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Xing Z, Wang C, Yang W, She D, Yang X, Cao D. Predicting glioblastoma recurrence using multiparametric MR imaging of non-enhancing peritumoral regions at baseline. Heliyon 2024; 10:e30411. [PMID: 38711642 PMCID: PMC11070862 DOI: 10.1016/j.heliyon.2024.e30411] [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: 07/18/2023] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/08/2024] Open
Abstract
Background To assess the feasibility of multiparametric magnetic resonance imaging in predicting tumor recurrence in nonenhancing peritumoral regions in patients with glioblastoma at baseline. Methods Fifty-eight patients with recurrent glioblastoma underwent multiparametric magnetic resonance imaging, including T2-weighted fluid-attenuated inversion recovery, diffusion-weighted imaging, and dynamic susceptibility contrast perfusion-weighted imaging. Nonenhancing peritumoral regions with glioblastoma recurrence were identified by coregistering preoperative and post-recurrent magnetic resonance images. Regions of interest were placed in nonenhancing peritumoral regions with and without tumor recurrence to calculate the apparent diffusion coefficient value, and relative ratios of T2-weighted fluid-attenuated inversion recovery signal intensity, apparent diffusion coefficient, and cerebral blood volume values. Results Significant lower relative T2-weighted fluid-attenuated inversion recovery signal intensity, apparent diffusion coefficient, and relative apparent diffusion coefficient but higher relative cerebral blood volume values were found in the nonenhancing peritumoral regions with tumor recurrence than without recurrence (all P < 0.05). The threshold values ≥ 0.89 for relative cerebral blood volume provide the optimal performance for predicting the nonenhancing peritumoral regions with future tumor recurrence, with the sensitivity, specificity, and accuracy of 84.7%, 83.6%, and 85.8%, respectively. The combination of relative T2-weighted fluid-attenuated inversion recovery signal intensity, apparent diffusion coefficient, and relative cerebral blood volume can provide better predictive performance than relative cerebral blood volume (P = 0.015). Conclusion The combined use of T2-weighted fluid-attenuated inversion recovery, diffusion-weighted imaging, and dynamic susceptibility contrast perfusion-weighted imaging can effectively estimate the risk of future tumor recurrence at baseline.
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Affiliation(s)
- Zhen Xing
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, Fujian, China
| | - Cong Wang
- Department of Nuclear Medicine, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Wen Yang
- The Webb Schools, Claremont, CA, 91711, USA
| | - Dejun She
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, Fujian, China
| | - Xiefeng Yang
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, Fujian, China
| | - Dairong Cao
- Department of Radiology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Radiology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, Fujian, China
- Department of Radiology, Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Key Laboratory of Radiation Biology of Fujian Higher Education Institutions, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
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Autry AW, Vaziri S, LaFontaine M, Gordon JW, Chen HY, Kim Y, Villanueva-Meyer JE, Molinaro A, Clarke JL, Oberheim Bush NA, Xu D, Lupo JM, Larson PEZ, Vigneron DB, Chang SM, Li Y. Multi-parametric hyperpolarized 13C/ 1H imaging reveals Warburg-related metabolic dysfunction and associated regional heterogeneity in high-grade human gliomas. Neuroimage Clin 2023; 39:103501. [PMID: 37611371 PMCID: PMC10470324 DOI: 10.1016/j.nicl.2023.103501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/29/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Dynamic hyperpolarized (HP)-13C MRI has enabled real-time, non-invasive assessment of Warburg-related metabolic dysregulation in glioma using a [1-13C]pyruvate tracer that undergoes conversion to [1-13C]lactate and [13C]bicarbonate. Using a multi-parametric 1H/HP-13C imaging approach, we investigated dynamic and steady-state metabolism, together with physiological parameters, in high-grade gliomas to characterize active tumor. METHODS Multi-parametric 1H/HP-13C MRI data were acquired from fifteen patients with progressive/treatment-naïve glioblastoma [prog/TN GBM, IDH-wildtype (n = 11)], progressive astrocytoma, IDH-mutant, grade 4 (G4AIDH+, n = 2) and GBM manifesting treatment effects (n = 2). Voxel-wise regional analysis of the cohort with prog/TN GBM assessed imaging heterogeneity across contrast-enhancing/non-enhancing lesions (CEL/NEL) and normal-appearing white matter (NAWM) using a mixed effects model. To enable cross-nucleus parameter association, normalized perfusion, diffusion, and dynamic/steady-state (HP-13C/spectroscopic) metabolic data were collectively examined at the 13C resolution. Prog/TN GBM were similarly compared against progressive G4AIDH+ and treatment effects. RESULTS Regional analysis of Prog/TN GBM metabolism revealed statistically significant heterogeneity in 1H choline-to-N-acetylaspartate index (CNI)max, [1-13C]lactate, modified [1-13C]lactate-to-[1-13C]pyruvate ratio (CELval > NELval > NAWMval); [1-13C]lactate-to-[13C]bicarbonate ratio (CELval > NELval/NAWMval); and 1H-lactate (CELval/NELval > NAWMundetected). Significant associations were found between normalized perfusion (cerebral blood volume, nCBV; peak height, nPH) and levels of [1-13C]pyruvate and [1-13C]lactate, as well as between CNImax and levels of [1-13C]pyruvate, [1-13C]lactate and modified ratio. GBM, by comparison to G4AIDH+, displayed lower perfusion %-recovery and modeled rate constants for [1-13C]pyruvate-to-[1-13C]lactate conversion (kPL), and higher 1H-lactate and [1-13C]pyruvate levels, while having higher nCBV, %-recovery, kPL, [1-13C]pyruvate-to-[1-13C]lactate and modified ratios relative to treatment effects. CONCLUSIONS GBM consistently displayed aberrant, Warburg-related metabolism and regional heterogeneity detectable by novel HP-13C/1H imaging techniques.
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Affiliation(s)
- Adam W Autry
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Sana Vaziri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Marisa LaFontaine
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Jeremy W Gordon
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Hsin-Yu Chen
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Yaewon Kim
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Javier E Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA; Department of Neurological Surgery, University of California, San Francisco, USA
| | - Annette Molinaro
- Department of Neurological Surgery, University of California, San Francisco, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jennifer L Clarke
- Department of Neurological Surgery, University of California, San Francisco, USA; Department of Neurology, University of California, San Francisco, USA
| | - Nancy Ann Oberheim Bush
- Department of Neurological Surgery, University of California, San Francisco, USA; Department of Neurology, University of California, San Francisco, USA
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Daniel B Vigneron
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA; Department of Bioengineering and Therapeutic Science, University of California, San Francisco, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Yan Li
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA.
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3
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Kouwenberg V, van Santwijk L, Meijer FJA, Henssen D. Reliability of dynamic susceptibility contrast perfusion metrics in pre- and post-treatment glioma. Cancer Imaging 2022; 22:28. [PMID: 35715866 PMCID: PMC9205029 DOI: 10.1186/s40644-022-00466-2] [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: 02/01/2022] [Accepted: 05/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background In neuro-oncology, dynamic susceptibility contrast magnetic resonance (DSC-MR) perfusion imaging emerged as a tool to aid in the diagnostic work-up and to surveil effectiveness of treatment. However, it is believed that a significant variability exists with regard to the measured in DSC-MR perfusion parameters. The aim of this study was to assess the observer variability in measured DSC-MR perfusion parameters in patients before and after treatment. In addition, we investigated whether region-of-interest (ROI) shape impacted the observer variability. Materials and methods Twenty non-treated patients and a matched group of twenty patients post-treatment (neurosurgical resection and post-chemoradiotherapy) were included. Six ROIs were independently placed by three readers: circular ROIs and polygonal ROIs covering 1) the tumor hotspot; 2) the peritumoral region (T2/FLAIR-hyperintense region) and 3) the whole tumor region. A two-way random Intra-class coefficient (ICC) model was used to assess variability in measured DSC-MRI perfusion parameters. The perfusion metrics as assessed by the circular and the polygonal ROI were compared by use of the dependent T-test. Results In the non-treated group, circular ROIs showed good–excellent overlap (ICC-values ranging from 0.741–0.963) with the exception of those representing the tumor hotspot. Polygonal ROIs showed lower ICC-values, ranging from 0.113 till 0.856. ROI-placement in the posttreatment group showed to be highly variable with a significant deterioration of ICC-values. Furthermore, perfusion metric assessment in similar tumor regions was not impacted by ROI shape. Discussion This study shows that posttreatment quantitative interpretation of DSC-MR perfusion imaging is highly variable and should be carried out with precaution. Pretreatment assessment of DSC-MR images, however, could be carried out be a single reader in order to provide valid data for further analyses. • DSC-MR perfusion imaging measurements in non-treated glioma is highly reliable between readers, even readers with little experience. • DSC-MR perfusion imaging measurements in treated glioma is show to be inconsistent between readers. • When using DSC-MR perfusion imaging as a quantitative surveillance tool for the recurrence of glioma after treatment, double-reading should be preferred.
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Affiliation(s)
- Valentina Kouwenberg
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 EZ, Nijmegen, The Netherlands
| | - Lusien van Santwijk
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 EZ, Nijmegen, The Netherlands
| | - Frederick J A Meijer
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 EZ, Nijmegen, The Netherlands
| | - Dylan Henssen
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 EZ, Nijmegen, The Netherlands.
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Petr J, Hogeboom L, Nikulin P, Wiegers E, Schroyen G, Kallehauge J, Chmelík M, Clement P, Nechifor RE, Fodor LA, De Witt Hamer PC, Barkhof F, Pernet C, Lequin M, Deprez S, Jančálek R, Mutsaerts HJMM, Pizzini FB, Emblem KE, Keil VC. A systematic review on the use of quantitative imaging to detect cancer therapy adverse effects in normal-appearing brain tissue. MAGMA (NEW YORK, N.Y.) 2022; 35:163-186. [PMID: 34919195 PMCID: PMC8901489 DOI: 10.1007/s10334-021-00985-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 12/03/2021] [Indexed: 12/17/2022]
Abstract
Cancer therapy for both central nervous system (CNS) and non-CNS tumors has been previously associated with transient and long-term cognitive deterioration, commonly referred to as 'chemo fog'. This therapy-related damage to otherwise normal-appearing brain tissue is reported using post-mortem neuropathological analysis. Although the literature on monitoring therapy effects on structural magnetic resonance imaging (MRI) is well established, such macroscopic structural changes appear relatively late and irreversible. Early quantitative MRI biomarkers of therapy-induced damage would potentially permit taking these treatment side effects into account, paving the way towards a more personalized treatment planning.This systematic review (PROSPERO number 224196) provides an overview of quantitative tomographic imaging methods, potentially identifying the adverse side effects of cancer therapy in normal-appearing brain tissue. Seventy studies were obtained from the MEDLINE and Web of Science databases. Studies reporting changes in normal-appearing brain tissue using MRI, PET, or SPECT quantitative biomarkers, related to radio-, chemo-, immuno-, or hormone therapy for any kind of solid, cystic, or liquid tumor were included. The main findings of the reviewed studies were summarized, providing also the risk of bias of each study assessed using a modified QUADAS-2 tool. For each imaging method, this review provides the methodological background, and the benefits and shortcomings of each method from the imaging perspective. Finally, a set of recommendations is proposed to support future research.
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Affiliation(s)
- Jan Petr
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands.
| | - Louise Hogeboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pavel Nikulin
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiopharmaceutical Cancer Research, Dresden, Germany
| | - Evita Wiegers
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gwen Schroyen
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Jesper Kallehauge
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Marek Chmelík
- Department of Technical Disciplines in Medicine, Faculty of Health Care, University of Prešov, Prešov, Slovakia
| | - Patricia Clement
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Ruben E Nechifor
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Liviu-Andrei Fodor
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Philip C De Witt Hamer
- Department of Neurosurgery, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Cyril Pernet
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Maarten Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sabine Deprez
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Radim Jančálek
- St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Henk J M M Mutsaerts
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Ghent Institute for Functional and Metabolic Imaging (GIfMI), Ghent University, Ghent, Belgium
| | - Francesca B Pizzini
- Radiology, Deptartment of Diagnostic and Public Health, Verona University, Verona, Italy
| | - Kyrre E Emblem
- Department of Diagnostic Physics, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Vera C Keil
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam Neuroscience, Amsterdam, The Netherlands
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5
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Kaprin AD, Zaitsev AM, Rerberg AG, Fedenko AA, Datsenko PV, Kirsanova ON. [Superselective intra-arterial administration of bevacizumab with blood-brain barrier disruption in patients with recurrent malignant gliomas: case report and literature review]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2021; 85:64-70. [PMID: 34714005 DOI: 10.17116/neiro20218505164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Glioblastoma multiforme is characterized by persistent recurrent course despite surgical, radio- and chemotherapeutic treatment. The outcomes of superselective intra-arterial administration of bevacizumab with blood-brain barrier disruption in patients with recurrent glioblastoma have been published. The authors reported significant increase in overall survival (up to 2.5 years). We report treatment of recurrent glioblastoma in a young patient with progressive course of disease despite 4 previous neurosurgical interventions, radiotherapy and first-line chemotherapy. Superselective intra-arterial administration of bevacizumab with blood-brain barrier disruption made it possible to achieve clinical response and improve neurological status.
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Affiliation(s)
- A D Kaprin
- National Medical Research Radiology Center, Moscow, Russia
| | - A M Zaitsev
- National Medical Research Radiology Center, Moscow, Russia
| | - A G Rerberg
- National Medical Research Radiology Center, Moscow, Russia
| | - A A Fedenko
- National Medical Research Radiology Center, Moscow, Russia
| | - P V Datsenko
- National Medical Research Radiology Center, Moscow, Russia
| | - O N Kirsanova
- National Medical Research Radiology Center, Moscow, Russia
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Mendel JT, Jaster AW, Yu FF, Morris LC, Lynch PT, Shah BR, Agarwal A, Timmerman RD, Nedzi LA, Raj KM. Fundamentals of Radiation Oncology for Neurologic Imaging. Radiographics 2020; 40:827-858. [PMID: 32216705 DOI: 10.1148/rg.2020190138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although the physical and biologic principles of radiation therapy have remained relatively unchanged, a technologic renaissance has led to continuous and ever-changing growth in the field of radiation oncology. As a result, medical devices, techniques, and indications have changed considerably during the past 20-30 years. For example, advances in CT and MRI have revolutionized the treatment planning process for a variety of central nervous system diseases, including primary and metastatic tumors, vascular malformations, and inflammatory diseases. The resultant improved ability to delineate normal from abnormal tissue has enabled radiation oncologists to achieve more precise targeting and helped to mitigate treatment-related complications. Nevertheless, posttreatment complications still occur and can pose a diagnostic challenge for radiologists. These complications can be divided into acute, early-delayed, and late-delayed complications on the basis of the time that they manifest after radiation therapy and include leukoencephalopathy, vascular complications, and secondary neoplasms. The different irradiation technologies and applications of these technologies in the brain, current concepts used in treatment planning, and essential roles of the radiation oncologist in the setting of brain disease are reviewed. In addition, relevant imaging findings that can be used to delineate the extent of disease before treatment, and the expected posttreatment imaging changes are described. Common and uncommon complications related to radiation therapy and the associated imaging manifestations also are discussed. Familiarity with these entities may aid the radiologist in making the diagnosis and help guide appropriate management. ©RSNA, 2020.
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Affiliation(s)
- J Travis Mendel
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Adam W Jaster
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Fang F Yu
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Lee C Morris
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Patrick T Lynch
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Bhavya R Shah
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Amit Agarwal
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Robert D Timmerman
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Lucien A Nedzi
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Karuna M Raj
- From the Departments of Radiation Oncology (J.T.M., P.T.L., R.D.T., L.A.N.) and Radiology (A.W.J., F.F.Y., L.C.M., B.R.S., A.A., K.M.R.), The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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Super selective intra-arterial cerebral infusion of modern chemotherapeutics after blood–brain barrier disruption: where are we now, and where we are going. J Neurooncol 2020; 147:261-278. [DOI: 10.1007/s11060-020-03435-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
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8
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Rotkopf LT, Wiestler B, Preibisch C, Liesche-Starnecker F, Pyka T, Nörenberg D, Bette S, Gempt J, Thierfelder KM, Zimmer C, Huber T. The wavelet power spectrum of perfusion weighted MRI correlates with tumor vascularity in biopsy-proven glioblastoma samples. PLoS One 2020; 15:e0228030. [PMID: 31971966 PMCID: PMC6977746 DOI: 10.1371/journal.pone.0228030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/06/2020] [Indexed: 01/16/2023] Open
Abstract
Background Wavelet transformed reconstructions of dynamic susceptibility contrast (DSC) MR perfusion (wavelet-MRP) are a new and elegant way of visualizing vascularization. Wavelet-MRP maps yield a clear depiction of hypervascular tumor regions, as recently shown. Objective The aim of this study was to elucidate a possible connection of the wavelet-MRP power spectrum in glioblastoma (GBM) with local vascularity and cell proliferation. Methods For this IRB-approved study 12 patients (63.0+/-14.9y; 7m) with histologically confirmed IDH-wildtype GBM were included. Target regions for biopsies were prospectively marked on tumor regions as seen on preoperative 3T MRI. During subsequent neurosurgical tumor resection 43 targeted biopsies were taken from these target regions, of which all 27 matching samples were analyzed. All specimens were immunohistochemically analyzed for endothelial cell marker CD31 and proliferation marker Ki67 and correlated to the wavelet-MRP power spectrum as derived from DSC perfusion weighted imaging. Results There was a strong correlation between wavelet-MRP power spectrum (median = 4.41) and conventional relative cerebral blood volume (median = 5.97 ml/100g) in Spearman's rank-order correlation (κ = .83, p < .05). In a logistic regression model, the wavelet-MRP power spectrum showed a significant correlation to CD31 dichotomized to no or present staining (p = .04), while rCBV did not show a significant correlation to CD31 (p = .30). No significant association between Ki67 and rCBV or wavelet-MRP was found (p = .62 and p = .70, respectively). Conclusion The wavelet-MRP power spectrum derived from existing DSC-MRI data might be a promising new surrogate for tumor vascularity in GBM.
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Affiliation(s)
- Lukas T. Rotkopf
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- * E-mail:
| | - Benedikt Wiestler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Christine Preibisch
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | | | - Thomas Pyka
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Dominik Nörenberg
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Universitaetsklinikum Augsburg, Augsburg, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Kolja M. Thierfelder
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center Rostock, Rostock, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Thomas Huber
- Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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9
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Rodriguez D, Chambers T, Warmuth-Metz M, Aliaga ES, Warren D, Calmon R, Hargrave D, Garcia J, Vassal G, Grill J, Zahlmann G, Morgan PS, Jaspan T. Evaluation of the Implementation of the Response Assessment in Neuro-Oncology Criteria in the HERBY Trial of Pediatric Patients with Newly Diagnosed High-Grade Gliomas. AJNR Am J Neuroradiol 2019; 40:568-575. [PMID: 30819765 DOI: 10.3174/ajnr.a5982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/31/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE HERBY was a Phase II multicenter trial setup to establish the efficacy and safety of adding bevacizumab to radiation therapy and temozolomide in pediatric patients with newly diagnosed non-brain stem high-grade gliomas. This study evaluates the implementation of the radiologic aspects of HERBY. MATERIALS AND METHODS We analyzed multimodal imaging compliance rates and scan quality for participating sites, adjudication rates and reading times for the central review process, the influence of different Response Assessment in Neuro-Oncology criteria in the final response, the incidence of pseudoprogression, and the benefit of incorporating multimodal imaging into the decision process. RESULTS Multimodal imaging compliance rates were the following: diffusion, 82%; perfusion, 60%; and spectroscopy, 48%. Neuroradiologists' responses differed for 50% of scans, requiring adjudication, with a total average reading time per patient of approximately 3 hours. Pseudoprogression occurred in 10/116 (9%) cases, 8 in the radiation therapy/temozolomide arm and 2 in the bevacizumab arm (P < .01). Increased target enhancing lesion diameter was a reason for progression in 8/86 cases (9.3%) but never the only radiologic or clinical reason. Event-free survival was predicted earlier in 5/86 (5.8%) patients by multimodal imaging (diffusion, n = 4; perfusion, n = 1). CONCLUSIONS The addition of multimodal imaging to the response criteria modified the assessment in a small number of cases, determining progression earlier than structural imaging alone. Increased target lesion diameter, accounting for a large proportion of reading time, was never the only reason to designate disease progression.
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Affiliation(s)
- D Rodriguez
- Medical Physics and Clinical Engineering (D.R., P.S.M.)
| | - T Chambers
- Cardiff University, School of Medicine (T.C.), Cardiff, UK
| | - M Warmuth-Metz
- Würzburg University, Institute for Diagnostic and Interventional Neuroradiology (M.W.-M.), Würzburg, Germany
| | - E Sanchez Aliaga
- VU University Medical Center, Department of Radiology & Nuclear Medicine (E.S.A.), Amsterdam, the Netherlands
| | - D Warren
- Leeds Teaching Hospital, Department of Radiology (D.W.), Leeds, UK
| | - R Calmon
- Assistance Publique-Hôpitaux de Paris, Pediatric Radiology (R.C.), Paris, France
| | - D Hargrave
- Great Ormond Street Hospital, Haematology and Oncology Department (D.H.), London, UK
| | - J Garcia
- F. Hoffmann-La Roche (J.Garcia, G.Z.), Basel, Switzerland
| | - G Vassal
- Gustave Roussy and Paris-Sud University, Pediatric and Adolescent Oncology and Unite Mixte de Recherche (G.V., J.Grill), Villejuif, France
| | - J Grill
- Gustave Roussy and Paris-Sud University, Pediatric and Adolescent Oncology and Unite Mixte de Recherche (G.V., J.Grill), Villejuif, France
| | - G Zahlmann
- F. Hoffmann-La Roche (J.Garcia, G.Z.), Basel, Switzerland
| | - P S Morgan
- Medical Physics and Clinical Engineering (D.R., P.S.M.).,Nottingham Biomedical Research Centre of the UK National Institute of Health Research (P.S.M.), Nottingham, UK
| | - T Jaspan
- From Nottingham University Hospitals, Department of Radiology (T.J.)
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10
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Yu FF, Rapalino O. Treated Gliomas. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00015-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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Huber T, Rotkopf L, Wiestler B, Kunz WG, Bette S, Gempt J, Preibisch C, Ricke J, Zimmer C, Kirschke JS, Sommer WH, Thierfelder KM. Wavelet-based reconstruction of dynamic susceptibility MR-perfusion: a new method to visualize hypervascular brain tumors. Eur Radiol 2018; 29:2669-2676. [PMID: 30552476 DOI: 10.1007/s00330-018-5892-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/16/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Parameter maps based on wavelet-transform post-processing of dynamic perfusion data offer an innovative way of visualizing blood vessels in a fully automated, user-independent way. The aims of this study were (i) a proof of concept regarding wavelet-based analysis of dynamic susceptibility contrast (DSC) MRI data and (ii) to demonstrate advantages of wavelet-based measures compared to standard cerebral blood volume (CBV) maps in patients with the initial diagnosis of glioblastoma (GBM). METHODS Consecutive 3-T DSC MRI datasets of 46 subjects with GBM (mean age 63.0 ± 13.1 years, 28 m) were retrospectively included in this feasibility study. Vessel-specific wavelet magnetic resonance perfusion (wavelet-MRP) maps were calculated using the wavelet transform (Paul wavelet, order 1) of each voxel time course. Five different aspects of image quality and tumor delineation were each qualitatively rated on a 5-point Likert scale. Quantitative analysis included image contrast and contrast-to-noise ratio. RESULTS Vessel-specific wavelet-MRP maps could be calculated within a mean time of 2:27 min. Wavelet-MRP achieved higher scores compared to CBV in all qualitative ratings: tumor depiction (4.02 vs. 2.33), contrast enhancement (3.93 vs. 2.23), central necrosis (3.86 vs. 2.40), morphologic correlation (3.87 vs. 2.24), and overall impression (4.00 vs. 2.41); all p < .001. Quantitative image analysis showed a better image contrast and higher contrast-to-noise ratios for wavelet-MRP compared to conventional perfusion maps (all p < .001). CONCLUSIONS wavelet-MRP is a fast and fully automated post-processing technique that yields reproducible perfusion maps with a clearer vascular depiction of GBM compared to standard CBV maps. KEY POINTS • Wavelet-MRP offers high-contrast perfusion maps with a clear delineation of focal perfusion alterations. • Both image contrast and visual image quality were beneficial for wavelet-MRP compared to standard perfusion maps like CBV. • Wavelet-MRP can be automatically calculated from existing dynamic susceptibility contrast (DSC) perfusion data.
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Affiliation(s)
- Thomas Huber
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lukas Rotkopf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wolfgang G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christine Preibisch
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Wieland H Sommer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Kolja M Thierfelder
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Institute of Diagnostic and Interventional Radiology, University Medicine Rostock, Schillingallee 35, 18057, Rostock, Germany
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12
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Oei MTH, Meijer FJA, Mordang JJ, Smit EJ, Idema AJS, Goraj BM, Laue HOA, Prokop M, Manniesing R. Observer variability of reference tissue selection for relativecerebral blood volume measurements in glioma patients. Eur Radiol 2018; 28:3902-3911. [PMID: 29572637 PMCID: PMC6096614 DOI: 10.1007/s00330-018-5353-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/27/2017] [Accepted: 01/23/2018] [Indexed: 11/05/2022]
Abstract
Objectives To assess observer variability of different reference tissues used for relative CBV (rCBV) measurements in DSC-MRI of glioma patients. Methods In this retrospective study, three observers measured rCBV in DSC-MR images of 44 glioma patients on two occasions. rCBV is calculated by the CBV in the tumour hotspot/the CBV of a reference tissue at the contralateral side for normalization. One observer annotated the tumour hotspot that was kept constant for all measurements. All observers annotated eight reference tissues of normal white and grey matter. Observer variability was evaluated using the intraclass correlation coefficient (ICC), coefficient of variation (CV) and Bland-Altman analyses. Results For intra-observer, the ICC ranged from 0.50–0.97 (fair–excellent) for all reference tissues. The CV ranged from 5.1–22.1 % for all reference tissues and observers. For inter-observer, the ICC for all pairwise observer combinations ranged from 0.44–0.92 (poor–excellent). The CV ranged from 8.1–31.1 %. Centrum semiovale was the only reference tissue that showed excellent intra- and inter-observer agreement (ICC>0.85) and lowest CVs (<12.5 %). Bland-Altman analyses showed that mean differences for centrum semiovale were close to zero. Conclusion Selecting contralateral centrum semiovale as reference tissue for rCBV provides the lowest observer variability. Key Points • Reference tissue selection for rCBV measurements adds variability to rCBV measurements. • rCBV measurements vary depending on the choice of reference tissue. • Observer variability of reference tissue selection varies between poor and excellent. • Centrum semiovale as reference tissue for rCBV provides the lowest observer variability.
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Affiliation(s)
- Marcel T H Oei
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Frederick J A Meijer
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Jan-Jurre Mordang
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Ewoud J Smit
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Albert J S Idema
- Department of Neurosurgery, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Bozena M Goraj
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Mathias Prokop
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rashindra Manniesing
- Department of Radiology and Nuclear Medicine, Radboudumc, Geert Grooteplein 10, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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13
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Apparent diffusion coefficient changes predict survival after intra-arterial bevacizumab treatment in recurrent glioblastoma. Neuroradiology 2017; 59:499-505. [PMID: 28343250 DOI: 10.1007/s00234-017-1820-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Superselective intra-arterial cerebral infusion (SIACI) of bevacizumab (BV) has emerged as a novel therapy in the treatment of recurrent glioblastoma (GB). This study assessed the use of apparent diffusion coefficient (ADC) in predicting length of survival after SIACI BV and overall survival in patients with recurrent GB. METHODS Sixty-five patients from a cohort enrolled in a phase I/II trial of SIACI BV for treatment of recurrent GB were retrospectively included in this analysis. MR imaging with a diffusion-weighted (DWI) sequence was performed before and after treatment. ROIs were manually delineated on ADC maps corresponding to the enhancing and non-enhancing portions of the tumor. Cox and logistic regression analyses were performed to determine which ADC values best predicted survival. RESULTS The change in minimum ADC in the enhancing portion of the tumor after SIACI BV therapy was associated with an increased risk of death (hazard ratio = 2.0, 95% confidence interval(CI) [1.04-3.79], p = 0.038), adjusting for age, tumor size, BV dose, and prior IV BV treatments. Similarly, the change in ADC after SIACI BV therapy was associated with greater likelihood of surviving less than 1 year after therapy (odds ratio = 7.0, 95% CI [1.08-45.7], p = 0.04). Having previously received IV BV was associated with increased risk of death (OR 18, 95% CI [1.8-180.0], p = 0.014). CONCLUSION In patients with recurrent GB treated with SIACI BV, the change in ADC value after treatment is predictive of overall survival.
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14
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Welz ME, Sattur MG, Gupta A, Aoun RJN, Turcotte PJ, Bendok BR. Superselective Intra-arterial Cerebral Infusion for High Grade Gliomas: Potential Imaging Biomarkers of Response. World Neurosurg 2017; 99:773-774. [PMID: 28130163 DOI: 10.1016/j.wneu.2017.01.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Matthew E Welz
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Mithun G Sattur
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Aman Gupta
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Rami James N Aoun
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA
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