliated Hospital, Binzhou, China
| | - Yan Ren
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | | | - Bin Wang
- Department of Medical Imaging and Nuclear Medicine, Binzhou Medical University, Yantai, China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
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25
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McCullough BJ, Ader V, Aguedan B, Feng X, Susanto D, Benkers TL, Henson JW, Mayberg M, Cobbs CS, Gwinn RP, Monteith SJ, Newell DW, Delashaw J, Fouke SJ, Rostad S, Keogh BP. Preoperative relative cerebral blood volume analysis in gliomas predicts survival and mitigates risk of biopsy sampling error. J Neurooncol 2017; 136:181-188. [PMID: 29098571 DOI: 10.1007/s11060-017-2642-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
Appropriate management of adult gliomas requires an accurate histopathological diagnosis. However, the heterogeneity of gliomas can lead to misdiagnosis and undergrading, especially with biopsy. We evaluated the role of preoperative relative cerebral blood volume (rCBV) analysis in conjunction with histopathological analysis as a predictor of overall survival and risk of undergrading. We retrospectively identified 146 patients with newly diagnosed gliomas (WHO grade II-IV) that had undergone preoperative MRI with rCBV analysis. We compared overall survival by histopathologically determined WHO tumor grade and by rCBV using Kaplan-Meier survival curves and the Cox proportional hazards model. We also compared preoperative imaging findings and initial histopathological diagnosis in 13 patients who underwent biopsy followed by subsequent resection. Survival curves by WHO grade and rCBV tier similarly separated patients into low, intermediate, and high-risk groups with shorter survival corresponding to higher grade or rCBV tier. The hazard ratio for WHO grade III versus II was 3.91 (p = 0.018) and for grade IV versus II was 11.26 (p < 0.0001) and the hazard ratio for each increase in 1.0 rCBV units was 1.12 (p < 0.002). Additionally, 3 of 13 (23%) patients initially diagnosed by biopsy were upgraded on subsequent resection. Preoperative rCBV was elevated at least one standard deviation above the mean in the 3 upgraded patients, suggestive of undergrading, but not in the ten concordant diagnoses. In conclusion, rCBV can predict overall survival similarly to pathologically determined WHO grade in patients with gliomas. Discordant rCBV analysis and histopathology may help identify patients at higher risk for undergrading.
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Affiliation(s)
- Brendan J McCullough
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA.
- Ben and Catherine Ivy Center for Advanced Brain Tumor Treatment, 550 17th Avenue, Seattle, WA, 98122, USA.
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA.
- Department of Health Services, University of Washington, 4333 Brooklyn Avenue NE, Box 359455, Seattle, WA, 98195, USA.
| | - Valerie Ader
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Brian Aguedan
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Xu Feng
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Daniel Susanto
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
| | - Tara L Benkers
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - John W Henson
- Piedmont Brain Tumor Center, 2001 Peachtree Road, Suite 645, Atlanta, GA, 30309, USA
| | - Marc Mayberg
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Charles S Cobbs
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Ryder P Gwinn
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Stephen J Monteith
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - David W Newell
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Johnny Delashaw
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
| | - Sarah J Fouke
- Brain and Spine Center, St. Luke's Hospital, 232 South Woods Mill Road, St. Louis, MO, 63117, USA
| | - Steven Rostad
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
- Cellnetix Pathology, 1124 Columbia Street, Suite 200, Seattle, WA, 98104, USA
| | - Bart P Keogh
- Swedish Neuroscience Institute, 550 17th Avenue, Seattle, WA, 98122, USA
- Radia, Inc., 19020 33rd Avenue West, Suite 210, Lynwood, WA, 98036, USA
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26
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Dehkordi ANV, Kamali-Asl A, Wen N, Mikkelsen T, Chetty IJ, Bagher-Ebadian H. DCE-MRI prediction of survival time for patients with glioblastoma multiforme: using an adaptive neuro-fuzzy-based model and nested model selection technique. NMR IN BIOMEDICINE 2017; 30:e3739. [PMID: 28543885 DOI: 10.1002/nbm.3739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/28/2017] [Accepted: 03/30/2017] [Indexed: 06/07/2023]
Abstract
This pilot study investigates the construction of an Adaptive Neuro-Fuzzy Inference System (ANFIS) for the prediction of the survival time of patients with glioblastoma multiforme (GBM). ANFIS is trained by the pharmacokinetic (PK) parameters estimated by the model selection (MS) technique in dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) data analysis, and patient age. DCE-MRI investigations of 33 treatment-naïve patients with GBM were studied. Using the modified Tofts model and MS technique, the following physiologically nested models were constructed: Model 1, no vascular leakage (normal tissue); Model 2, leakage without efflux; Model 3, leakage with bidirectional exchange (influx and efflux). For each patient, the PK parameters of the three models were estimated as follows: blood plasma volume (vp ) for Model 1; vp and volume transfer constant (Ktrans ) for Model 2; vp , Ktrans and rate constant (kep ) for Model 3. Using Cox regression analysis, the best combination of the estimated PK parameters, together with patient age, was identified for the design and training of ANFIS. A K-fold cross-validation (K = 33) technique was employed for training, testing and optimization of ANFIS. Given the survival time distribution, three classes of survival were determined and a confusion matrix for the correct classification fraction (CCF) of the trained ANFIS was estimated as an accuracy index of ANFIS's performance. Patient age, kep and ve (Ktrans /kep ) of Model 3, and Ktrans of Model 2, were found to be the most effective parameters for training ANFIS. The CCF of the trained ANFIS was 84.8%. High diagonal elements of the confusion matrix (81.8%, 90.1% and 81.8% for Class 1, Class 2 and Class 3, respectively), with low off-diagonal elements, strongly confirmed the robustness and high performance of the trained ANFIS for predicting the three survival classes. This study confirms that DCE-MRI PK analysis, combined with the MS technique and ANFIS, allows the construction of a DCE-MRI-based fuzzy integrated predictor for the prediction of the survival of patients with GBM.
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Affiliation(s)
- Azimeh N V Dehkordi
- Department of Radiation Medicine Engineering, Shahid Beheshti University, Tehran, Iran
| | - Alireza Kamali-Asl
- Department of Radiation Medicine Engineering, Shahid Beheshti University, Tehran, Iran
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Tom Mikkelsen
- Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan, USA
- Ontario Brain Institute, Toronto, Ontario, Canada
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Hassan Bagher-Ebadian
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
- Department of Physics, Oakland University, Rochester, Michigan, USA
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Abstract
PURPOSE OF REVIEW Magnetic resonance imaging (MRI) is routinely employed in the diagnosis and clinical management of brain tumors. This review provides an overview of the advancements in the field of MRI, with a particular focus on the quantitative assessment by advanced physiological magnetic resonance techniques in light of the new molecular classification of brain tumor. RECENT FINDINGS Understanding how molecular phenotypes of brain tumors are reflected in noninvasive imaging is the goal of radiogenomics, which aims at determining the association between imaging features and molecular markers in neuro-oncology. Advanced MRI techniques such as diffusion magnetic resonance imaging and perfusion-weighted imaging add important structural, hemodynamic, and physiological information for tumor diagnosis and classification, as well as to stratify tumor response. Magnetic resonance spectroscopy is able to depict with unprecedented accuracy metabolic biomarkers, which are relevant for molecular subtyping. Ultra-high-field imaging enhances anatomical detail and enables to explore new horizon in tumor imaging. SUMMARY The noninvasive MRI-based assessment of tumor malignancy and molecular status may offer the opportunity to predict prognosis and to select patients who may be candidates for individualized targeted therapies, providing more sensitive tools for their follow-up.
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Choi YS, Ahn SS, Lee HJ, Chang JH, Kang SG, Kim EH, Kim SH, Lee SK. The Initial Area Under the Curve Derived from Dynamic Contrast-Enhanced MRI Improves Prognosis Prediction in Glioblastoma with Unmethylated MGMT Promoter. AJNR Am J Neuroradiol 2017. [PMID: 28642265 DOI: 10.3174/ajnr.a5265] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Although perfusion and permeability MR parameters have known to have prognostic value, they have reproducibility issues. Our aim was to evaluate whether the initial area under the time-to-signal intensity curve (IAUC) derived from dynamic contrast-enhanced MR imaging can improve prognosis prediction in patients with glioblastoma with known MGMT status. MATERIALS AND METHODS We retrospectively examined 88 patients with glioblastoma who underwent preoperative dynamic contrast-enhanced MR imaging. The means of IAUC values at 30 and 60 seconds (IAUC30mean and IAUC60mean) were extracted from enhancing tumors. The prognostic values of IAUC parameters for overall survival and progression-free survival were assessed with log-rank tests, according to the MGMT status. Multivariate overall survival and progression-free survival models before and after adding the IAUC parameters as covariates were explored by net reclassification improvement after receiver operating characteristic analysis for 1.5-year overall survival and 1-year progression-free survival and by random survival forest. RESULTS High IAUC parameters were associated with worse overall survival and progression-free survival in the unmethylated MGMT group, but not in the methylated group. In the unmethylated MGMT group, 1.5-year overall survival and 1-year progression-free survival prediction improved significantly after adding IAUC parameters (overall survival area under the receiver operating characteristic curve, 0.86; progression-free survival area under the receiver operating characteristic curve, 0.74-0.76) to the model with other prognostic factors (overall survival area under the receiver operating characteristic curve, 0.81; progression-free survival area under the receiver operating characteristic curve, 0.69; P < .05 for all) except in the case of IAUC60mean for 1-year progression-free survival prediction (P = .059). Random survival forest models indicated that the IAUC parameters were the second or most important predictors in the unmethylated MGMT group, except in the case of the IAUC60mean for progression-free survival. CONCLUSIONS IAUC can be a useful prognostic imaging biomarker in patients with glioblastoma with known MGMT status, improving prediction of glioblastoma prognosis with the unmethylated MGMT promoter status.
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Affiliation(s)
- Y S Choi
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
| | - S S Ahn
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
| | - H-J Lee
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
| | - J H Chang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - S-G Kang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - E H Kim
- Neurosurgery (J.H.C., S.-G.K., E.H.K.), Yonsei University College of Medicine, Seoul, Korea
| | - S H Kim
- Departments of Pathology (S.H.K.)
| | - S-K Lee
- From the Department of Radiology and Research Institute of Radiological Science (Y.S.C., S.S.A., H.-J.L., S.-K.L.)
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Clinical Applications of Contrast-Enhanced Perfusion MRI Techniques in Gliomas: Recent Advances and Current Challenges. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:7064120. [PMID: 29097933 PMCID: PMC5612612 DOI: 10.1155/2017/7064120] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023]
Abstract
Gliomas possess complex and heterogeneous vasculatures with abnormal hemodynamics. Despite considerable advances in diagnostic and therapeutic techniques for improving tumor management and patient care in recent years, the prognosis of malignant gliomas remains dismal. Perfusion-weighted magnetic resonance imaging techniques that could noninvasively provide superior information on vascular functionality have attracted much attention for evaluating brain tumors. However, nonconsensus imaging protocols and postprocessing analysis among different institutions impede their integration into standard-of-care imaging in clinic. And there have been very few studies providing a comprehensive evidence-based and systematic summary. This review first outlines the status of glioma theranostics and tumor-associated vascular pathology and then presents an overview of the principles of dynamic contrast-enhanced MRI (DCE-MRI) and dynamic susceptibility contrast-MRI (DSC-MRI), with emphasis on their recent clinical applications in gliomas including tumor grading, identification of molecular characteristics, differentiation of glioma from other brain tumors, treatment response assessment, and predicting prognosis. Current challenges and future perspectives are also highlighted.
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30
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Carceller F, Jerome NP, Miyazaki K, Collins DJ, Orton MR, d'Arcy JA, Wallace T, Moreno L, Pearson ADJ, Zacharoulis S, Leach MO, Marshall LV, Koh DM. Feasibility and applicability of diffusion-weighted and dynamic contrast-enhanced magnetic resonance imaging in routine assessments of children with high-grade gliomas. Pediatr Blood Cancer 2017; 64:279-283. [PMID: 27615273 DOI: 10.1002/pbc.26216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 12/28/2022]
Abstract
Diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) have been used as imaging biomarkers in adults with high-grade gliomas (HGGs). We incorporated free-breathing DW-MRI and DCE-MRI, at a single time point, in the routine follow-up of five children (median age 9 years, range 8-15) with histologically confirmed HGG within a prospective imaging study. It was feasible to incorporate DW-MRI and DCE-MRI in routine assessments of children with HGG. DW and DCE parameters were repeatable in paediatric HGG. Higher median ADC100-1000 significantly correlated with longer survival in our sample.
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Affiliation(s)
- Fernando Carceller
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Neil P Jerome
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Keiko Miyazaki
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - David J Collins
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Matthew R Orton
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - James A d'Arcy
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Toni Wallace
- Radiology Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lucas Moreno
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
- Clinical Trials Unit, Paediatric Oncology Department, Hospital Niño Jesús, Madrid, Spain
| | - Andrew D J Pearson
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Stergios Zacharoulis
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Martin O Leach
- Cancer Research UK Cancer Imaging Centre, The Institute of Cancer Research, London, United Kingdom
| | - Lynley V Marshall
- Paediatric & Adolescent Drug Development Team, Children & Young People's Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Clinical Studies and Cancer Therapeutics, The Institute of Cancer Research, London, United Kingdom
| | - Dow-Mu Koh
- Radiology Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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31
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Comparison between perfusion computed tomography and dynamic contrast-enhanced magnetic resonance imaging in assessing glioblastoma microvasculature. Eur J Radiol 2016; 87:120-124. [PMID: 28034567 DOI: 10.1016/j.ejrad.2016.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 12/15/2016] [Accepted: 12/17/2016] [Indexed: 12/15/2022]
Abstract
PURPOSE Perfusion computed tomography (PCT) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) provide independent measurements of biomarkers related to tumor perfusion. The aim of this study was to compare the two techniques in assessing glioblastoma microvasculature. MATERIALS AND METHODS Twenty-five patients diagnosed with glioblastoma (14 males and 11 females; 51±11years old, ranging from 33 to 70 years) were includede in this prospective study. All patients underwent both PCT and DCE-MRI. Imaging was performed on a 256-slice CT scanner and a 3-T MRI system. PCT yielded permeability surface-area product (PS) using deconvolution physiological models; meanwhile, DCE-MRI determined volume transfer constant (Ktrans) using the Tofts-Kermode compartment model. All cases were submitted to surgical intervention, and CD105-microvascular density (CD105-MVD) was measured in each glioblastoma specimen. Then, Spearman's correlation coefficients and Bland-Altman plots were obtained for PS, Ktrans and CD105-MVD. P<0.05 was considered statistically significant. RESULTS Tumor PS and Ktrans values were correlated with CD105-MVD (r=0.644, P<0.001; r=0.683, P<0.001). In addition, PS was correlated with Ktrans in glioblastoma (r=0.931, P<0.001). Finally, Bland-Altman plots showed no significant differences between PS and Ktrans (P=0.063). CONCLUSION PCT and DCE-MRI measurements of glioblastoma perfusion biomarkers have similar results, suggesting that both techniques may have comparable utility. Therefore, PCT may serve as an alternative modality to DCE-MRI for the in vivo evaluation of glioblastoma microvasculature.
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Ulyte A, Katsaros VK, Liouta E, Stranjalis G, Boskos C, Papanikolaou N, Usinskiene J, Bisdas S. Prognostic value of preoperative dynamic contrast-enhanced MRI perfusion parameters for high-grade glioma patients. Neuroradiology 2016; 58:1197-1208. [PMID: 27796446 PMCID: PMC5153415 DOI: 10.1007/s00234-016-1741-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/16/2016] [Indexed: 12/22/2022]
Abstract
Introduction The prognostic value of the dynamic contrast-enhanced (DCE) MRI perfusion and its histogram analysis-derived metrics is not well established for high-grade glioma (HGG) patients. The aim of this prospective study was to investigate DCE perfusion transfer coefficient (Ktrans), vascular plasma volume fraction (vp), extracellular volume fraction (ve), reverse transfer constant (kep), and initial area under gadolinium concentration time curve (IAUGC) as predictors of progression-free (PFS) and overall survival (OS) in HGG patients. Methods Sixty-nine patients with suspected anaplastic astrocytoma or glioblastoma underwent preoperative DCE-MRI scans. DCE perfusion whole tumor region histogram parameters, clinical details, and PFS and OS data were obtained. Univariate, multivariate, and Kaplan–Meier survival analyses were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify perfusion parameters with the best differentiation performance. Results On univariate analysis, ve and skewness of vp had significant negative impacts, while kep had significant positive impact on OS (P < 0.05). ve was also a negative predictor of PFS (P < 0.05). Patients with lower ve and IAUGC had longer median PFS and OS on Kaplan–Meier analysis (P < 0.05). Ktrans and ve could also differentiate grade III from IV gliomas (area under the curve 0.819 and 0.791, respectively). Conclusions High ve is a consistent predictor of worse PFS and OS in HGG glioma patients. vp skewness and kep are also predictive for OS. Ktrans and ve demonstrated the best diagnostic performance for differentiating grade III from IV gliomas.
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Affiliation(s)
- Agne Ulyte
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Vasileios K Katsaros
- Department of Advanced Imaging Modalities - CT and MRI, General Anticancer and Oncological Hospital "St. Savvas", Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Evangelia Liouta
- Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Georgios Stranjalis
- Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece
| | - Christos Boskos
- Department of Neurosurgery, Evangelismos Hospital, University of Athens, Athens, Greece.,Department of Radiation Oncology, General Anticancer and Oncological Hospital "St. Savvas", Athens, Greece
| | - Nickolas Papanikolaou
- Department of Radiology, Centre for the Unknown, Champalimaud Foundation, Lisbon, Portugal
| | - Jurgita Usinskiene
- National Cancer Institute, Vilnius, Lithuania.,Affidea Lietuva, Vilnius, Lithuania
| | - Sotirios Bisdas
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Box 65, Queen Square 8-11, London, WC1N 3BG, UK.
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33
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Nguyen TB, Cron GO, Bezzina K, Perdrizet K, Torres CH, Chakraborty S, Woulfe J, Jansen GH, Thornhill RE, Zanette B, Cameron IG. Correlation of Tumor Immunohistochemistry with Dynamic Contrast-Enhanced and DSC-MRI Parameters in Patients with Gliomas. AJNR Am J Neuroradiol 2016; 37:2217-2223. [PMID: 27585700 DOI: 10.3174/ajnr.a4908] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tumor CBV is a prognostic and predictive marker for patients with gliomas. Tumor CBV can be measured noninvasively with different MR imaging techniques; however, it is not clear which of these techniques most closely reflects histologically-measured tumor CBV. Our aim was to investigate the correlations between dynamic contrast-enhanced and DSC-MR imaging parameters and immunohistochemistry in patients with gliomas. MATERIALS AND METHODS Forty-three patients with a new diagnosis of glioma underwent a preoperative MR imaging examination with dynamic contrast-enhanced and DSC sequences. Unnormalized and normalized cerebral blood volume was obtained from DSC MR imaging. Two sets of plasma volume and volume transfer constant maps were obtained from dynamic contrast-enhanced MR imaging. Plasma volume obtained from the phase-derived vascular input function and bookend T1 mapping (Vp_Φ) and volume transfer constant obtained from phase-derived vascular input function and bookend T1 mapping (Ktrans_Φ) were determined. Plasma volume obtained from magnitude-derived vascular input function (Vp_SI) and volume transfer constant obtained from magnitude-derived vascular input function (Ktrans_SI) were acquired, without T1 mapping. Using CD34 staining, we measured microvessel density and microvessel area within 3 representative areas of the resected tumor specimen. The Mann-Whitney U test was used to test for differences according to grade and degree of enhancement. The Spearman correlation was performed to determine the relationship between dynamic contrast-enhanced and DSC parameters and histopathologic measurements. RESULTS Microvessel area, microvessel density, dynamic contrast-enhanced, and DSC-MR imaging parameters varied according to the grade and degree of enhancement (P < .05). A strong correlation was found between microvessel area and Vp_Φ and between microvessel area and unnormalized blood volume (rs ≥ 0.61). A moderate correlation was found between microvessel area and normalized blood volume, microvessel area and Vp_SI, microvessel area and Ktrans_Φ, microvessel area and Ktrans_SI, microvessel density and Vp_Φ, microvessel density and unnormalized blood volume, and microvessel density and normalized blood volume (0.44 ≤ rs ≤ 0.57). A weaker correlation was found between microvessel density and Ktrans_Φ and between microvessel density and Ktrans_SI (rs ≤ 0.41). CONCLUSIONS With dynamic contrast-enhanced MR imaging, use of a phase-derived vascular input function and bookend T1 mapping improves the correlation between immunohistochemistry and plasma volume, but not between immunohistochemistry and the volume transfer constant. With DSC-MR imaging, normalization of tumor CBV could decrease the correlation with microvessel area.
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Affiliation(s)
- T B Nguyen
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - G O Cron
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - K Bezzina
- Psychiatry (K.B.), The Ottawa Hospital, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - C H Torres
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - S Chakraborty
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | | | | | - R E Thornhill
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.)
| | - B Zanette
- Department of Medical Biophysics (B.Z.), University of Toronto, Toronto, Ontario, Canada
| | - I G Cameron
- From the Departments of Radiology (T.B.N., G.O.C., C.H.T., R.E.T., I.G.C., S.C.).,Medical Physics (I.G.C.)
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34
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Usinskiene J, Ulyte A, Bjørnerud A, Venius J, Katsaros VK, Rynkeviciene R, Letautiene S, Norkus D, Suziedelis K, Rocka S, Usinskas A, Aleknavicius E. Optimal differentiation of high- and low-grade glioma and metastasis: a meta-analysis of perfusion, diffusion, and spectroscopy metrics. Neuroradiology 2016; 58:339-50. [DOI: 10.1007/s00234-016-1642-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/06/2016] [Indexed: 12/01/2022]
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35
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Arevalo-Perez J, Kebede AA, Peck KK, Diamond E, Holodny AI, Rosenblum M, Rubel J, Gaal J, Hatzoglou V. Dynamic Contrast-Enhanced MRI in Low-Grade Versus Anaplastic Oligodendrogliomas. J Neuroimaging 2015; 26:366-71. [PMID: 26707628 DOI: 10.1111/jon.12320] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/30/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Low-grade and anaplastic oligodendrogliomas are often difficult to differentiate on the basis of conventional MR imaging characteristics. Dynamic contrast-enhanced (DCE) MRI can assess tumor microvasculature and has demonstrated utility for predicting glioma grade and prognosis in primary brain tumors. The aim of our study was to evaluate the performance of plasma volume (Vp) and volume transfer coefficient (K(trans) ) derived from DCE MRI in differentiating between grade II and grade III oligodendrogliomas. MATERIALS AND METHODS Twenty-four consecutive patients with pathologically confirmed oligodendroglioma (World Health Organization grade II, n = 14 and grade III, n = 10) were retrospectively assessed. Pretreatment DCE MRI was performed and regions of interest were manually drawn around the entire tumor volume to calculate Vp and K(trans) . The Mann-Whitney U test and receiver operating characteristic (ROC) analysis were performed to compare pharmacokinetic parameters between the 2 groups. RESULTS The Vpmean values for grade III oligodendrogliomas were significantly higher (P = .03) than those for grade II oligodendrogliomas. The K(trans) mean values were higher in grade III lesions, but the difference between the 2 groups was not statistically significant (P > .05). Based on ROC analysis, the Vpmean (area under curve = .757, SD = .1) cut-off value that provided the best combination of high sensitivity and specificity to distinguish between grade II and III oligodendrogliomas was 2.35 (P < .03). CONCLUSION The results of our study suggest the DCE MRI parameter Vpmean can noninvasively differentiate between grade II and grade III oligodendrogliomas.
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Affiliation(s)
- Julio Arevalo-Perez
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amanuel A Kebede
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kyung K Peck
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Eli Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrei I Holodny
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jennifer Rubel
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joshua Gaal
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vaios Hatzoglou
- Department of Radiology, Neuroradiology Service, Memorial Sloan Kettering Cancer Center, New York, NY.,Brain Tumor Center, Memorial Sloan Kettering Cancer Center, New York, NY
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36
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Choi YS, Kim DW, Lee SK, Chang JH, Kang SG, Kim EH, Kim SH, Rim TH, Ahn SS. The Added Prognostic Value of Preoperative Dynamic Contrast-Enhanced MRI Histogram Analysis in Patients with Glioblastoma: Analysis of Overall and Progression-Free Survival. AJNR Am J Neuroradiol 2015; 36:2235-41. [PMID: 26338911 DOI: 10.3174/ajnr.a4449] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/20/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The prognostic value of dynamic contrast-enhanced MR imaging in patients with glioblastoma is controversial. We investigated the added prognostic value of dynamic contrast-enhanced MR imaging to clinical parameters and molecular biomarkers in patients with glioblastoma by using histogram analysis. MATERIALS AND METHODS This retrospective study consisted of 61 patients who underwent preoperative dynamic contrast-enhanced MR imaging for glioblastoma. The histogram parameters of dynamic contrast-enhanced MR imaging, including volume transfer constant, extravascular extracellular volume fraction, and plasma volume fraction, were calculated from entire enhancing tumors. Univariate analyses for overall survival and progression-free survival were performed with preoperative clinical and dynamic contrast-enhanced MR imaging parameters and postoperative molecular biomarkers. Multivariate Cox regression was performed to build pre- and postoperative models for overall survival and progression-free survival. The performance of models was assessed by calculating the Harrell concordance index. RESULTS In univariate analysis, patients with higher volume transfer constant and extravascular extracellular volume fraction values showed worse overall survival and progression-free survival, whereas plasma volume fraction showed no significant correlation. In multivariate analyses for overall survival, the fifth percentile value of volume transfer constant and kurtosis of extravascular extracellular volume fraction were independently prognostic in the preoperative model, and kurtosis of volume transfer constant and extravascular extracellular volume fraction were independently prognostic in the postoperative model. For progression-free survival, independent prognostic factors were minimum and fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction in the preoperative model and kurtosis of extravascular extracellular volume fraction in the postoperative model. The performance of preoperative models for progression-free survival was significantly improved when minimum or fifth percentile values of volume transfer constant and kurtosis of extravascular extracellular volume fraction were added. CONCLUSIONS Higher volume transfer constant and extravascular extracellular volume fraction values are associated with worse prognosis, and dynamic contrast-enhanced MR imaging may have added prognostic value in combination with preoperative clinical parameters, especially in predicting progression-free survival.
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Affiliation(s)
- Y S Choi
- From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.)
| | - D W Kim
- Department of Policy Research Affairs (D.W.K.), National Health Insurance Service Ilsan Hospital, Goyang, Gyeonggi-do, Korea
| | - S-K Lee
- From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.)
| | - J H Chang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - S-G Kang
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | - E H Kim
- Neurosurgery (J.H.C., S.-G.K., E.H.K.)
| | | | - T H Rim
- Ophthalmology (T.H.R.), Yonsei University College of Medicine, Seoul, Korea
| | - S S Ahn
- From the Departments of Radiology and Research Institute of Radiological Science (Y.S.C., S.-K.L., S.S.A.)
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37
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Jia ZZ, Gu HM, Zhou XJ, Shi JL, Li MD, Zhou GF, Wu XH. The assessment of immature microvascular density in brain gliomas with dynamic contrast-enhanced magnetic resonance imaging. Eur J Radiol 2015; 84:1805-9. [PMID: 26066470 DOI: 10.1016/j.ejrad.2015.05.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/19/2015] [Accepted: 05/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This study was designed to quantitatively evaluate the immature microvascular density (MVD) of brain gliomas using the volume transfer constant (K(trans)) and volume of extravascular extracellular space per unit volume of tissue (Ve) from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) noninvasively. MATERIALS AND METHODS Fifty-seven patients (35 males, 22 females; age range, 14-70, mean age 46±12 years old) with brain glioma were included in this study. The maximal values of K(trans) and Ve of all patients with brain glioma (grade II 24, III 7 and IV 26) were obtained. The CD105-microvascular density (CD105-MVD) of each tumor was measured in surgical specimen. The differences of K(trans), Ve and CD105-MVD between the different grades of gliomas were analyzed using the Mann-Whitney U-test. The Pearman correlation coefficient was determined between K(trans), Ve and CD105-MVD. A P-value of less than 0.05 was considered statistically significant. RESULTS The differences in K(trans), Ve and CD105-MVD were statistically significant between low-grade glioma (LGG) and high-grade glioma (HGG) (P=0.001, P<0.001, P<0.001). The K(trans), Ve and CD105-MVD of grade II were significantly lower than those of grade III and IV. K(trans) and Ve were positively correlated with CD105-MVD in HGG (P<0.001, P<0.001). CONCLUSIONS Our results suggest DCE-MRI plays an important part in noninvasively evaluating the immature MVD of brain gliomas.
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Affiliation(s)
- Zhong Zheng Jia
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Hong Mei Gu
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Xue Jun Zhou
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Jin Long Shi
- Department of Neurosurgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, Jiangsu, PR China.
| | - Min Da Li
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Guo Feng Zhou
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
| | - Xian Hua Wu
- Department of Radiology, Affiliated Hospital of Nantong University, 20 Xisi Road Nantong, 226001 Jiangsu, PR China.
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