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Qiu J, Zhu M, Chen CY, Luo Y, Wen J. Diffusion heterogeneity and vascular perfusion in tumor and peritumoral areas for prediction of overall survival in patients with high-grade glioma. Magn Reson Imaging 2023; 104:23-28. [PMID: 37734575 DOI: 10.1016/j.mri.2023.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 08/24/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE To evaluation of diffusion heterogeneity and vascular perfusion in tumor and peritumoral areas for prognostic prediction in high-grade glioma (HGG, WHO III/IV grade). METHODS Forty patients with HGG underwent diffusion kurtosis imaging (DKI), intravoxel incoherent motion (IVIM), and arterial spin labeling (ASL) MRI before operation. After normalization, the parameters were divided into diffusion heterogeneity parameters (rD, rMD, rMK, rKr, rKa) and vascular perfusion parameters (rD*, rF, rCBF). Univariate and multivariate Cox regression analyses were used to evaluate associations between overall survival (OS) and the above parameters, clinical factors, and IDH1 status. The Mann-Whitney test was used to evaluate differences in the parameters between different IDH1 states. RESULTS In the univariate Cox regression analysis, OS was significantly associated with tumor resection range, IDH1 status, tumor heterogeneity parameters (rD, rMD, rMK, rKr, rKa), and rCBF in tumor area(all p < 0.05). In addition, rD and rCBF measured in the peritumoral region were also predictors of poor OS (both p < 0.01). Multivariate Cox regression analysis indicated that rMK in the tumor area and rCBF in the peritumoral area (hazard ratio = 7.900 and 5.466, respectively, for each 0.1 increase in the normalized value) were independent predictors of OS. CONCLUSION The rMK of tumor area and rCBF of peritumoral area had independent predictive value for OS in patients with HGG. ADVANCES IN KNOWLEDGE This study explored useful imaging biomarkers from the diffusion heterogeneity and vascular perfusion of tumor and peritumoral areas in HGG, which is useful to help clinician to make precise therapeutic plans, and predict the prognostic for glioma patients.
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Affiliation(s)
- Jun Qiu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China.
| | - Min Zhu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China
| | - Chuan Yu Chen
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China
| | - Yi Luo
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China
| | - Jie Wen
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230036, China.
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2
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Sollmann N, Zhang H, Kloth C, Zimmer C, Wiestler B, Rosskopf J, Kreiser K, Schmitz B, Beer M, Krieg SM. Modern preoperative imaging and functional mapping in patients with intracranial glioma. ROFO-FORTSCHR RONTG 2023; 195:989-1000. [PMID: 37224867 DOI: 10.1055/a-2083-8717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Magnetic resonance imaging (MRI) in therapy-naïve intracranial glioma is paramount for neuro-oncological diagnostics, and it provides images that are helpful for surgery planning and intraoperative guidance during tumor resection, including assessment of the involvement of functionally eloquent brain structures. This study reviews emerging MRI techniques to depict structural information, diffusion characteristics, perfusion alterations, and metabolism changes for advanced neuro-oncological imaging. In addition, it reflects current methods to map brain function close to a tumor, including functional MRI and navigated transcranial magnetic stimulation with derived function-based tractography of subcortical white matter pathways. We conclude that modern preoperative MRI in neuro-oncology offers a multitude of possibilities tailored to clinical needs, and advancements in scanner technology (e. g., parallel imaging for acceleration of acquisitions) make multi-sequence protocols increasingly feasible. Specifically, advanced MRI using a multi-sequence protocol enables noninvasive, image-based tumor grading and phenotyping in patients with glioma. Furthermore, the add-on use of preoperatively acquired MRI data in combination with functional mapping and tractography facilitates risk stratification and helps to avoid perioperative functional decline by providing individual information about the spatial location of functionally eloquent tissue in relation to the tumor mass. KEY POINTS:: · Advanced preoperative MRI allows for image-based tumor grading and phenotyping in glioma.. · Multi-sequence MRI protocols nowadays make it possible to assess various tumor characteristics (incl. perfusion, diffusion, and metabolism).. · Presurgical MRI in glioma is increasingly combined with functional mapping to identify and enclose individual functional areas.. · Advancements in scanner technology (e. g., parallel imaging) facilitate increasing application of dedicated multi-sequence imaging protocols.. CITATION FORMAT: · Sollmann N, Zhang H, Kloth C et al. Modern preoperative imaging and functional mapping in patients with intracranial glioma. Fortschr Röntgenstr 2023; 195: 989 - 1000.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, United States
| | - Haosu Zhang
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- TranslaTUM - Central Institute for Translational Cancer Research, Klinikum rechts der Isar, Technical University of Munich, München, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Radiology and Neuroradiology, Universitäts- und Rehabilitationskliniken Ulm, Ulm, Germany
| | - Bernd Schmitz
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Sandro M Krieg
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, München, Germany
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, München, Germany
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3
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Sohn B, Park K, Ahn SS, Park YW, Choi SH, Kang SG, Kim SH, Chang JH, Lee SK. Dynamic contrast-enhanced MRI radiomics model predicts epidermal growth factor receptor amplification in glioblastoma, IDH-wildtype. J Neurooncol 2023; 164:341-351. [PMID: 37689596 DOI: 10.1007/s11060-023-04435-y] [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: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/11/2023]
Abstract
PURPOSE To develop and validate a dynamic contrast-enhanced (DCE) MRI-based radiomics model to predict epidermal growth factor receptor (EGFR) amplification in patients with glioblastoma, isocitrate dehydrogenase (IDH) wildtype. METHODS Patients with pathologically confirmed glioblastoma, IDH wildtype, from January 2015 to December 2020, with an EGFR amplification status, were included. Patients who did not undergo DCE or conventional brain MRI were excluded. Patients were categorized into training and test sets by a ratio of 7:3. DCE MRI data were used to generate volume transfer constant (Ktrans) and extracellular volume fraction (Ve) maps. Ktrans, Ve, and conventional MRI were then used to extract the radiomics features, from which the prediction models for EGFR amplification status were developed and validated. RESULTS A total of 190 patients (mean age, 59.9; male, 55.3%), divided into training (n = 133) and test (n = 57) sets, were enrolled. In the test set, the radiomics model using the Ktrans map exhibited the highest area under the receiver operating characteristic curve (AUROC), 0.80 (95% confidence interval [CI], 0.65-0.95). The AUROC for the Ve map-based and conventional MRI-based models were 0.74 (95% CI, 0.58-0.90) and 0.76 (95% CI, 0.61-0.91). CONCLUSION The DCE MRI-based radiomics model that predicts EGFR amplification in glioblastoma, IDH wildtype, was developed and validated. The MRI-based radiomics model using the Ktrans map has higher AUROC than conventional MRI.
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Affiliation(s)
- Beomseok Sohn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kisung Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, South Korea
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea.
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
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Zhu H, Ouyang H, Pan X, Zhang Z, Tan J, Yu N, Li M, Zhao Y. Increased ASF1B Expression Correlates With Poor Prognosis in Patients With Gliomas. Front Oncol 2022; 12:912101. [PMID: 35875094 PMCID: PMC9298524 DOI: 10.3389/fonc.2022.912101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Several studies have suggested that anti-silencing function 1 B (ASF1B) can serve as a good potential marker for predicting tumor prognosis. But the values of ASF1B in gliomas have not been elucidated and further confirmation is needed. Methods Transcriptomic and clinical data were downloaded from The Cancer Genome Atlas database (TCGA), genotypic tissue expression (GTEx), and the Chinese Gliomas Genome Atlas database (CGGA). Univariate and multivariate Cox regression analyses were used to investigate the link between clinical variables and ASF1B. Survival analysis was used to assess the association between ASF1B expression and overall survival (OS). The relationship between ASF1B expression and OS was studied using survival analysis. To investigate the probable function and immunological infiltration, researchers used gene ontology (GO) analysis, gene set enrichment analysis (GSEA), and single-sample GSEA (ssGSEA). Results In glioma tissues, ASF1B expression was considerably higher than in normal tissues. The survival analysis found that increased ASF1B expression was linked with a poor prognosis in glioma patients. ASF1B demonstrated a high diagnostic value in glioma patients, according to a Receiver Operating Characteristic (ROC) analysis. ASF1B was found to be an independent predictive factor for OS in a Cox regression study (HR = 1.573, 95% CI: 1.053–2.350, p = 0.027). GO, KEGG, and GSEA functional enrichment analysis revealed that ASF1B was associated with nuclear division, cell cycle, m-phase, and cell cycle checkpoints. Immuno-infiltration analysis revealed that ASF1B was positively related to Th2 cells, macrophages, and aDC and was negatively related to pDC, TFH, and NK CD56 bright cells. Conclusion A high level of ASF1B mRNA expression was correlated with a poor prognosis in glioma patients in this study, implying that it could be a reliable prognostic biomarker for glioma patients.
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Affiliation(s)
- Huaxin Zhu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | | | - Xinyi Pan
- Huankui Academy, Nanchang University, Nangchang, China
| | - Zhixiong Zhang
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jiacong Tan
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Nianzu Yu
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meihua Li
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yeyu Zhao
- Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, China
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5
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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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Batalov AI, Zakharova NE, Pronin IN, Belyaev AY, Pogosbekyan EL, Goryaynov SA, Bykanov AE, Tyurina AN, Shevchenko AM, Solozhentseva KD, Nikitin PV, Potapov AA. 3D pCASL-perfusion in preoperative assessment of brain gliomas in large cohort of patients. Sci Rep 2022; 12:2121. [PMID: 35136119 PMCID: PMC8826414 DOI: 10.1038/s41598-022-05992-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/18/2022] [Indexed: 01/02/2023] Open
Abstract
The aim of the study was to evaluate the role of pseudocontinuous arterial spin labeling perfusion (pCASL-perfusion) in preoperative assessment of cerebral glioma grades. The study group consisted of 253 patients, aged 7-78 years with supratentorial gliomas (65 low-grade gliomas (LGG), 188 high-grade gliomas (HGG)). We used 3D pCASL-perfusion for each patient in order to calculate the tumor blood flow (TBF). We obtained maximal tumor blood flow (maxTBF) in small regions of interest (30 ± 10 mm2) and then normalized absolute maximum tumor blood flow (nTBF) to that of the contralateral normal-appearing white matter of the centrum semiovale. MaxTBF and nTBF values significantly differed between HGG and LGG groups (p < 0.001), as well as between patient groups separated by the grades (grade II vs. grade III) (p < 0.001). Moreover, we performed ROC-analysis which demonstrated high sensitivity and specificity in differentiating between HGG and LGG. We found significant differences for maxTBF and nTBF between grade III and IV gliomas, however, ROC-analysis showed low sensitivity and specificity. We did not observe a significant difference in TBF for astrocytomas and oligodendrogliomas. Our study demonstrates that 3D pCASL-perfusion as an effective diagnostic tool for preoperative differentiation of glioma grades.
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Affiliation(s)
- A I Batalov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - N E Zakharova
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - I N Pronin
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A Yu Belyaev
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - E L Pogosbekyan
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - S A Goryaynov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A E Bykanov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A N Tyurina
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A M Shevchenko
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation.
| | - K D Solozhentseva
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - P V Nikitin
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - A A Potapov
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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7
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Zhou Q, Xue C, Ke X, Zhou J. Treatment Response and Prognosis Evaluation in High-Grade Glioma: An Imaging Review Based on MRI. J Magn Reson Imaging 2022; 56:325-340. [PMID: 35129845 DOI: 10.1002/jmri.28103] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 12/19/2022] Open
Abstract
In recent years, the development of advanced magnetic resonance imaging (MRI) technology and machine learning (ML) have created new tools for evaluating treatment response and prognosis of patients with high-grade gliomas (HGG); however, patient prognosis has not improved significantly. This is mainly due to the heterogeneity between and within HGG tumors, resulting in standard treatment methods not benefitting all patients. Moreover, the survival of patients with HGG is not only related to tumor cells, but also to noncancer cells in the tumor microenvironment (TME). Therefore, during preoperative diagnosis and follow-up treatment of patients with HGG, noninvasive imaging markers are needed to characterize intratumoral heterogeneity, and then to evaluate treatment response and predict prognosis, timeously adjust treatment strategies, and achieve individualized diagnosis and treatment. In this review, we summarize the research progress of conventional MRI, advanced MRI technology, and ML in evaluation of treatment response and prognosis of patients with HGG. We further discuss the significance of the TME in the prognosis of HGG patients, associate imaging features with the TME, indirectly reflecting the heterogeneity within the tumor, and shifting treatment strategies from tumor cells alone to systemic therapy of the TME, which may be a major development direction in the future. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 4.
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Affiliation(s)
- Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Second Clinical School, Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
| | - Caiqiang Xue
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Second Clinical School, Lanzhou University, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
| | - Xiaoai Ke
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China.,Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, Gansu, China.,Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, Gansu, China
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8
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Perfusion measurement in brain gliomas using velocity-selective arterial spin labeling: comparison with pseudo-continuous arterial spin labeling and dynamic susceptibility contrast MRI. Eur Radiol 2022; 32:2976-2987. [DOI: 10.1007/s00330-021-08406-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
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9
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Lu J, Li X, Li H. Perfusion parameters derived from MRI for preoperative prediction of IDH mutation and MGMT promoter methylation status in glioblastomas. Magn Reson Imaging 2021; 83:189-195. [PMID: 34506909 DOI: 10.1016/j.mri.2021.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/14/2021] [Accepted: 09/05/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate the feasibility for preoperative prediction of IDH mutation and MGMT promoter methylation status in glioblastomas(GBMs) by intravoxel incoherent motion(IVIM) and dynamic susceptibility contrast(DSC). METHODS Preoperative IVIM and DSC images of 71 patients(IDH mutation:45, IDH wildtype: 26; MGMT methylation: 31, MGMT unmethylation:40) with glioblastomas were analyzed retrospectively. Perfusion parameters including microcirculation perfusion coefficient(D*), perfusion fraction(f), cerebral blood volume(CBV) and cerebral blood flow(CBF) were measured. Corrected perfusion parameters containing corrected perfusion coefficient(ADCperf) and simplified perfusion fraction(SPF) were from the simplified IVIM with 3 b values. Correlations among parameters were analyzed by Spearman correlation. All parameters were compared with Mann-Whitney U test. Univariate and multivariate logistic regression models were constructed. The receiver operating characteristic(ROC) curve was analyzed. RESULTS The IVIM parameters showed merely moderate correlations with CBV and showed no correlation with CBF. IDH mutation GBMs showed lower D*, ADCperf, SPF, CBV and higher f than IDH wildtype GBMs(all p < 0.05). D* was the independent predictor for IDH mutation with the highest AUC of 0.912(95%CI: 0.821-0.966). The D*, ADCperf, SPF and CBV of MGMT promoter methylation GBMs were lower than unmethylation GBMs while f was higher(all p < 0.05). Multivariate model showed the highest prediction efficacy for MGMT promoter methylation with an AUC of 0.915(95%CI: 0.824-0.968). The CBF was not useful in distinguishing IDH mutation and MGMT promoter methylation status(p = 0.055, 0.215). CONCLUSION IDH mutation and MGMT promoter methylation status in GBMs can be assessed effectively by IVIM and DSC. Besides, D* was the independent predictor of IDH mutation status.
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Affiliation(s)
- Jun Lu
- Department of Radiology, The Affiliated Tumor Hospital of Zhengzhou University & Henan Cancer Hospital, China
| | - Xiang Li
- Department of Radiology, The Affiliated Tumor Hospital of Zhengzhou University & Henan Cancer Hospital, China
| | - Hailiang Li
- Department of Radiology, The Affiliated Tumor Hospital of Zhengzhou University & Henan Cancer Hospital, China.
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10
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Sprugnoli G, Rossi S, Rotenberg A, Pascual-Leone A, El-Fakhri G, Golby AJ, Santarnecchi E. Personalised, image-guided, noninvasive brain stimulation in gliomas: Rationale, challenges and opportunities. EBioMedicine 2021; 70:103514. [PMID: 34391090 PMCID: PMC8365310 DOI: 10.1016/j.ebiom.2021.103514] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/12/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022] Open
Abstract
Malignant brain tumours are among the most aggressive human cancers, and despite intensive efforts made over the last decades, patients’ survival has scarcely improved. Recently, high-grade gliomas (HGG) have been found to be electrically integrated with healthy brain tissue, a communication that facilitates tumour mitosis and invasion. This link to neuronal activity has provided new insights into HGG pathophysiology and opened prospects for therapeutic interventions based on electrical modulation of neural and synaptic activity in the proximity of tumour cells, which could potentially slow tumour growth. Noninvasive brain stimulation (NiBS), a group of techniques used in research and clinical settings to safely modulate brain activity and plasticity via electromagnetic or electrical stimulation, represents an appealing class of interventions to characterise and target the electrical properties of tumour-neuron interactions. Beyond neuronal activity, NiBS may also modulate function of a range of substrates and dynamics that locally interacts with HGG (e.g., vascular architecture, perfusion and blood-brain barrier permeability). Here we discuss emerging applications of NiBS in patients with brain tumours, covering potential mechanisms of action at both cellular, regional, network and whole-brain levels, also offering a conceptual roadmap for future research to prolong survival or promote wellbeing via personalised NiBS interventions.
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Affiliation(s)
- Giulia Sprugnoli
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Radiology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy; Image Guided Neurosurgery laboratory, Department of Neurosurgery and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Brain investigation and Neuromodulation Laboratory (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Simone Rossi
- Brain investigation and Neuromodulation Laboratory (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience, Neurology and Clinical Neurophysiology Unit, University of Siena, Siena, Italy
| | - Alexander Rotenberg
- Department of Neurology and Division of Epilepsy and Clinical Neurophysiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Hinda and Arthur Marcus Institute for Aging Research and Center for Memory Health, Hebrew Senior Life, Boston, MA, USA; Guttmann Brain Health Institute, Institut Guttmann, Universitat Autonoma, Barcelona, Spain
| | - Georges El-Fakhri
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra J Golby
- Image Guided Neurosurgery laboratory, Department of Neurosurgery and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emiliano Santarnecchi
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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11
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Waqar M, Lewis D, Agushi E, Gittins M, Jackson A, Coope D. Cerebral and tumoral blood flow in adult gliomas: a systematic review of results from magnetic resonance imaging. Br J Radiol 2021; 94:20201450. [PMID: 34106749 PMCID: PMC9327770 DOI: 10.1259/bjr.20201450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: Blood flow is the rate of blood movement and relevant to numerous processes, though understudied in gliomas. The aim of this review was to pool blood flow metrics obtained from MRI modalities in adult supratentorial gliomas. Methods: MEDLINE, EMBASE and the Cochrane database were queried 01/01/2000–31/12/2019. Studies measuring blood flow in adult Grade II–IV supratentorial gliomas using dynamic susceptibility contrast (DSC) MRI, dynamic contrast enhanced MRI (DCE-MRI) or arterial spin labelling (ASL) were included. Absolute and relative cerebral blood flow (CBF), peritumoral blood flow and tumoral blood flow (TBF) were reported. Results: 34 studies were included with 1415 patients and 1460 scans. The mean age was 52.4 ± 7.3 years. Most patients had glioblastoma (n = 880, 64.6%). The most common imaging modality was ASL (n = 765, 52.4%) followed by DSC (n = 538, 36.8%). Most studies were performed pre-operatively (n = 1268, 86.8%). With increasing glioma grade (II vs IV), TBF increased (70.8 vs 145.5 ml/100 g/min, p < 0.001) and CBF decreased (85.3 vs 49.6 ml/100 g/min, p < 0.001). In Grade IV gliomas, following treatment, CBF increased in ipsilateral (24.9 ± 1.2 vs 26.1 ± 0.0 ml/100 g/min, p < 0.001) and contralateral white matter (25.6 ± 0.2 vs 26.0± 0.0 ml/100 g/min, p < 0.001). Conclusion: Our findings demonstrate that increased mass effect from high-grade gliomas impairs blood flow within the surrounding brain that can improve with surgery. Advances in knowledge: This systematic review demonstrates how mass effect from brain tumours impairs blood flow in the surrounding brain parenchyma that can improve with treatment.
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Affiliation(s)
- Mueez Waqar
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Daniel Lewis
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Erjon Agushi
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK
| | - Matthew Gittins
- Department of Biostatistics, Division of Population Health, Health Services Research& Primary Care, The University of Manchester, Manchester, UK
| | - Alan Jackson
- Division of Informatics, Imaging and Data Sciences, Wolfson Molecular Imaging Centre, Manchester, UK.,Department of Neuroradiology, Salford Royal NHS Foundation Trust, Salford, UK
| | - David Coope
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, UK.,Division of Neuroscience and Experimental Psychology, Wolfson Molecular Imaging Centre, Manchester, UK
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12
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Fudaba H, Momii Y, Matsuta H, Onishi K, Kawasaki Y, Sugita K, Shimomura T, Fujiki M. Perfusion Parameter Obtained on 3-Tesla Magnetic Resonance Imaging and the Ki-67 Labeling Index Predict the Overall Survival of Glioblastoma. World Neurosurg 2021; 149:e469-e480. [PMID: 33567368 DOI: 10.1016/j.wneu.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/31/2021] [Accepted: 02/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulsed arterial spin-labeling, diffusion tensor imaging (DTI), and magnetic resonance spectroscopy (MRS) are useful for predicting glioma survival. We performed a comparative review of multiple parameters obtained using these pulse sequences on 3-Tesla magnetic resonance imaging (MRI) including the molecular status and Ki-67 labeling index in newly diagnosed supratentorial glioblastomas. METHODS A total of 35 patients with glioblastomas underwent pulsed arterial spin-labeling, DTI, and MRS studies using 3-Tesla MRI preoperatively. The isocitrate dehydrogenase (IDH) mutation status, methylguanine-DNA methyltransferase methylation status, and Ki-67 labeling index were calculated from the tumor specimen. Cutoff values were identified by analyzing a receiver operating characteristic curve, and the multivariate survival statistical technique was performed to determine the significant and independent parameters for predicting overall survival. RESULTS The multivariate Cox analysis showed that the maximum/mean relative cerebral blood flow (rCBF) ratio and the Ki-67 labeling index were significant and independent predictive parameters with a cutoff value of 1.589 for the maximum rCBF ratio, 1.286 for the mean rCBF ratio, and 19% for the Ki-67 labeling index and hazard ratios of 6.132 and 5.119, respectively. The Kaplan-Meier survival curves showed that patients with higher rCBF ratios and Ki-67 labeling indices had a shorter overall survival than others, with median overall survival durations of 479 (95% CI, 370-559) and 1243 (95% CI, 666-NA) days, respectively (P = 0.000167). CONCLUSIONS Our findings indicate that the preoperative rCBF ratio and Ki-67 labeling index are useful parameters for predicting the overall survival of cerebral glioblastomas.
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Affiliation(s)
- Hirotaka Fudaba
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan.
| | - Yasutomo Momii
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Hiroyuki Matsuta
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kouhei Onishi
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yukari Kawasaki
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Kenji Sugita
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
| | - Tsuyoshi Shimomura
- Department of Medical Informatics, Oita University Faculty of Medicine, Oita, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan
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13
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Hara S, Tanaka Y, Ueda Y, Abe D, Hayashi S, Inaji M, Maehara T, Ishii K, Nariai T. Detection of hemodynamic impairment on 15O gas PET using visual assessment of arterial spin-labeling MR imaging in patients with moyamoya disease. J Clin Neurosci 2019; 72:258-263. [PMID: 31843438 DOI: 10.1016/j.jocn.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 12/25/2018] [Accepted: 11/19/2019] [Indexed: 12/24/2022]
Abstract
It is unclear whether the visual assessment of noninvasive arterial spin labeling magnetic resonance imaging (ASL) can identify instances of hemodynamic compromise including an elevated oxygen extraction fraction (OEF) measured by 15O-gas positron emission tomography (PET). Here we evaluated the relationship between a four-point visual assessment system referred to as 'ASL scores' using ASL with two postlabeling delays (PLDs; 1525 ms and 2525 ms) and some quantitative hemodynamic parameters measured by PET. We retrospectively evaluated the cases of 18 Japanese patients with moyamoya disease who underwent ASL and PET. We compared the patients' regional ASL scores on two ASL images to the regional values of PET parameters, and we observed a significant trend in accord with the presumed clinical severity among all PET parameters and ASL scores (p < .003). The ASL score of the long PLD (2525 ms) showed the highest specificity (98.5%) for elevated OEF. Our results suggest that hemodynamic impairment (including elevated OEF) in patients with moyamoya disease may be grossly assessed by a visual assessment of noninvasive ASL images, which can be easily obtained in clinical settings.
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Affiliation(s)
- Shoko Hara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoji Tanaka
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Yasuhiro Ueda
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisu Abe
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shihori Hayashi
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Motoki Inaji
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Taketoshi Maehara
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Ishii
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tadashi Nariai
- Department of Neurosurgery, Tokyo Medical and Dental University, Tokyo, Japan; Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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14
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AlRayahi J, Zapotocky M, Ramaswamy V, Hanagandi P, Branson H, Mubarak W, Raybaud C, Laughlin S. Pediatric Brain Tumor Genetics: What Radiologists Need to Know. Radiographics 2019; 38:2102-2122. [PMID: 30422762 DOI: 10.1148/rg.2018180109] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Brain tumors are the most common solid tumors in the pediatric population. Pediatric neuro-oncology has changed tremendously during the past decade owing to ongoing genomic advances. The diagnosis, prognosis, and treatment of pediatric brain tumors are now highly reliant on the genetic profile and histopathologic features of the tumor rather than the histopathologic features alone, which previously were the reference standard. The clinical information expected to be gleaned from radiologic interpretations also has evolved. Imaging is now expected to not only lead to a relevant short differential diagnosis but in certain instances also aid in predicting the specific tumor and subtype and possibly the prognosis. These processes fall under the umbrella of radiogenomics. Therefore, to continue to actively participate in patient care and/or radiogenomic research, it is important that radiologists have a basic understanding of the molecular mechanisms of common pediatric central nervous system tumors. The genetic features of pediatric low-grade gliomas, high-grade gliomas, medulloblastomas, and ependymomas are reviewed; differences between pediatric and adult gliomas are highlighted; and the critical oncogenic pathways of each tumor group are described. The role of the mitogen-activated protein kinase pathway in pediatric low-grade gliomas and of histone mutations as epigenetic regulators in pediatric high-grade gliomas is emphasized. In addition, the oncogenic drivers responsible for medulloblastoma, the classification of ependymomas, and the associated imaging correlations and clinical implications are discussed. ©RSNA, 2018.
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Affiliation(s)
- Jehan AlRayahi
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Michal Zapotocky
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Vijay Ramaswamy
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Prasad Hanagandi
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Helen Branson
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Walid Mubarak
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Charles Raybaud
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
| | - Suzanne Laughlin
- From the Departments of Diagnostic Imaging (J.A., W.M.), Neurooncology (M.Z., V.R.), and Pediatric Neuroradiology (H.B., C.R., S.L.), The Hospital for Sick Children, University of Toronto, 555 University Ave, Toronto, ON, Canada M5G 1X8; and Departments of Diagnostic Imaging (J.A., P.H.) and Pediatric Interventional Radiology (W.M.), Sidra Medical and Research Center, Doha, Ad Dawhah, Qatar
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15
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Arterial spin labeling perfusion-weighted imaging aids in prediction of molecular biomarkers and survival in glioblastomas. Eur Radiol 2019; 30:1202-1211. [PMID: 31468161 DOI: 10.1007/s00330-019-06379-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/09/2019] [Accepted: 07/19/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Prediction of progression-free survival (PFS) and overall survival (OS) and early identification of molecular biomarkers with prognostic information are clinically important in glioblastoma (GBM) patients. We aimed to explore the utility of arterial spin labeling perfusion-weighted imaging (ASL-PWI) in the prediction of molecular biomarkers and survival in GBM patients. METHODS We retrospectively analyzed 149 consecutive GBM patients, who had undergone maximal surgical resection or biopsy followed by concurrent chemoradiotherapy and adjuvant chemotherapy using temozolomide between November 2010 and June 2016. On preoperative ASL-PWI, cerebral blood flow (CBF) within contrast-enhancing (CE) and nonenhancing (NE) portions were evaluated both qualitatively (perfusion pattern[CE] and perfusion pattern[NE]) and quantitatively (nCBFCE and nCBFNE). ASL-PWI findings were correlated with molecular biomarkers, including isocitrate dehydrogenase (IDH) and O6-methylguanine-DNA methyltransferase (MGMT) methylation statuses, and survival, using the Mann-Whitney U-test, Spearman rank correlation, Kaplan-Meier analysis, and receiver operating characteristics analysis. RESULTS nCBFCE was significantly higher in the IDH wild-type group than in the IDH mutant group (p = .013) and in the MGMT unmethylated group than in the methylated group (p = .047). Areas under the receiver operating characteristic curve were 0.678 for IDH mutation (p = .022) and 0.601 for MGMT promoter methylation (p = .043). Hyperperfusion was associated with the shortest median PFS for both perfusion pattern[CE] (7.6 months) and perfusion pattern[NE] (4.0 months). The perfusion pattern[NE] remained an independent predictor for PFS and OS even after adjusting for clinical and molecular predictors, unlike perfusion pattern[CE]. CONCLUSIONS ASL-PWI can aid to predict survival and molecular biomarkers including IDH mutation and MGMT promoter methylation statuses in GBM patients. KEY POINTS • ASL-PWI can aid to predict survival in GBM patients. • ASL-PWI can aid to predict IDH and MGMT promoter methylation statuses in GBM.
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16
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Larkin JR, Simard MA, Khrapitchev AA, Meakin JA, Okell TW, Craig M, Ray KJ, Jezzard P, Chappell MA, Sibson NR. Quantitative blood flow measurement in rat brain with multiphase arterial spin labelling magnetic resonance imaging. J Cereb Blood Flow Metab 2019; 39:1557-1569. [PMID: 29498562 PMCID: PMC6681434 DOI: 10.1177/0271678x18756218] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/01/2017] [Accepted: 12/22/2017] [Indexed: 11/29/2022]
Abstract
Cerebral blood flow is an important parameter in many diseases and functional studies that can be accurately measured in humans using arterial spin labelling (ASL) MRI. However, although rat models are frequently used for preclinical studies of both human disease and brain function, rat CBF measurements show poor consistency between studies. This lack of reproducibility is due, partly, to the smaller size and differing head geometry of rats compared to humans, as well as the differing analysis methodologies employed and higher field strengths used for preclinical MRI. To address these issues, we have implemented, optimised and validated a multiphase pseudo-continuous ASL technique, which overcomes many of the limitations of rat CBF measurement. Three rat strains (Wistar, Sprague Dawley and Berlin Druckrey IX) were used, and CBF values validated against gold-standard autoradiography measurements. Label positioning was found to be optimal at 45°, while post-label delay was optimised to 0.55 s. Whole brain CBF measures were 109 ± 22, 111 ± 18 and 100 ± 15 mL/100 g/min by multiphase pCASL, and 108 ± 12, 116 ± 14 and 122 ± 16 mL/100 g/min by autoradiography in Wistar, SD and BDIX cohorts, respectively. Tumour model analysis shows that the developed methods also apply in disease states. Thus, optimised multiphase pCASL provides robust, reproducible and non-invasive measurement of CBF in rats.
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Affiliation(s)
- James R Larkin
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - Manon A Simard
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - Alexandre A Khrapitchev
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - James A Meakin
- Wellcome Centre for Integrative
Neuroimaging, FMRIB Division, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, UK
| | - Thomas W Okell
- Wellcome Centre for Integrative
Neuroimaging, FMRIB Division, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, UK
| | - Martin Craig
- Institute of Biomedical Engineering,
University of Oxford, Oxford, UK
| | - Kevin J Ray
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
| | - Peter Jezzard
- Wellcome Centre for Integrative
Neuroimaging, FMRIB Division, University of Oxford, John Radcliffe Hospital,
Headington, Oxford, UK
| | | | - Nicola R Sibson
- Department of Oncology, Cancer Research
UK & Medical Research Council Oxford Institute for Radiation Oncology,
University of Oxford, Oxford, UK
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17
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Sprugnoli G, Monti L, Lippa L, Neri F, Mencarelli L, Ruffini G, Salvador R, Oliveri G, Batani B, Momi D, Cerase A, Pascual-Leone A, Rossi A, Rossi S, Santarnecchi E. Reduction of intratumoral brain perfusion by noninvasive transcranial electrical stimulation. SCIENCE ADVANCES 2019; 5:eaau9309. [PMID: 31453319 PMCID: PMC6693907 DOI: 10.1126/sciadv.aau9309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 07/10/2019] [Indexed: 05/04/2023]
Abstract
Malignant brain neoplasms have a poor prognosis despite aggressive treatments. Animal models and evidence from human bodily tumors reveal that sustained reduction in tumor perfusion via electrical stimulation promotes tumor necrosis, therefore possibly representing a therapeutic option for patients with brain tumors. Here, we demonstrate that transcranial electrical stimulation (tES) allows to safely and noninvasively reduce intratumoral perfusion in humans. Selected patients with glioblastoma or metastasis underwent tES, while perfusion was assessed using magnetic resonance imaging. Multichannel tES was applied according to personalized biophysical modeling, to maximize the induced electrical field over the solid tumor mass. All patients completed the study and tolerated the procedure without adverse effects, with tES selectively reducing the perfusion of the solid tumor. Results potentially open the door to noninvasive therapeutic interventions in brain tumors based on stand-alone tES or its combination with other available therapies.
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Affiliation(s)
- G. Sprugnoli
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - L. Monti
- Unit of Neuroimaging and Neurointervention, “Santa Maria alle Scotte” Medical Center, Siena, Italy
| | - L. Lippa
- Unit of Neurosurgery, “Santa Maria alle Scotte” Medical Center, Siena, Italy
| | - F. Neri
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - L. Mencarelli
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | | | | | - G. Oliveri
- Unit of Neurosurgery, “Santa Maria alle Scotte” Medical Center, Siena, Italy
| | - B. Batani
- Unit of Neurosurgery, “Santa Maria alle Scotte” Medical Center, Siena, Italy
| | - D. Momi
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
| | - A. Cerase
- Unit of Neuroimaging and Neurointervention, “Santa Maria alle Scotte” Medical Center, Siena, Italy
| | - A. Pascual-Leone
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
- Institut Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
| | - A. Rossi
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
- Department of Medicine, Surgery and Neuroscience, Human Physiology Section, Siena Medical School, Siena, Italy
| | - S. Rossi
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
- Department of Medicine, Surgery and Neuroscience, Human Physiology Section, Siena Medical School, Siena, Italy
| | - E. Santarnecchi
- Brain Investigation and Neuromodulation Laboratory, Department of Medicine, Surgery and Neuroscience, Unit of Neurology and Clinical Neurophysiology, Siena Medical School, Siena, Italy
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
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Wang N, Xie SY, Liu HM, Chen GQ, Zhang WD. Arterial Spin Labeling for Glioma Grade Discrimination: Correlations with IDH1 Genotype and 1p/19q Status. Transl Oncol 2019; 12:749-756. [PMID: 30878893 PMCID: PMC6423366 DOI: 10.1016/j.tranon.2019.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/21/2019] [Indexed: 12/18/2022] Open
Abstract
Since accurate grading of gliomas has important clinical value, the aim of this study is to evaluate the diagnostic efficacy of perfusion values derived from arterial spin labeling (ASL) to grade gliomas. In addition, the correlation between perfusion and isocitrate dehydrogenase 1 (IDH1) genotypes and chromosome arms 1p and 19q (1p/19q) status of gliomas was assessed. A total of 52 cases of supratentorial gliomas in adults who received ASL imaging were enrolled in this retrospective study. The cerebral blood flow (CBF) images derived from ASL and anatomical maps were normalized to the Montreal Neurological Institute coordinate system and matched. The mean CBF (meanCBF), the maximum CBF (maxCBF), and their relative values (rmeanCBF and rmaxCBF, respectively) were assessed in each case. The tumor grades, IDH1 genotypes, and 1p/19q status were diagnosed according to the 2016 WHO criteria. Receiver operating characteristic curves were performed to assess the efficacy of perfusion parameters for grading. Qualitatively, all gliomas were divided into high- and low-perfusion groups. The crosstabs chi-square test of independence was performed to calculate contingency coefficient (C) and Cramer V coefficient to assess the correlation between perfusion and IDH1 genotypes and 1p/19q status of gliomas. The rmaxCBF showed the best diagnostic efficacy; meanwhile, rmeanCBF had the best specificity for grade discrimination. In astrocytoma, there was a mild correlation between IDH1 genotypes and tumor perfusion with the Cramer's V coefficient of 0.378. There was no significant association between 1p/19q codeletion and perfusion in grade II and III gliomas.
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Affiliation(s)
- Ning Wang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Shu-Yi Xie
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Hui-Ming Liu
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Guo-Quan Chen
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Wei-Dong Zhang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou 510060, China.
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Hou BL, Wen S, Katsevman GA, Liu H, Urhie O, Turner RC, Carpenter J, Bhatia S. Magnetic Resonance Imaging Parameters and Their Impact on Survival of Patients with Glioblastoma: Tumor Perfusion Predicts Survival. World Neurosurg 2018; 124:S1878-8750(18)32908-5. [PMID: 30593971 PMCID: PMC6597330 DOI: 10.1016/j.wneu.2018.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many prognostic factors influence overall survival (OS) of patients with glioblastoma. Despite gross total resection and Stupp protocol adherence, many patients have poor survival. Perfusion magnetic resonance imaging may assist in diagnosis, treatment monitoring, and prognostication. METHODS This retrospective study of 36 patients with glioblastoma assessed influence of preoperative magnetic resonance imaging parameters reflecting tumor cell density and vascularity and patient age on OS. RESULTS The area under curve based on optimal receiver operating characteristic curves for the perfusion parameters normalized relative tumor blood volume (n_rTBV) and normalized relative tumor blood flow (n_rTBF) were 0.92 and 0.89, respectively, and the highest among all imaging parameters and age. OS showed strongly negative correlations with corrected n_rTBV (R = -0.70; P < 0.001) and n_rTBF (R = -0.67; P < 0.001). The Cox model, which included age and imaging parameters, demonstrated that n_rTBV and n_rTBF were most predictive of OS, with hazard ratios of 5.97 (P = 0.0001) and 8.76 (P = 0.0001), respectively, compared with 1.63 (P = 0.19) for age. Eighteen patients with corrected n_rTBV ≤2.5 (best cutoff value) had a median OS of 15.1 months (95% confidence interval (CI), 11.34-21.25) compared with 2.8 months (95% CI, 1.48-4.03; P < 0.001) for 18 patients with corrected n_rTBV >2.5. Twenty-four patients with n_rTBF ≤2.79 had a median OS of 12 months (95% CI, 10.46-17.9) compared with 2.8 months for 12 patients with n_rTBF >2.79 (95% CI, 1.31-4.2; P < 0.001). CONCLUSIONS The dominant predictors of OS are normalized perfusion parameters n_rTBV and n_rTBF. Preoperative perfusion imaging may be used as a surrogate to predict glioblastoma aggressiveness and survival independent of treatment.
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Affiliation(s)
- Bob L Hou
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Gennadiy A Katsevman
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA.
| | - Hui Liu
- Department of Biostatistics, West Virginia University, Morgantown, West Virginia, USA
| | - Ogaga Urhie
- West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffrey Carpenter
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Sanjay Bhatia
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia, USA
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Luna A, Martín Noguerol T, Mata LA. Bases de la imagen funcional II: técnicas emergentes de resonancia magnética y nuevos métodos de análisis. RADIOLOGIA 2018. [DOI: 10.1016/j.rx.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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21
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Batalov AI, Zakharova NE, Pogosbekyan EL, Fadeeva LM, Goryaynov SA, Baev AA, Shul'ts EI, Chelushkin DM, Potapov AA, Pronin IN. [Non-contrast ASL perfusion in preoperative diagnosis of supratentorial gliomas]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2018; 82:15-22. [PMID: 30721213 DOI: 10.17116/neiro20188206115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The purpose of this study was to investigate the potential of pseudocontinuous arterial spin labeling perfusion (pCASL) in assessing the degree of malignancy of brain gliomas at the preoperative stage. MATERIAL AND METHODS: The study included 126 patients aged 12-75 years with supratentorial gliomas of different malignancy (35 low-grade gliomas and 91 high-grade gliomas). The maximum tumor blood flow (TBF) was measured, and the normalized tumor blood flow (nTBF) was calculated relative to the intact semiovale white matter of the contralateral hemisphere. The TBF and nTBF indicators differed significantly between low-grade and high-grade glioma groups (p<0.001). When using TBF and nTBF in the differential diagnosis of low-grade and high-grade gliomas, the area under the ROC curve was 0.96 in both cases. Our findings suggest that 3D pCASL perfusion is an effective technique for preoperative differential diagnosis of low-grade and high-grade gliomas. The study was supported by the Russian Foundation for Basic Research (grant #18-315-00384).
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Affiliation(s)
- A I Batalov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | | | - L M Fadeeva
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Baev
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - E I Shul'ts
- Burdenko Neurosurgical Institute, Moscow, Russia
| | | | - A A Potapov
- Burdenko Neurosurgical Institute, Moscow, Russia
| | - I N Pronin
- Burdenko Neurosurgical Institute, Moscow, Russia
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Zeng Q, Jiang B, Shi F, Ling C, Dong F, Zhang J. 3D Pseudocontinuous Arterial Spin-Labeling MR Imaging in the Preoperative Evaluation of Gliomas. AJNR Am J Neuroradiol 2017; 38:1876-1883. [PMID: 28729293 PMCID: PMC7963629 DOI: 10.3174/ajnr.a5299] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/22/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies showed conflicting results concerning the value of CBF maps obtained from arterial spin-labeling MR imaging in grading gliomas. This study was performed to investigate the effectiveness of CBF maps derived from 3D pseudocontinuous arterial spin-labeling in preoperatively assessing the grade, cellular proliferation, and prognosis of gliomas. MATERIALS AND METHODS Fifty-eight patients with pathologically confirmed gliomas underwent preoperative 3D pseudocontinuous arterial spin-labeling. The receiver operating characteristic curves for parameters to distinguish high-grade gliomas from low-grade gliomas were generated. Pearson correlation analysis was used to assess the correlation among parameters. Survival analysis was conducted with Cox regression. RESULTS Both maximum CBF and maximum relative CBF were significantly higher in high-grade gliomas than in low-grade gliomas (P < .001). The areas under the curve for maximum CBF and maximum relative CBF in distinguishing high-grade gliomas from low-grade gliomas were 0.828 and 0.863, respectively. Both maximum CBF and maximum relative CBF had no correlation with the Ki-67 index in all subjects and had a moderate negative correlation with the Ki-67 index in glioblastomas (r = -0.475, -0.534, respectively). After adjustment for age, a higher maximum CBF (P = .008) and higher maximum relative CBF (P = .005) were associated with worse progression-free survival in gliomas, while a higher maximum relative CBF (P = .033) was associated with better overall survival in glioblastomas. CONCLUSIONS 3D pseudocontinuous arterial spin-labeling-derived CBF maps are effective in preoperative evaluation of gliomas. Although gliomas with a higher blood flow are more malignant, glioblastomas with a lower blood flow are likely to be more aggressive.
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Affiliation(s)
- Q Zeng
- From the Departments of Neurosurgery (Q.Z., C.L., J.Z.)
| | | | - F Shi
- Neurology (F.S.), Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - C Ling
- From the Departments of Neurosurgery (Q.Z., C.L., J.Z.)
| | | | - J Zhang
- From the Departments of Neurosurgery (Q.Z., C.L., J.Z.)
- Brain Research Institute (J.Z.)
- Collaborative Innovation Center for Brain Science (J.Z.), Zhejiang University, Hangzhou, Zhejiang, China
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Villanueva-Meyer JE, Mabray MC, Cha S. Current Clinical Brain Tumor Imaging. Neurosurgery 2017; 81:397-415. [PMID: 28486641 PMCID: PMC5581219 DOI: 10.1093/neuros/nyx103] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/23/2017] [Indexed: 01/12/2023] Open
Abstract
Neuroimaging plays an ever evolving role in the diagnosis, treatment planning, and post-therapy assessment of brain tumors. This review provides an overview of current magnetic resonance imaging (MRI) methods routinely employed in the care of the brain tumor patient. Specifically, we focus on advanced techniques including diffusion, perfusion, spectroscopy, tractography, and functional MRI as they pertain to noninvasive characterization of brain tumors and pretreatment evaluation. The utility of both structural and physiological MRI in the post-therapeutic brain evaluation is also reviewed with special attention to the challenges presented by pseudoprogression and pseudoresponse.
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Affiliation(s)
- Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Marc C. Mabray
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
| | - Soonmee Cha
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California San Francisco, San Francisco, California
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24
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Abstract
Radiogenomics is a relatively new and exciting field within radiology that links different imaging features with diverse genomic events. Genomics advances provided by the Cancer Genome Atlas and the Human Genome Project have enabled us to harness and integrate this information with noninvasive imaging phenotypes to create a better 3-dimensional understanding of tumor behavior and biology. Beyond imaging-histopathology, imaging genomic linkages provide an important layer of complexity that can help in evaluating and stratifying patients into clinical trials, monitoring treatment response, and enhancing patient outcomes. This article reviews some of the important radiogenomic literatures in brain tumors.
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25
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Heiland DH, Demerath T, Kellner E, Kiselev VG, Pfeifer D, Schnell O, Staszewski O, Urbach H, Weyerbrock A, Mader I. Molecular differences between cerebral blood volume and vessel size in glioblastoma multiforme. Oncotarget 2017; 8:11083-11093. [PMID: 27613830 PMCID: PMC5355248 DOI: 10.18632/oncotarget.11522] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 07/28/2016] [Indexed: 01/08/2023] Open
Abstract
The purpose of this study was to investigate the molecular background of cerebral blood volume (CBV) and vessel size (VS) of capillaries in glioblastoma multiforme (GBM). Both parameters are derived from extended perfusion MR imaging.A prospective case study including 21 patients (median age 66 years, 10 females) was performed. Before operation, CBV and VS of contrast enhancing tumor were assessed. Tissue was sampled from the assessed areas under neuronavigation control. After RNA extraction, transcriptional data was analyzed by Weighted Gene Co-Expression Network Analysis (WGCNA) and split into modules based on its network affiliations. Gene Set Enrichment Analysis (GSEA) identified biological functions or pathways of the genetic modules. These were applied on 484 GBM samples of the TCGA database.Ten modules were highly correlated to CBV and VS. One module was exclusively associated to VS and highly correlated to hypoxia, another one exclusively to CBV showing strong enrichments in the Epithelial Growth Factor (EGF) pathway and Epithelial-to-Mesenchymal-Transition (EMT). Moreover, patients with increased CBV and VS predominantly showed a mesenchymal gene-expression, a finding that could be corroborated by TCGA data.In conclusion, CBV and VS mirror different genetic pathways and reflect certain molecular subclasses of GBM.
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Affiliation(s)
- Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Theo Demerath
- Department of Neuroradiology, Medical Center University of Freiburg, Freiburg, Germany.,Department of Radiology, Kantonsspital, Medical Center Universtiy of Basel, Switzerland
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Valerij G Kiselev
- Medical Physics, Department of Radiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Dietmar Pfeifer
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Ori Staszewski
- Department of Neuropathology, Medical Center University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, Medical Center University of Freiburg, Freiburg, Germany
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MRI features can predict EGFR expression in lower grade gliomas: A voxel-based radiomic analysis. Eur Radiol 2017; 28:356-362. [PMID: 28755054 DOI: 10.1007/s00330-017-4964-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/05/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify the magnetic resonance imaging (MRI) features associated with epidermal growth factor (EGFR) expression level in lower grade gliomas using radiomic analysis. METHODS 270 lower grade glioma patients with known EGFR expression status were randomly assigned into training (n=200) and validation (n=70) sets, and were subjected to feature extraction. Using a logistic regression model, a signature of MRI features was identified to be predictive of the EGFR expression level in lower grade gliomas in the training set, and the accuracy of prediction was assessed in the validation set. RESULTS A signature of 41 MRI features achieved accuracies of 82.5% (area under the curve [AUC] = 0.90) in the training set and 90.0% (AUC = 0.95) in the validation set. This radiomic signature consisted of 25 first-order statistics or related wavelet features (including range, standard deviation, uniformity, variance), one shape and size-based feature (spherical disproportion), and 15 textural features or related wavelet features (including sum variance, sum entropy, run percentage). CONCLUSIONS A radiomic signature allowing for the prediction of the EGFR expression level in patients with lower grade glioma was identified, suggesting that using tumour-derived radiological features for predicting genomic information is feasible. KEY POINTS • EGFR expression status is an important biomarker for gliomas. • EGFR in lower grade gliomas could be predicted using radiogenomic analysis. • A logistic regression model is an efficient approach for analysing radiomic features.
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Perfusion of surgical cavity wall enhancement in early post-treatment MR imaging may stratify the time-to-progression in glioblastoma. PLoS One 2017; 12:e0181933. [PMID: 28732091 PMCID: PMC5521835 DOI: 10.1371/journal.pone.0181933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine if perfusion in surgical cavity wall enhancement (SCWE) obtained in early post-treatment MR imaging can stratify time-to-progression (TTP) in glioblastoma. MATERIALS AND METHODS This study enrolled 60 glioblastoma patients with more than 5-mm-thick SCWEs as detected on contrast-enhanced MR imaging after concurrent chemoradiation therapy. Two independent readers categorized the shape and perfusion state of SCWEs as nodular or non-nodular and as having positive or negative perfusion compared with the contralateral grey matter on arterial spin labeling (ASL). The perfusion fraction on ASL within the contrast-enhancing lesion was calculated. The independent predictability of TTP was analyzed using the Kaplan-Meier method and Cox proportional hazards modelling. RESULTS The perfusion fraction was higher in the non-progression group, significantly for reader 2 (P = 0.03) and borderline significantly for reader 1 (P = 0.08). A positive perfusion state and (P = 0.02) a higher perfusion fraction of the SCWE were found to become an independent predictor of longer TTP (P = 0.001 for reader 1 and P < 0.001 for reader 2). The contrast enhancement pattern did not become a TTP predictor. CONCLUSION Assessment of perfusion in early post-treatment MR imaging can stratify TTP in patients with glioblastoma for adjuvant temozolomide therapy. Positive perfusion in SCWEs can become a predictor of a longer TTP.
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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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Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 2017; 281:337-356. [PMID: 27755938 DOI: 10.1148/radiol.2016150789] [Citation(s) in RCA: 323] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic focus, both in peri- and interictal period. In neoplasms, ASL is of particular interest in cases in which gadolinium-based perfusion is contraindicated (eg, allergy, renal impairment) and holds promise in differentiating tumor progression from benign causes of enhancement. Finally, various neurologic and psychiatric diseases including mild traumatic brain injury or posttraumatic stress disorder display alterations on ASL images in the absence of visualized structural changes. In the final part, current limitations and future developments of ASL techniques to improve clinical applicability, such as multiple inversion time ASL sequences to assess alterations of transit time, reproducibility and quantification of cerebral blood flow, and to measure cerebrovascular reserve, will be reviewed. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Sven Haller
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Greg Zaharchuk
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - David L Thomas
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Karl-Olof Lovblad
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Frederik Barkhof
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Xavier Golay
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
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30
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Abstract
The imaging of treated gliomas is complicated by a variety of treatment related effects, which can falsely simulate disease improvement or progression. Distinguishing between disease progression and treatment effects is difficult with standard MR imaging pulse sequences and added specificity can be gained by the addition of advanced imaging techniques.
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Affiliation(s)
- Mark F Dalesandro
- Department of Radiology, Harborview Medical Center, University of Washington, Box 357115, 1959 Northeast Pacific Street, NW011, Seattle, WA 98195-7115, USA
| | - Jalal B Andre
- Department of Radiology, Harborview Medical Center, University of Washington, Box 357115, 1959 Northeast Pacific Street, NW011, Seattle, WA 98195-7115, USA.
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Multiparametric MRI-based differentiation of WHO grade II/III glioma and WHO grade IV glioblastoma. Sci Rep 2016; 6:35142. [PMID: 27739434 PMCID: PMC5064384 DOI: 10.1038/srep35142] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 09/22/2016] [Indexed: 01/08/2023] Open
Abstract
Non-invasive, imaging-based examination of glioma biology has received increasing attention in the past couple of years. To this end, the development and refinement of novel MRI techniques, reflecting underlying oncogenic processes such as hypoxia or angiogenesis, has greatly benefitted this research area. We have recently established a novel BOLD (blood oxygenation level dependent) based MRI method for the measurement of relative oxygen extraction fraction (rOEF) in glioma patients. In a set of 37 patients with newly diagnosed glioma, we assessed the performance of a machine learning model based on multiple MRI modalities including rOEF and perfusion imaging to predict WHO grade. An oblique random forest machine learning classifier using the entire feature vector as input yielded a five-fold cross-validated area under the curve of 0.944, with 34/37 patients correctly classified (accuracy 91.8%). The most important features in this classifier as per bootstrapped feature importance scores consisted of standard deviation of T1-weighted contrast enhanced signal, maximum rOEF value and cerebral blood volume (CBV) standard deviation. This study suggests that multimodal MRI information reflects underlying tumor biology, which is non-invasively detectable through integrative data analysis, and thus highlights the potential of such integrative approaches in the field of radiogenomics.
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Belliveau JG, Bauman G, Macdonald DR. Detecting tumor progression in glioma: current standards and new techniques. Expert Rev Anticancer Ther 2016; 16:1177-1188. [PMID: 27661768 DOI: 10.1080/14737140.2016.1240621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The post-treatment monitoring of glioma patients remains an area of active research and development. Conventional imaging with MRI is a highly sensitive modality for detecting and monitoring primary and secondary brain tumors and includes multi-parametric sequences to better characterize the disease. Standardized schemes for measuring response to treatment are in wide clinical use; however, the introduction of new therapeutics have introduced new patterns of response that can confound interpretation of conventional MRI and can cause uncertainty in the proper management following therapy. Areas covered: A summary of current and evolving techniques for assessing glioma response in this era of new therapies that address these challenges are presented in this review. While this review focuses more on clinical and early clinical methodologies for MRI and nuclear medicine techniques some promising pre-clinical techniques are also presented. Expert commentary: While successful single institution results have been widely reported in the literature, any new methodologies must be undertaken in multi-center settings. Additionally, the need for standardization of protocols in quantitative measured are an important area that must be addressed for new and promising techniques to be implemented to a wide array of patients.
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Affiliation(s)
- Jean-Guy Belliveau
- a Department of Medical Biophysics , University of Western Ontario , London , ON , Canada
| | - Glenn Bauman
- b Department of Medical Biophysics and Oncology , University of Western Ontario , London , ON , Canada
| | - David R Macdonald
- c Department of Oncology , University of Western Ontario , London , ON , Canada
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Kim C, Kim HS, Shim WH, Choi CG, Kim SJ, Kim JH. Recurrent Glioblastoma: Combination of High Cerebral Blood Flow with MGMT Promoter Methylation Is Associated with Benefit from Low-Dose Temozolomide Rechallenge at First Recurrence. Radiology 2016; 282:212-221. [PMID: 27428890 DOI: 10.1148/radiol.2016152152] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if the combination of high cerebral blood flow (CBF) and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation is associated with benefit from a second round of low-dose temozolomide (TMZ) (ie, rechallenge) in patients with glioblastoma at first recurrence. Materials and Methods The institutional review board approved this retrospective cohort study and waived the requirement for informed consent. Seventy-two patients with recurrent glioblastoma after concurrent TMZ radiation therapy were treated with a low-dose TMZ rechallenge and underwent arterial spin labeling magnetic resonance imaging. The cohort was dichotomized to high-CBF and low-CBF subgroups. MGMT promoter methylation was determined before concurrent TMZ radiation therapy. The coprimary end points were median time to progression (TTP) and 6-month outcome after the initiation of low-dose TMZ. The Cox proportional hazards model was used to assess the association between clinical outcome and CBF status. Results There was a significant difference between the high- and low-CBF cohorts in median TTP (6 months vs 3 months, respectively; P = .001). Favorable 6-month outcomes occurred in 16 of 31 (52%) patients with high CBF and six of 41 (15%) patients with low CBF (P = .001). At multivariate analysis, high CBF was independently associated with longer TTP (P = .023). The association between high CBF and favorable outcome was significant only in the MGMT promoter methylation group (P = .006 for TTP; P = .005 for 6-month outcome). Conclusion The combination of high CBF with MGMT methylation may be associated with benefits from a low-dose TMZ rechallenge in patients with recurrent glioblastoma. However, alternative strategies might be needed for patients with both low CBF and a lack of MGMT methylation. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Cherry Kim
- From the Department of Radiology and Research Institute of Radiology (C.K., H.S.K., W.H.S., C.G.C., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Seoul 138-736, Korea
| | - Ho Sung Kim
- From the Department of Radiology and Research Institute of Radiology (C.K., H.S.K., W.H.S., C.G.C., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Seoul 138-736, Korea
| | - Woo Hyun Shim
- From the Department of Radiology and Research Institute of Radiology (C.K., H.S.K., W.H.S., C.G.C., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Seoul 138-736, Korea
| | - Choong Gon Choi
- From the Department of Radiology and Research Institute of Radiology (C.K., H.S.K., W.H.S., C.G.C., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Seoul 138-736, Korea
| | - Sang Joon Kim
- From the Department of Radiology and Research Institute of Radiology (C.K., H.S.K., W.H.S., C.G.C., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Seoul 138-736, Korea
| | - Jeong Hoon Kim
- From the Department of Radiology and Research Institute of Radiology (C.K., H.S.K., W.H.S., C.G.C., S.J.K.) and Department of Neurosurgery (J.H.K.), University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Seoul 138-736, Korea
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Eilaghi A, Yeung T, d'Esterre C, Bauman G, Yartsev S, Easaw J, Fainardi E, Lee TY, Frayne R. Quantitative Perfusion and Permeability Biomarkers in Brain Cancer from Tomographic CT and MR Images. BIOMARKERS IN CANCER 2016; 8:47-59. [PMID: 27398030 PMCID: PMC4933536 DOI: 10.4137/bic.s31801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/03/2015] [Accepted: 11/06/2015] [Indexed: 12/28/2022]
Abstract
Dynamic contrast-enhanced perfusion and permeability imaging, using computed tomography and magnetic resonance systems, are important techniques for assessing the vascular supply and hemodynamics of healthy brain parenchyma and tumors. These techniques can measure blood flow, blood volume, and blood-brain barrier permeability surface area product and, thus, may provide information complementary to clinical and pathological assessments. These have been used as biomarkers to enhance the treatment planning process, to optimize treatment decision-making, and to enable monitoring of the treatment noninvasively. In this review, the principles of magnetic resonance and computed tomography dynamic contrast-enhanced perfusion and permeability imaging are described (with an emphasis on their commonalities), and the potential values of these techniques for differentiating high-grade gliomas from other brain lesions, distinguishing true progression from posttreatment effects, and predicting survival after radiotherapy, chemotherapy, and antiangiogenic treatments are presented.
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Affiliation(s)
- Armin Eilaghi
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Timothy Yeung
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Christopher d'Esterre
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
| | - Glenn Bauman
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Slav Yartsev
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Jay Easaw
- Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Neurosciences and Rehabilitation, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna, Ferrara, Italy.; Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Ting-Yim Lee
- Lawson Health Research Institute and Robarts Research Institute, London, ON, Canada
| | - Richard Frayne
- Department of Radiology, University of Calgary, Calgary, AB, Canada.; Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.; Seaman Family MR Centre, Foothills Medical Centre, Calgary, AB, Canada
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Heiland DH, Mader I, Schlosser P, Pfeifer D, Carro MS, Lange T, Schwarzwald R, Vasilikos I, Urbach H, Weyerbrock A. Integrative Network-based Analysis of Magnetic Resonance Spectroscopy and Genome Wide Expression in Glioblastoma multiforme. Sci Rep 2016; 6:29052. [PMID: 27350391 PMCID: PMC4924099 DOI: 10.1038/srep29052] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022] Open
Abstract
The goal of this study was to identify correlations between metabolites from proton MR spectroscopy and genetic pathway activity in glioblastoma multiforme (GBM). Twenty patients with primary GBM were analysed by short echo-time chemical shift imaging and genome-wide expression analyses. Weighed Gene Co-Expression Analysis was used for an integrative analysis of imaging and genetic data. N-acetylaspartate, normalised to the contralateral healthy side (nNAA), was significantly correlated to oligodendrocytic and neural development. For normalised creatine (nCr), a group with low nCr was linked to the mesenchymal subtype, while high nCr could be assigned to the proneural subtype. Moreover, clustering of normalised glutamine and glutamate (nGlx) revealed two groups, one with high nGlx being attributed to the neural subtype, and one with low nGlx associated with the classical subtype. Hence, the metabolites nNAA, nCr, and nGlx correlate with a specific gene expression pattern reflecting the previously described subtypes of GBM. Moreover high nNAA was associated with better clinical prognosis, whereas patients with lower nNAA revealed a shorter progression-free survival (PFS).
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Affiliation(s)
- Dieter Henrik Heiland
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Irina Mader
- Department of Neuroradiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Pascal Schlosser
- Institute for Medical Biometry and Statistics, Medical Center University of Freiburg, Freiburg, Germany
| | - Dietmar Pfeifer
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center University of Freiburg, Freiburg, Germany
| | - Maria Stella Carro
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Thomas Lange
- Department of Medical Physics, Diagnostic Radiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Ralf Schwarzwald
- Department of Neuroradiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Ioannis Vasilikos
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center University of Freiburg, Freiburg, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany
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Abstract
Currently, gliomas are diagnosed by neuroimaging, and refined diagnosis requires resection or biopsy to obtain tumour tissue for histopathological classification and grading. Blood-derived biomarkers, therefore, would be useful as minimally invasive markers that could support diagnosis and enable monitoring of tumour growth and response to treatment. Such circulating biomarkers could distinguish true progression from therapy-associated changes such as radiation necrosis, and help evaluate the persistence or disappearance of a therapeutic target, such as an oncoprotein or a targetable gene mutation, after targeted therapy. Unlike for other tumours, circulating biomarkers for gliomas are still being defined and are not yet in use in clinical practice. Circulating tumour DNA (ctDNA) isolated from plasma has been shown to reflect the mutational status of glioblastoma, and extracellular vesicles (EVs) containing ctDNA, microRNA and proteins function as rapidly adapting reservoirs for glioma biomarkers such as typical DNA mutations, regulatory microRNAs and oncoproteins. Ideally, circulating tumour cells could enable profiling of the whole-tumour genome, but they are difficult to detect and can reflect only a single cell type of the heterogeneous tumour composition, whereas EVs reflect the complex heterogeneity of the whole tumour, as well as its adaptations to therapy. Although all categories of potential blood-derived biomarkers need to be developed further, findings from other tumour types suggest that EVs are the most promising biomarkers.
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