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Du S, Gong G, Liu R, Meng K, Yin Y. Advances in determining the gross tumor target volume for radiotherapy of brain metastases. Front Oncol 2024; 14:1338225. [PMID: 38779095 PMCID: PMC11109437 DOI: 10.3389/fonc.2024.1338225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Brain metastases (BMs) are the most prevalent intracranial malignant tumors in adults and are the leading cause of mortality attributed to malignant brain diseases. Radiotherapy (RT) plays a critical role in the treatment of BMs, with local RT techniques such as stereotactic radiosurgery (SRS)/stereotactic body radiotherapy (SBRT) showing remarkable therapeutic effectiveness. The precise determination of gross tumor target volume (GTV) is crucial for ensuring the effectiveness of SRS/SBRT. Multimodal imaging techniques such as CT, MRI, and PET are extensively used for the diagnosis of BMs and GTV determination. With the development of functional imaging and artificial intelligence (AI) technology, there are more innovative ways to determine GTV for BMs, which significantly improve the accuracy and efficiency of the determination. This article provides an overview of the progress in GTV determination for RT in BMs.
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Affiliation(s)
- Shanshan Du
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Rui Liu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Kangning Meng
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Sanvito F, Kaufmann TJ, Cloughesy TF, Wen PY, Ellingson BM. Standardized brain tumor imaging protocols for clinical trials: current recommendations and tips for integration. FRONTIERS IN RADIOLOGY 2023; 3:1267615. [PMID: 38152383 PMCID: PMC10751345 DOI: 10.3389/fradi.2023.1267615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023]
Abstract
Standardized MRI acquisition protocols are crucial for reducing the measurement and interpretation variability associated with response assessment in brain tumor clinical trials. The main challenge is that standardized protocols should ensure high image quality while maximizing the number of institutions meeting the acquisition requirements. In recent years, extensive effort has been made by consensus groups to propose different "ideal" and "minimum requirements" brain tumor imaging protocols (BTIPs) for gliomas, brain metastases (BM), and primary central nervous system lymphomas (PCSNL). In clinical practice, BTIPs for clinical trials can be easily integrated with additional MRI sequences that may be desired for clinical patient management at individual sites. In this review, we summarize the general concepts behind the choice and timing of sequences included in the current recommended BTIPs, we provide a comparative overview, and discuss tips and caveats to integrate additional clinical or research sequences while preserving the recommended BTIPs. Finally, we also reflect on potential future directions for brain tumor imaging in clinical trials.
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Affiliation(s)
- Francesco Sanvito
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Timothy F. Cloughesy
- UCLA Neuro-Oncology Program, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Patrick Y. Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, United States
| | - Benjamin M. Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Jung YH, Park M, Joo B, Suh SH, Lee K, Ahn SJ. Prominent cerebral veins on susceptibility-weighted angiography in acute meningoencephalitis. Brain Behav 2023; 13:e3255. [PMID: 37721542 PMCID: PMC10636387 DOI: 10.1002/brb3.3255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/05/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND PURPOSE We have commonly observed prominent cerebral veins on susceptibility-weighted angiography (SWAN) in acute meningoencephalitis. This study aimed to investigate the clinical significance of these findings. METHODS Cerebral veins on SWAN of 98 patients with acute meningoencephalitis diagnosed from February 2016 through October 2020 were classified into three groups according to the degree of venous prominence (mild, 23; moderate, 53; and prominent, 22). Clinical variables and laboratory findings were compared between these groups. The influence of variables on the prediction of prominent cerebral veins was measured by random forest (RF) and gradient boosting machine (GBM). RESULTS As cerebral veins became more prominent, cerebrospinal fluid (CSF) glucose level decreased (69.61 ± 29.05 vs. 59.72 ± 22.57 vs. 48.36 ± 20.29 mg/dL, p = .01) and CSF protein level increased (100.73 ± 82.98 vs. 104.73 ± 70.99 vs. 159.12 ± 118.15 mg/dL, p = .03). The etiology of meningoencephalitis, neurological symptoms, and increased intracranial pressure (ICP) signs differed between groups (p < .05). RF and GBM demonstrated that CSF protein level was the variable with the highest power to predict the prominent cerebral vein (mean decrease in node impurity: 4.19, relative influence: 50.66). CONCLUSION The presence of prominent cerebral veins on SWAN in acute meningoencephalitis was significantly associated with a low CSF glucose level and a high CSF protein level, as well as ICP. Thus, the visual grade of the cerebral veins on SWAN may be utilized for the management of patients with acute meningoencephalitis.
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Affiliation(s)
- Yo Han Jung
- Department of Neurology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
- Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulSouth Korea
| | - Mina Park
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
| | - Bio Joo
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
- Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulSouth Korea
| | - Kyung‐Yul Lee
- Department of Neurology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
- Severance Institute for Vascular and Metabolic ResearchYonsei University College of MedicineSeoulSouth Korea
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance HospitalYonsei University, College of MedicineSeoulSouth Korea
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Yoo J, Cha YJ, Park HH, Park M, Joo B, Suh SH, Ahn SJ. The Extent of Necrosis in Brain Metastases May Predict Subtypes of Primary Cancer and Overall Survival in Patients Receiving Craniotomy. Cancers (Basel) 2022; 14:cancers14071694. [PMID: 35406466 PMCID: PMC8997083 DOI: 10.3390/cancers14071694] [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: 02/21/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 02/04/2023] Open
Abstract
Although necrosis is common in brain metastasis (BM), its biological and clinical significances remain unknown. We evaluated necrosis extent differences by primary cancer subtype and correlated BM necrosis to overall survival post-craniotomy. We analyzed 145 BMs of patients receiving craniotomy. Necrosis to tumor ratio (NTR) was measured. Patients were divided into two groups by NTR: BMs with sparse necrosis and with abundant necrosis. Clinical features were compared. To investigate factor relevance for BM necrosis, multivariate logistic regression, random forests, and gradient boosting machine analyses were performed. Kaplan−Meier analysis and log-rank tests were performed to evaluate the effect of BM necrosis on overall survival. Lung cancer was a more common origin for BMs with abundant necrosis (42/72, 58.33%) versus sparse necrosis (23/73, 31.51%, p < 0.01). Primary cancer subtype and tumor volume were the most relevant factors for BM necrosis (p < 0.01). BMs harboring moderately abundant necrosis showed longer survival, versus sparse or highly abundant necrosis (p = 0.04). Lung cancer BM may carry larger necrosis than BMs from other cancers. Further, moderately abundant necrosis in BM may predict a good prognosis post-craniotomy.
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Affiliation(s)
- Jihwan Yoo
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (J.Y.); (H.H.P.)
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea;
| | - Hun Ho Park
- Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (J.Y.); (H.H.P.)
| | - Mina Park
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
| | - Bio Joo
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
| | - Sang Hyun Suh
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
| | - Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06230, Korea; (M.P.); (B.J.); (S.H.S.)
- Correspondence: ; Tel.: +82-2-2019-3510; Fax: +82-2-3462-5472
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Ahn SJ, Taoka T, Moon WJ, Naganawa S. Contrast-Enhanced Fluid-Attenuated Inversion Recovery in Neuroimaging: A Narrative Review on Clinical Applications and Technical Advances. J Magn Reson Imaging 2022; 56:341-353. [PMID: 35170148 DOI: 10.1002/jmri.28117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 12/15/2022] Open
Abstract
While contrast-enhanced fluid-attenuated inversion recovery (FLAIR) has long been regarded as an adjunct sequence to evaluate leptomeningeal disease in addition to contrast-enhanced T1-weighted imaging, it is gradually being used for more diverse pathologies beyond leptomeningeal disease. Contrast-enhanced FLAIR is known to be highly sensitive to low concentrations of gadolinium within the fluid. Accordingly, recent research has suggested the potential utility of contrast-enhanced FLAIR in various kinds of disease, such as Meniere's disease, seizure, stroke, traumatic brain injury, and brain metastasis, in addition to being used for visualizing glymphatic dysfunction. However, its potential applications have been reported sporadically in an unorganized manner. Furthermore, the exact mechanism for its superior sensitivity to low concentrations of gadolinium has not been fully understood. Rapidly developing magnetic resonance technology and unoptimized parameters for FLAIR may challenge its accurate application in clinical practice. This review provides the fundamental mechanism of contrast-enhanced FLAIR, systematically describes its current and potential clinical application, and elaborates on technical considerations for its optimization. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 5.
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Affiliation(s)
- Sung Jun Ahn
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Toshiaki Taoka
- Department of Innovative Biomedical Visualization (iBMV), Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Jin T, Zhang H, Liu X, Kong X, Makamure J, Chen Z, Alwalid O, Yao Z, Wang J. Enhancement degree of brain metastases: correlation analysis between enhanced T2 FLAIR and vascular permeability parameters of dynamic contrast-enhanced MRI. Eur Radiol 2021; 31:5595-5604. [PMID: 33847812 DOI: 10.1007/s00330-020-07625-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/13/2020] [Accepted: 12/10/2020] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To investigate the correlation between enhancement degrees of brain metastases on contrast-enhanced T2-fluid-attenuated inversion recovery (CE-T2 FLAIR) and vascular permeability parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS Thirty-nine patients with brain metastases were prospectively collected. They underwent non-enhanced T2 FLAIR, DCE-MRI, CE-T2 FLAIR, and contrast-enhanced three-dimensional brain volume imaging (CE-BRAVO). Quantitative parameters of DCE-MRI were evaluated for all lesions, which included volume transfer constant (Ktrans), rate constant (Kep), and fractional volume of the extracellular extravascular space (Ve). Contrast ratio (CR) and percentage increase (PI) values of all lesions on CE-T2 FLAIR were also measured. The tumor enhancement degree on CE-T2 FLAIR in relation to CE-BRAVO was visually classified as higher (group A), equal (group B), and lower (group C). RESULTS A total of 82 brain metastases were evaluated, including 31 in group A, 19 in group B, and 32 in group C. The Ktrans and Kep were negatively correlated with the CR (ρ = - 0.551, p < 0.001 and ρ = - 0.708, p < 0.001, respectively) and PI (ρ = - 0.511, p < 0.001 and ρ = - 0.621, p < 0.001, respectively). The Ktrans and Kep of group A were significantly lower than those of group C (both p < 0.001). No significant difference was found in Ve among the groups (p = 0.327). CONCLUSIONS The enhancement degree of brain metastases on CE-T2 FLAIR is negatively correlated with Ktrans and Kep values, which indicate that vascular permeability parameters may play an important role in explaining the difference in enhancement between CE-T2 FLAIR and CE-BRAVO. KEY POINTS • The enhancement degree on CE-T2 FLAIR was negatively correlated with Ktrans and Kep values. • The vascular permeability of brain metastasis accounted for the difference in enhancement degree between CE-T2 FLAIR and CE-BRAVO. • CE-T2 FLAIR is useful for detecting brain metastases with mild disruption of the blood-brain barrier.
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Affiliation(s)
- Teng Jin
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Hua Zhang
- Department of Radiology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaoming Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Joyman Makamure
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ziwen Chen
- Department of General Surgery, the Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China
| | - Osamah Alwalid
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhenwei Yao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Jin T, Ge M, Huang R, Yang Y, Liu T, Zhan Q, Yao Z, Zhang H. Utility of Contrast-Enhanced T2 FLAIR for Imaging Brain Metastases Using a Half-dose High-Relaxivity Contrast Agent. AJNR Am J Neuroradiol 2021; 42:457-463. [PMID: 33361381 DOI: 10.3174/ajnr.a6931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Efficient detection of metastases is important for patient' treatment. This prospective study was to explore the clinical value of contrast-enhanced T2 FLAIR in imaging brain metastases using half-dose gadobenate dimeglumine. MATERIALS AND METHODS In vitro signal intensity of various gadolinium concentrations was explored by spin-echo T1-weighted imaging and T2 FLAIR. Then, 46 patients with lung cancer underwent nonenhanced T2 FLAIR before administration of half-dose gadobenate dimeglumine and 3 consecutive contrast-enhanced T2 FLAIR sequences followed by 1 spin-echo T1WI after administration of half-dose gadobenate dimeglumine. After an additional dose of 0.05 mmol/kg, 3D brain volume imaging was performed. All brain metastases were classified as follows: solid-enhancing, ≥ 5 mm (group A); ring-enhancing, ≥ 5 mm (group B); and lesion diameter of <5 mm (group C). The contrast ratio of the lesions on 3 consecutive phases of contrast-enhanced T2 FLAIR was measured, and the percentage increase of contrast-enhanced T2 FLAIR among the 3 groups was compared. RESULTS In vitro, the maximal signal intensity was achieved in T2 FLAIR at one-eighth to one-half of the contrast concentration needed for maximal signal intensity in T1WI. In vivo, the mean contrast ratio values of metastases on contrast-enhanced T2 FLAIR for the 3 consecutive phases ranged from 63.64% to 83.05%. The percentage increase (PI) values of contrast-enhanced T2 FLAIR were as follows: PIA < PIB (P = .001) and PIA < PIC (P < .001). The degree of enhancement of brain metastases on contrast-enhanced T2 FLAIR was lower than on 3D brain volume imaging (P < .001) in group A, and higher than on 3D brain volume imaging (P < .001) in group C. CONCLUSIONS Small or ring-enhancing metastases can be better visualized on delayed contrast-enhanced T2 FLAIR using a half-dose high-relaxivity contrast agent.
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Affiliation(s)
- T Jin
- From the Department of Radiology (T.J.), Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - M Ge
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - R Huang
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - Y Yang
- Department of Oncology (Y.Y.), Huashan North Hospital, Fudan University, Shanghai, China
| | - T Liu
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - Q Zhan
- Department of Oncology (M.G., R.H., T.L., Q.Z.)
| | - Z Yao
- Radiology (Z.Y.), Huashan Hospital, Fudan University, Shanghai, China
| | - H Zhang
- Department of Radiology (H.Z.), The Affiliated Hospital of Qingdao University, Qingdao, China
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Liheng M, Guofan X, Balzano RF, Yuying L, Weifeng H, Ning Y, Yayun J, Mouyuan L, Guglielmi G. The value of DTI: achieving high diagnostic performance for brain metastasis. LA RADIOLOGIA MEDICA 2021; 126:291-298. [PMID: 32564269 DOI: 10.1007/s11547-020-01243-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/08/2020] [Indexed: 12/08/2022]
Abstract
BACKGROUND The evaluation of brain metastases generally requires post-contrast MRI exam, but some patients have contraindication to contrast medium administration. PURPOSE To investigate the value of the MRI diffusion tensor imaging (DTI) for detection of metastatic brain tumor. MATERIALS AND METHODS We retrospectively analyzed the MRI data from 23 patients (13 males and 10 females) with brain metastases. The MRI protocol consisted in T1WI, T2WI, post-contrast 3DT1WI and DTI images (b = 1000) sequences. The brain metastatic lesions were counted in each of these sequences. We compared the advantages and limitations of different sequences in the brain metastases detection. The number of metastatic lesions identified on the contrast-enhanced 3DT1WI image is used as the reference. FA values were measured in the intratumoral, adjacent peritumoral and distant peritumoral edema area (PTEA) of brain metastasis, and the differences were statistically analyzed. RESULTS DTI can detect more brain metastatic lesions rather than T1WI and T2WI. The number of brain metastases on DTI is similar to post-contrast 3D T1WI. There is no statistical difference in the FA value change between the adjacent and distant PTEA. CONCLUSION The DTI original image can be used as an alternative examination for patients with contraindications to contrast-enhanced MRI. It has high sensitivity to intratumoral hemorrhage, which has advantage to detect brain metastatic lesions as compared with T1WI or T2WI images.
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Affiliation(s)
- Ma Liheng
- Imaging Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou City, Guangdong Province, China
| | - Xu Guofan
- Division of Diagnostic Imaging, Department of Nuclear Medicine and Imaging Physics, MD Anderson Cancer Center, Houston City, TX, USA
| | - Rosario Francesco Balzano
- Department of Clinical and Experimental Medicine, University School of Medicine, Viale L. Pinto, 1, 71121, Foggia, Italy
| | - Liang Yuying
- Imaging Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou City, Guangdong Province, China
| | - Hong Weifeng
- Imaging Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou City, Guangdong Province, China
| | - Yang Ning
- Pathology Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou City, Guangdong Province, China
| | - Ji Yayun
- Imaging Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou City, Guangdong Province, China
| | - Liu Mouyuan
- Imaging Department, First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou City, Guangdong Province, China
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, University School of Medicine, Viale L. Pinto, 1, 71121, Foggia, Italy.
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Optimization of Contrast Agent Dosage on Contrast-Enhanced T2 Fluid-Attenuated Inversion Recovery: An In Vitro and In Vivo Study. J Comput Assist Tomogr 2021; 45:121-127. [PMID: 32976269 DOI: 10.1097/rct.0000000000001055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to ascertain the minimum gadolinium dosage on contrast-enhanced (CE) T2 fluid-attenuated inversion recovery (FLAIR) at appropriate imaging time. METHODS Different dosages of gadodiamide were imaged with a 3.0-T magnetic resonance scanner for T2-FLAIR and T1WI. Twenty glioma-induced rat models were randomly assigned into 4 groups (1/2, 1/4, 1/6, 1/8 of routine dosage) and imaged for T2-FLAIR and T1WI preinjection and postinjection of gadodiamide. Contrast-enhanced T2-FLAIR was acquired for 8 repetitions postinjection. Enhancement effects were assessed by calculating contrast-noise ratio and contrast ratio using Kruskal-Wallis and Mann-Whitney rank sum test. RESULTS The in vitro experiment showed that gadodiamide at 1/4 of the T1WI dosage presented the best contrast on CE-T2-FLAIR. For in vivo study, the best enhancement effect on CE-T2-FLAIR was achieved at 1/2 of the routine dosage at 8 to 12 minutes of delayed scanning. Compared with CE-T1WI at routine dosage, CE-T2-FLAIR at 1/2 gadodiamide dosage presented similar enhancement effects with no statistical difference (P = 0.244 and 0.090 for contrast-noise ratio and contrast ratio, respectively). CONCLUSIONS Contrast-enhanced T2-FLAIR imaging with half of T1WI routine gadodiamide dosage can produce similar enhancement effects to CE-T1WI when characterizing brain gliomas. The cut-down of contrast agent dosage may help reduce gadolinium accumulation in certain tissues.
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Interpretation of fluid-attenuated inversion recovery vascular hyperintensity in stroke. J Neuroradiol 2021; 49:258-266. [PMID: 33515596 DOI: 10.1016/j.neurad.2021.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 01/01/2023]
Abstract
Fluid-attenuation inversion recovery (FLAIR) vascular hyperintensity (FVH) is a common presentation on brain magnetic resonance images of patients with acute ischemic stroke. This sign is known as a sluggish collateral flow. Although FVH represents the large ischemic penumbra and collateral circulation, the clinical significance of FVH has not been established. Varying protocols for FLAIR, treatment differences, and heterogeneity of endpoints across studies have complicated the interpretation of FVH in patients with acute stroke. In this review article, we describe the mechanism of FVH, as well as its association with functional outcome, perfusion-weighted images, and large artery stenosis. In addition, we review the technological variables that affect FVH and discuss the future perspectives.
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Falk Delgado A, Van Westen D, Nilsson M, Knutsson L, Sundgren PC, Larsson EM, Falk Delgado A. Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging-a comprehensive overview. Insights Imaging 2019; 10:84. [PMID: 31444580 PMCID: PMC6708018 DOI: 10.1186/s13244-019-0771-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/12/2019] [Indexed: 12/16/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017. This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging. Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke. In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.
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Affiliation(s)
- Anna Falk Delgado
- Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden. .,Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
| | - Danielle Van Westen
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Markus Nilsson
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Linda Knutsson
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.,Russell H. Morgan Department of Radiology and Radiological Science, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Pia C Sundgren
- Department of Clinical Sciences/Radiology, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
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12
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Detectability of Brain Metastases by Using Frequency-Selective Nonlinear Blending in Contrast-Enhanced Computed Tomography. Invest Radiol 2019; 54:98-102. [DOI: 10.1097/rli.0000000000000514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Park YW, Ahn SJ. Comparison of Contrast-Enhanced T2 FLAIR and 3D T1 Black-Blood Fast Spin-Echo for Detection of Leptomeningeal Metastases. ACTA ACUST UNITED AC 2018. [DOI: 10.13104/imri.2018.22.2.86] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Yae Won Park
- Department of Radiology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Sung Jun Ahn
- Department of Radiology, Yonsei University, College of Medicine, Seoul, Korea
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14
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Gadolinium deposition in the brain: association with various GBCAs using a generalized additive model. Eur Radiol 2017; 27:3353-3361. [DOI: 10.1007/s00330-016-4724-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/11/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
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15
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Suh CH, Jung SC, Kim KW, Pyo J. The detectability of brain metastases using contrast-enhanced spin-echo or gradient-echo images: a systematic review and meta-analysis. J Neurooncol 2016; 129:363-71. [PMID: 27324495 DOI: 10.1007/s11060-016-2185-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 06/11/2016] [Indexed: 01/27/2023]
Abstract
This study aimed to compare the detectability of brain metastases using contrast-enhanced spin-echo (SE) and gradient-echo (GRE) T1-weighted images. The Ovid-MEDLINE and EMBASE databases were searched for studies on the detectability of brain metastases using contrast-enhanced SE or GRE images. The pooled proportions for the detectability of brain metastases were assessed using random-effects modeling. Heterogeneity among studies was determined using χ (2) statistics for the pooled estimates and the inconsistency index, I (2) . To overcome heterogeneity, subgroup analyses according to slice thickness and lesion size were performed. A total of eight eligible studies, which included a sample size of 252 patients and 1413 brain metastases, were included. The detectability of brain metastases using SE images (89.2 %) was higher than using GRE images (81.6 %; adjusted 84.0 %), but this difference was not statistically significant (p = 0.2385). In subgroup analysis of studies with 1-mm-thick slices and small metastases (<5 mm in diameter), 3-dimensional (3D) SE images demonstrated a higher detectability in comparison to 3D GRE images (93.7 % vs 73.1 % in 1-mm-thick slices; 89.5 % vs 59.4 % for small metastases) (p < 0.0001). Although both SE or GRE images are acceptable for detecting brain metastases, contrast-enhanced 3D SE images using 1-mm-thick slices are preferred for detecting brain metastases, especially small lesions (<5 mm in diameter).
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Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.,Department of Radiology, Namwon Medical Center, 365, Chungjeong-ro, Namwon-si, Jeollabuk-do, 590-702, Republic of Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea.
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 138-736, Republic of Korea
| | - Junhee Pyo
- Department of Pharmaceutical Science, WHO Collaborating Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, The Netherlands
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16
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Lee EK, Lee EJ, Kim S, Lee YS. Importance of Contrast-Enhanced Fluid-Attenuated Inversion Recovery Magnetic Resonance Imaging in Various Intracranial Pathologic Conditions. Korean J Radiol 2016; 17:127-41. [PMID: 26798225 PMCID: PMC4720800 DOI: 10.3348/kjr.2016.17.1.127] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 10/29/2015] [Indexed: 11/30/2022] Open
Abstract
Intracranial lesions may show contrast enhancement through various mechanisms that are closely associated with the disease process. The preferred magnetic resonance sequence in contrast imaging is T1-weighted imaging (T1WI) at most institutions. However, lesion enhancement is occasionally inconspicuous on T1WI. Although fluid-attenuated inversion recovery (FLAIR) sequences are commonly considered as T2-weighted imaging with dark cerebrospinal fluid, they also show mild T1-weighted contrast, which is responsible for the contrast enhancement. For several years, FLAIR imaging has been successfully incorporated as a routine sequence at our institution for contrast-enhanced (CE) brain imaging in detecting various intracranial diseases. In this pictorial essay, we describe and illustrate the diagnostic importance of CE-FLAIR imaging in various intracranial pathologic conditions.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea.; Department of Radiology, College of Medicine, Kangwon National University, Chuncheon 24289, Korea
| | - Eun Ja Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Sungwon Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
| | - Yong Seok Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang 10326, Korea
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