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Demir MK, Kılıc D, Zorlu E, Kılıc T. Giant Intracranial Cavernous Malformations: A Review on Magnetic Resonance Imaging Characteristics. Indian J Radiol Imaging 2024; 34:511-521. [PMID: 38912256 PMCID: PMC11188748 DOI: 10.1055/s-0044-1779587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background Intracranial cavernous malformations (CMs), commonly known as cavernomas or cavernous angiomas, are low-flow, well-circumscribed vascular lesions composed of sinusoidal spaces lined by a single layer of endothelium and separated by a collagenous matrix without elastin, smooth muscle, or other vascular wall elements. A diameter greater than 3 cm for a CM is unlikely. These lesions may have atypical appearances on magnetic resonance imaging (MRI). MRI with advanced techniques such as a susceptibility-weighted image or T2-gradient echo, a diffusion-weighted image and corresponding apparent diffusion coefficient map, and diffusion tensor tractography have revolutionized the diagnostic approach to these lesions. Materials and Method The present study reviews the etiopathogenesis, clinical manifestations, MRI strategy, and MRI appearances of the CMs, with a few examples of the giant CMs from our archive. Results Intracranial giant CMs may have unexpected locations, sizes, numbers, and varied imaging appearances due to repeated hemorrhages, unusual enhancement patterns, intense perifocal edema, and unusual associations, making the differential diagnosis difficult. Conclusion Familiarity with the MRI appearances of the giant intracranial CMs and the differential diagnosis improves diagnostic accuracy and patient management.
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Affiliation(s)
- Mustafa Kemal Demir
- Clinic of Radiology, Bahcesehir University Goztepe Medical Park Hospital, Istanbul, Turkey
| | - Deniz Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Emre Zorlu
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
| | - Turker Kılıc
- Department of Neurosurgery, Bahcesehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
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Ordonez-Rubiano EG, Johnson JM, Abdalá-Vargas N, Zorro OF, Marin-Munoz JH, Álvarez-Tobián R, Forlizzi V, Rangel CC, Luzzi S, Campero A, Patiño-Gómez JG, Baldoncini M. Preoperative tractography algorithm for safe resection of tumors located in the descending motor pathways zone. Surg Neurol Int 2023; 14:255. [PMID: 37560574 PMCID: PMC10408624 DOI: 10.25259/sni_230_2023] [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: 03/12/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Diffusion tensor imaging (DTI) tractography facilitates maximal safe resection and optimizes planning to avoid injury during subcortical dissection along descending motor pathways (DMPs). We provide an affordable, safe, and timely algorithm for preoperative DTI motor reconstruction for gliomas adjacent to DMPs. METHODS Preoperative DTI reconstructions were extracted from a prospectively acquired registry of glioma resections adjacent to DMPs. The surgeries were performed over a 7-year period. Demographic, clinical, and radiographic data were extracted from patients' electronic medical records. RESULTS Nineteen patients (12 male) underwent preoperative tractography between January 1, 2013, and May 31, 2020. The average age was 44.5 years (range, 19-81 years). A complete radiological resection was achieved in nine patients, a subtotal resection in five, a partial resection in three, and a biopsy in two. Histopathological diagnoses included 10 patients with high-grade glioma and nine with low-grade glioma. A total of 16 perirolandic locations (10 frontal and six frontoparietal) were recorded, as well as two in the insula and one in the basal ganglia. In 9 patients (47.3%), the lesion was in the dominant hemisphere. The median preoperative and postoperative Karnofsky Performance Scores were 78 and 80, respectively. Motor function was unchanged or improved over time in 15 cases (78.9%). CONCLUSION This protocol of DTI reconstruction for glioma removal near the DMP shows good results in low-term neurological functional outcomes.
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Affiliation(s)
- Edgar G. Ordonez-Rubiano
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Jason M. Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Nadin Abdalá-Vargas
- Department of Neurological Surgery, Hospital de San José - Sociedad de Cirugía de Bogotá, Colombia
| | - Oscar F. Zorro
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Jorge H. Marin-Munoz
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Ricardo Álvarez-Tobián
- Department of Diagnostic Imaging and Diagnostic Radiology, Fundación Universitaria de Ciencias de la Salud, Hospital Infantil Universitario de San José, Bogotá, Colombia
| | - Valeria Forlizzi
- Department of Anatomy, University of Buenos Aires, Buenos Aires, Argentina
| | - Carlos Castillo Rangel
- Department of Neurosurgery, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Sabino Luzzi
- Department of Neurosurgery, University of Pavia, Pavia, Italy
| | - Alvaro Campero
- Department of Neurosurgery, Hospital Padilla de Tucuman, Tucuman, Argentina
| | - Javier G. Patiño-Gómez
- Department of Neurosurgery, Hospital de San José - Fundación Universitaria de Ciencias de la Salud, Bogota, Colombia
| | - Matias Baldoncini
- Department of Neurosurgery, San Fernando Hospital, San Fernando, Argentina
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Manan AA, Yahya NA, Taib NHM, Idris Z, Manan HA. The Assessment of White Matter Integrity Alteration Pattern in Patients with Brain Tumor Utilizing Diffusion Tensor Imaging: A Systematic Review. Cancers (Basel) 2023; 15:3326. [PMID: 37444435 DOI: 10.3390/cancers15133326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Alteration in the surrounding brain tissue may occur in the presence of a brain tumor. The present study aims to assess the characteristics and criteria of the pattern of white matter tract microstructure integrity alteration in brain tumor patients. The Scopus, PubMed/Medline, and Web of Science electronic databases were searched for related articles based on the guidelines established by PRISMA. Twenty-five studies were selected on the morphological changes of white matter tract integrity based on the differential classification of white matter tract (WMT) patterns in brain tumor patients through diffusion tensor imaging (DTI). The characterization was based on two criteria: the visualization of the tract-its orientation and position-and the DTI parameters, which were the fractional anisotropy and apparent diffusion coefficient. Individual evaluations revealed no absolute, mutually exclusive type of tumor in relation to morphological WMT microstructure integrity changes. In most cases, different types and grades of tumors have shown displacement or infiltration. Characterizing morphological changes in the integrity of the white matter tract microstructures is vital in the diagnostic and prognostic evaluation of the tumor's progression and could be a potential assessment for the early detection of possible neurological defects that may affect the patient, as well as aiding in surgery decision-making.
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Affiliation(s)
- Aiman Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia
| | - Noorazrul Azmie Yahya
- Diagnostic Imaging and Radiotherapy Program, Faculty of Health Sciences, School of Diagnostic and Applied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
| | - Nur Hartini Mohd Taib
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Department of Radiology, School of Medical Science, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Zamzuri Idris
- Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Specialist Children Hospital), Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
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Muscas G, Pisano A, Carrai R, Bianchi A, Capelli F, Montemurro VM, Martinelli C, Fainardi E, Grippo A, Della Puppa A. A Diffusion Tensor Imaging-Based Prognostic Classification for Surgery of Intrinsic Lesions Involving the Motor Pathways. World Neurosurg 2023; 172:e565-e573. [PMID: 36706980 DOI: 10.1016/j.wneu.2023.01.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging-based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways. METHODS We included patients consecutively enrolled at our institution between April 2020 and September 2022 with 3 patterns of increasing complexity according to the relationship between the lesion and the corticospinal tract as identified on preoperative diffusion tensor imaging. Outcome measures were >50% reduction in intraoperative MEPs and neurological outcome defined as unchanged, improved, or worsened. RESULTS The study included 83 patients. A statistically significant linear trend between higher rates of reduction of MEPs and higher classification grades was observed (P = 0.001), with sensitivity 0.60, specificity 0.88, accuracy 0.83, and area under the curve 0.75. Higher grades were associated with worse neurological outcomes (P = 0.02). CONCLUSIONS The classification proved reliable in anticipating reduction in intraoperative MEPs and in predicting neurological outcome. Using this classification in patients undergoing surgery for lesions involving the motor pathways could help in counseling the patient, surgical planning, enhancing teamwork of operating room personnel, and improving the patient's prognosis.
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Affiliation(s)
- Giovanni Muscas
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy.
| | - Antonio Pisano
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy
| | - Riccardo Carrai
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, Careggi University Hospital, Florence, Italy
| | - Andrea Bianchi
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Federico Capelli
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy
| | - Vita Maria Montemurro
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy
| | - Cristiana Martinelli
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Antonello Grippo
- SODc Neurophysiopathology, Department Neuromuscolo-Scheletrico e degli Organi di Senso, Careggi University Hospital, Florence, Italy
| | - Alessandro Della Puppa
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital and University of Florence, Florence, Italy
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Liu X, Wei Z, Chen L, Duan W, Li H, Kong L, Shu Y, Li P, Li K, Xie W, Zeng Y, Huang L, Long T, Peng D. Effects of 3-month CPAP therapy on brain structure in obstructive sleep apnea: A diffusion tensor imaging study. Front Neurol 2022; 13:913193. [PMID: 36071900 PMCID: PMC9441568 DOI: 10.3389/fneur.2022.913193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
White matter (WM) fiber alterations in patients with obstructive sleep apnea (OSA) is associated with cognitive impairment, which can be alleviated by continuous positive airway pressure (CPAP). In this study, we aimed to investigate the changes in WM in patients with OSA at baseline (pre-CPAP) and 3 months after CPAP adherence treatment (post-CPAP), and to provide a basis for understanding the reversible changes after WM alteration in this disease. Magnetic resonance imaging (MRI) was performed on 20 severely untreated patients with OSA and 20 good sleepers. Tract-based spatial statistics was used to evaluate the fractional anisotropy (FA), mean diffusion coefficient, axial diffusion coefficient, and radial diffusion coefficient (RD) of WM. To assess the efficacy of treatment, 20 patients with pre-CPAP OSA underwent MRI again 3 months later. A correlation analysis was conducted to evaluate the relationship between WM injury and clinical evaluation. Compared with good sleepers, patients with OSA had decreased FA and increased RD in the anterior thalamic radiation, forceps major, inferior fronto-occipital tract, inferior longitudinal tract, and superior longitudinal tract, and decreased FA in the uncinate fasciculus, corticospinal tract, and cingulate gyrus (P < 0.05). No significant change in WM in patients with post-CPAP OSA compared with those with pre-CPAP OSA. Abnormal changes in WM in untreated patients with OSA were associated with oxygen saturation, Montreal cognitive score, and the apnea hypoventilation index. WM fiber was extensively alteration in patients with severe OSA, which is associated with cognitive impairment. Meanwhile, cognitive recovery was not accompanied by reversible changes in WM microstructure after short-term CPAP therapy.
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Affiliation(s)
- Xiang Liu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhipeng Wei
- Department of Radiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Liting Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wenfeng Duan
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haijun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Linghong Kong
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yongqiang Shu
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Panmei Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Kunyao Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Xie
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yaping Zeng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ling Huang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Ting Long
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dechang Peng
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Dechang Peng
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Manan AA, Yahya N, Idris Z, Manan HA. The Utilization of Diffusion Tensor Imaging as an Image-Guided Tool in Brain Tumor Resection Surgery: A Systematic Review. Cancers (Basel) 2022; 14:cancers14102466. [PMID: 35626069 PMCID: PMC9139820 DOI: 10.3390/cancers14102466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Diffusion tensor imaging (DTI) is an image-guided tool, especially in brain tumor resection surgery. Neuroimaging tools are essential for operative planning, particularly for maximizing tumor resection and, at the same time, preserving brain function. In this systematic review, we discuss the utilization of DTI in brain tumor resection, by looking into its ability to assess the perioperative approach, as well as evaluating its benefits for successful surgery. The present study proposes to use DTI as a vital neuroimaging tool for preoperative planning in brain tumor resection surgery. Abstract The diffusion tensor imaging technique has been recognized as a neuroimaging tool for in vivo visualization of white matter tracts. However, DTI is not a routine procedure for preoperative planning for brain tumor resection. Our study aimed to systematically evaluate the effectiveness of DTI and the outcomes of surgery. The electronic databases, PubMed/MEDLINE and Scopus, were searched for relevant studies. Studies were systematically reviewed based on the application of DTI in pre-surgical planning, modification of operative planning, re-evaluation of preoperative DTI data intraoperatively, and the outcome of surgery decisions. Seventeen studies were selected based on the inclusion and exclusion criteria. Most studies agreed that preoperative planning using DTI improves postoperative neuro-deficits, giving a greater resection yield and shortening the surgery time. The results also indicate that the re-evaluation of preoperative DTI intraoperatively assists in a better visualization of white matter tract shifts. Seven studies also suggested that DTI modified the surgical decision of the initial surgical approach and the rate of the GTR in tumor resection surgery. The utilization of DTI may give essential information on white matter tract pathways, for a better surgical approach, and eventually reduce the risk of neurologic deficits after surgery.
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Affiliation(s)
- Aiman Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia;
| | - Noorazrul Yahya
- Diagnostic Imaging and Radiotherapy, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, Kuala Lumpur 50300, Malaysia;
| | - Zamzuri Idris
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Penang 16150, Malaysia;
| | - Hanani Abdul Manan
- Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia;
- Department of Radiology and Intervensy, Hospital Pakar Kanak-Kanak (HPKK), Universiti Kebangsaan Malaysia, Jalan Yaakob Latiff, Kuala Lumpur 56000, Malaysia
- Correspondence:
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7
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Chong ST, Liu X, Kao HW, Lin CYE, Hsu CCH, Kung YC, Kuo KT, Huang CC, Lo CYZ, Li Y, Zhao G, Lin CP. Exploring Peritumoral Neural Tracts by Using Neurite Orientation Dispersion and Density Imaging. Front Neurosci 2021; 15:702353. [PMID: 34646116 PMCID: PMC8502884 DOI: 10.3389/fnins.2021.702353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
Diffusion Tensor Imaging (DTI) tractography has been widely used in brain tumor surgery to ensure thorough resection and minimize functional damage. However, due to enhanced anisotropic uncertainty in the area with peritumoral edema, diffusion tractography is generally not practicable leading to high false-negative results in neural tracking. In this study, we evaluated the usefulness of the neurite orientation dispersion and density imaging (NODDI) derived tractography for investigating structural heterogeneity of the brain in patients with brain tumor. A total of 24 patients with brain tumors, characterized by peritumoral edema, and 10 healthy counterparts were recruited from 2014 to 2021. All participants underwent magnetic resonance imaging. Moreover, we used the images obtained from the healthy participants for calibrating the orientation dispersion threshold for NODDI-derived corticospinal tract (CST) reconstruction. Compared to DTI, NODDI-derived tractography has a great potential to improve the reconstruction of fiber tracking through regions of vasogenic edema. The regions with edematous CST in NODDI-derived tractography demonstrated a significant decrease in the intracellular volume fraction (VFic, p < 0.000) and an increase in the isotropic volume fraction (VFiso, p < 0.014). Notably, the percentage of the involved volume of the concealed CST and lesion-to-tract distance could reflect the motor function of the patients. After the tumor resection, four patients with 1–5 years follow-up were showed subsidence of the vasogenic edema and normal CST on DTI tractography. NODDI-derived tractography revealed tracts within the edematous area and could assist neurosurgeons to locate the neural tracts that are otherwise not visualized by conventional DTI tractography.
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Affiliation(s)
- Shin Tai Chong
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Xinrui Liu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Hung-Wen Kao
- Department of Medical Imaging, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Radiology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | | | - Chih-Chin Heather Hsu
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Chia Kung
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Kuan-Tsen Kuo
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chu-Chung Huang
- School of Psychology and Cognitive Science, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
| | - Chun-Yi Zac Lo
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Yunqian Li
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Gang Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Zattra CM, La Corte E, Broggi M. Commentary: Microsurgical and Tractographic Anatomical Study of Transtemporal-Transchoroidal Fissure Approaches to the Ambient Cistern. Oper Neurosurg (Hagerstown) 2021; 20:E241-E242. [PMID: 33372983 DOI: 10.1093/ons/opaa386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/13/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Costanza M Zattra
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Wang K, Li Z, Wu Z, Zheng Y, Zeng S, E L, Liang J. Diagnostic Performance of Diffusion Tensor Imaging for Characterizing Breast Tumors: A Comprehensive Meta-Analysis. Front Oncol 2019; 9:1229. [PMID: 31803615 PMCID: PMC6876668 DOI: 10.3389/fonc.2019.01229] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022] Open
Abstract
Rationale and Objectives: Controversy still exists on the diagnosability of diffusion tensor imaging (DTI) for breast lesions characterization across published studies. The clinical guideline of DTI used in the breast has not been established. This meta-analysis aims to pool relevant evidences and evaluate the diagnostic performance of DTI in the differential diagnosis of malignant and benign breast lesions. Materials and Methods: The studies that assessed the diagnostic performance of DTI parameters in the breast were searched in Embase, PubMed, and Cochrane Library between January 2010 and September 2019. Standardized mean differences and 95% confidence intervals of fractional anisotropy (FA), mean diffusivity (MD), and three diffusion eigenvalues (λ1, λ2, and λ3) were calculated using Review Manager 5.2. The pooled sensitivity, specificity, and area under the curve (AUC) were calculated with a bivariate model. Publication bias and heterogeneity between studies were also assessed using Stata 12.0. Results: Sixteen eligible studies incorporating 1,636 patients were included. The standardized mean differences indicated that breast cancers had a significantly higher FA but lower MD, λ1, λ2, and λ3 than those of benign lesions (all P < 0.05). Subgroup analysis indicated that invasive breast carcinoma (IBC) had a significantly lower MD value than that of ductal carcinoma in situ (DCIS) (P = 0.02). λ1 showed the best diagnostic accuracy with pooled sensitivity, specificity, and AUC of 93%, 92%, and 0.97, followed by MD (AUC = 0.92, sensitivity = 87%, specificity = 83%) and FA (AUC = 0.76, sensitivity = 70%, specificity = 70%) in the differential diagnosis of breast lesions. Conclusion: DTI with multiple quantitative parameters was adequate to differentiate breast cancers from benign lesions based on their biological characteristics. MD can further distinguish IBC from DCIS. The parameters, especially λ1 and MD, should attract our attention in clinical practice.
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Affiliation(s)
- Kai Wang
- Department of Medical Imaging, Shanxi DAYI Hospital, Taiyuan, China
| | - Zhipeng Li
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhifeng Wu
- Department of Medical Imaging, Shanxi DAYI Hospital, Taiyuan, China
| | - Yucong Zheng
- Department of Medical Imaging, Shanxi DAYI Hospital, Taiyuan, China
| | - Sihui Zeng
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Linning E
- Department of Medical Imaging, Shanxi DAYI Hospital, Taiyuan, China
| | - Jianye Liang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China
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