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Osorio-Londoño D, Heras-Romero Y, Tovar-y-Romo LB, Olayo-González R, Morales-Guadarrama A. Improved Recovery of Complete Spinal Cord Transection by a Plasma-Modified Fibrillar Scaffold. Polymers (Basel) 2024; 16:1133. [PMID: 38675052 PMCID: PMC11054293 DOI: 10.3390/polym16081133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/07/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Complete spinal cord injury causes an irreversible disruption in the central nervous system, leading to motor, sensory, and autonomic function loss, and a secondary injury that constitutes a physical barrier preventing tissue repair. Tissue engineering scaffolds are presented as a permissive platform for cell migration and the reconnection of spared tissue. Iodine-doped plasma pyrrole polymer (pPPy-I), a neuroprotective material, was applied to polylactic acid (PLA) fibers and implanted in a rat complete spinal cord transection injury model to evaluate whether the resulting composite implants provided structural and functional recovery, using magnetic resonance (MR) imaging, diffusion tensor imaging and tractography, magnetic resonance spectroscopy, locomotion analysis, histology, and immunofluorescence. In vivo, MR studies evidenced a tissue response to the implant, demonstrating that the fibrillar composite scaffold moderated the structural effects of secondary damage by providing mechanical stability to the lesion core, tissue reconstruction, and significant motor recovery. Histologic analyses demonstrated that the composite scaffold provided a permissive environment for cell attachment and neural tissue guidance over the fibers, reducing cyst formation. These results supply evidence that pPPy-I enhanced the properties of PLA fibrillar scaffolds as a promising treatment for spinal cord injury recovery.
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Affiliation(s)
- Diana Osorio-Londoño
- Electrical Engineering Department, Universidad Autónoma Metropolitana, Mexico City 09340, Mexico;
| | - Yessica Heras-Romero
- Experimental Analysis of Behavior Department, Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | - Luis B. Tovar-y-Romo
- Department of Molecular Neuropathology, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico;
| | | | - Axayácatl Morales-Guadarrama
- Medical Imaging and Instrumentation Research National Center, Universidad Autónoma Metropolitana, Mexico City 09340, Mexico
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2
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Ballestín A, Armocida D, Ribecco V, Seano G. Peritumoral brain zone in glioblastoma: biological, clinical and mechanical features. Front Immunol 2024; 15:1347877. [PMID: 38487525 PMCID: PMC10937439 DOI: 10.3389/fimmu.2024.1347877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/14/2024] [Indexed: 03/17/2024] Open
Abstract
Glioblastoma is a highly aggressive and invasive tumor that affects the central nervous system (CNS). With a five-year survival rate of only 6.9% and a median survival time of eight months, it has the lowest survival rate among CNS tumors. Its treatment consists of surgical resection, subsequent fractionated radiotherapy and concomitant and adjuvant chemotherapy with temozolomide. Despite the implementation of clinical interventions, recurrence is a common occurrence, with over 80% of cases arising at the edge of the resection cavity a few months after treatment. The high recurrence rate and location of glioblastoma indicate the need for a better understanding of the peritumor brain zone (PBZ). In this review, we first describe the main radiological, cellular, molecular and biomechanical tissue features of PBZ; and subsequently, we discuss its current clinical management, potential local therapeutic approaches and future prospects.
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Affiliation(s)
- Alberto Ballestín
- Tumor Microenvironment Laboratory, UMR3347 CNRS/U1021 INSERM, Institut Curie, Orsay, France
| | - Daniele Armocida
- Human Neurosciences Department, Neurosurgery Division, Sapienza University, Rome, Italy
| | - Valentino Ribecco
- Tumor Microenvironment Laboratory, UMR3347 CNRS/U1021 INSERM, Institut Curie, Orsay, France
| | - Giorgio Seano
- Tumor Microenvironment Laboratory, UMR3347 CNRS/U1021 INSERM, Institut Curie, Orsay, France
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3
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Lemarié A, Lubrano V, Delmas C, Lusque A, Cerapio JP, Perrier M, Siegfried A, Arnauduc F, Nicaise Y, Dahan P, Filleron T, Mounier M, Toulas C, Cohen-Jonathan Moyal E. The STEMRI trial: Magnetic resonance spectroscopy imaging can define tumor areas enriched in glioblastoma stem-like cells. SCIENCE ADVANCES 2023; 9:eadi0114. [PMID: 37922359 PMCID: PMC10624352 DOI: 10.1126/sciadv.adi0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/03/2023] [Indexed: 11/05/2023]
Abstract
Despite maximally safe resection of the magnetic resonance imaging (MRI)-defined contrast-enhanced (CE) central tumor area and chemoradiotherapy, most patients with glioblastoma (GBM) relapse within a year in peritumoral FLAIR regions. Magnetic resonance spectroscopy imaging (MRSI) can discriminate metabolic tumor areas with higher recurrence potential as CNI+ regions (choline/N-acetyl-aspartate index >2) can predict relapse sites. As relapses are mainly imputed to glioblastoma stem-like cells (GSCs), CNI+ areas might be GSC enriched. In this prospective trial, 16 patients with GBM underwent MRSI/MRI before surgery/chemoradiotherapy to investigate GSC content in CNI-/+ biopsies from CE/FLAIR. Biopsy and derived-GSC characterization revealed a FLAIR/CNI+ sample enrichment in GSC and in gene signatures related to stemness, DNA repair, adhesion/migration, and mitochondrial bioenergetics. FLAIR/CNI+ samples generate GSC-enriched neurospheres faster than FLAIR/CNI-. Parameters assessing biopsy GSC content and time-to-neurosphere formation in FLAIR/CNI+ were associated with worse patient outcome. Preoperative MRI/MRSI would certainly allow better resection and targeting of FLAIR/CNI+ areas, as their GSC enrichment can predict worse outcomes.
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Affiliation(s)
- Anthony Lemarié
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- UFR Santé, Université de Toulouse III–Paul Sabatier, Toulouse, France
| | - Vincent Lubrano
- TONIC, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Toulouse Neuro Imaging Center, Toulouse, France
- CHU de Toulouse, Neurosurgery Department, Toulouse, France
| | - Caroline Delmas
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Institut Claudius Regaud, IUCT-Oncopole, Interface Department, Toulouse, France
| | - Amélie Lusque
- Institut Claudius Regaud, IUCT-Oncopole, Biostatistics and Health Data Science Unit, Toulouse, France
| | - Juan-Pablo Cerapio
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
| | - Marion Perrier
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
| | - Aurore Siegfried
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- CHU de Toulouse, Anatomopathology Department, Toulouse, France
| | - Florent Arnauduc
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- UFR Santé, Université de Toulouse III–Paul Sabatier, Toulouse, France
| | - Yvan Nicaise
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- UFR Santé, Université de Toulouse III–Paul Sabatier, Toulouse, France
| | - Perrine Dahan
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
| | - Thomas Filleron
- Institut Claudius Regaud, IUCT-Oncopole, Biostatistics and Health Data Science Unit, Toulouse, France
| | - Muriel Mounier
- Institut Claudius Regaud, IUCT-Oncopole, Clinical Trials Office, Toulouse, France
| | - Christine Toulas
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- Institut Claudius Regaud, IUCT-Oncopole, Cancer Biology Department, Molecular Oncology Division, Toulouse, France
| | - Elizabeth Cohen-Jonathan Moyal
- CRCT, Université de Toulouse, Inserm, CNRS, Université Toulouse III–Paul Sabatier, Centre de Recherches en Cancérologie de Toulouse, Toulouse, France
- UFR Santé, Université de Toulouse III–Paul Sabatier, Toulouse, France
- Institut Claudius Regaud, IUCT-Oncopole, Radiation Oncology Department, Toulouse, France
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Martucci M, Russo R, Giordano C, Schiarelli C, D’Apolito G, Tuzza L, Lisi F, Ferrara G, Schimperna F, Vassalli S, Calandrelli R, Gaudino S. Advanced Magnetic Resonance Imaging in the Evaluation of Treated Glioblastoma: A Pictorial Essay. Cancers (Basel) 2023; 15:3790. [PMID: 37568606 PMCID: PMC10417432 DOI: 10.3390/cancers15153790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
MRI plays a key role in the evaluation of post-treatment changes, both in the immediate post-operative period and during follow-up. There are many different treatment's lines and many different neuroradiological findings according to the treatment chosen and the clinical timepoint at which MRI is performed. Structural MRI is often insufficient to correctly interpret and define treatment-related changes. For that, advanced MRI modalities, including perfusion and permeability imaging, diffusion tensor imaging, and magnetic resonance spectroscopy, are increasingly utilized in clinical practice to characterize treatment effects more comprehensively. This article aims to provide an overview of the role of advanced MRI modalities in the evaluation of treated glioblastomas. For a didactic purpose, we choose to divide the treatment history in three main timepoints: post-surgery, during Stupp (first-line treatment) and at recurrence (second-line treatment). For each, a brief introduction, a temporal subdivision (when useful) or a specific drug-related paragraph were provided. Finally, the current trends and application of radiomics and artificial intelligence (AI) in the evaluation of treated GB have been outlined.
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Affiliation(s)
- Matia Martucci
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Rosellina Russo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Carolina Giordano
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Chiara Schiarelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Gabriella D’Apolito
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Laura Tuzza
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Francesca Lisi
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Giuseppe Ferrara
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Francesco Schimperna
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Stefania Vassalli
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
| | - Rosalinda Calandrelli
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
| | - Simona Gaudino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico “A. Gemelli” IRCCS, 00168 Rome, Italy; (R.R.); (C.G.); (C.S.); (G.D.); (R.C.); (S.G.)
- Istituto di Radiologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (L.T.); (F.L.); (G.F.); (F.S.); (S.V.)
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5
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Scola E, Del Vecchio G, Busto G, Bianchi A, Desideri I, Gadda D, Mancini S, Carlesi E, Moretti M, Desideri I, Muscas G, Della Puppa A, Fainardi E. Conventional and Advanced Magnetic Resonance Imaging Assessment of Non-Enhancing Peritumoral Area in Brain Tumor. Cancers (Basel) 2023; 15:cancers15112992. [PMID: 37296953 DOI: 10.3390/cancers15112992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
The non-enhancing peritumoral area (NEPA) is defined as the hyperintense region in T2-weighted and fluid-attenuated inversion recovery (FLAIR) images surrounding a brain tumor. The NEPA corresponds to different pathological processes, including vasogenic edema and infiltrative edema. The analysis of the NEPA with conventional and advanced magnetic resonance imaging (MRI) was proposed in the differential diagnosis of solid brain tumors, showing higher accuracy than MRI evaluation of the enhancing part of the tumor. In particular, MRI assessment of the NEPA was demonstrated to be a promising tool for distinguishing high-grade gliomas from primary lymphoma and brain metastases. Additionally, the MRI characteristics of the NEPA were found to correlate with prognosis and treatment response. The purpose of this narrative review was to describe MRI features of the NEPA obtained with conventional and advanced MRI techniques to better understand their potential in identifying the different characteristics of high-grade gliomas, primary lymphoma and brain metastases and in predicting clinical outcome and response to surgery and chemo-irradiation. Diffusion and perfusion techniques, such as diffusion tensor imaging (DTI), diffusional kurtosis imaging (DKI), dynamic susceptibility contrast-enhanced (DSC) perfusion imaging, dynamic contrast-enhanced (DCE) perfusion imaging, arterial spin labeling (ASL), spectroscopy and amide proton transfer (APT), were the advanced MRI procedures we reviewed.
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Affiliation(s)
- Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Guido Del Vecchio
- Radiodiagnostic Unit N. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50121 Florence, Italy
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Andrea Bianchi
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Ilaria Desideri
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Davide Gadda
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Sara Mancini
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Edoardo Carlesi
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Marco Moretti
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
| | - Isacco Desideri
- Radiation Oncology, Oncology Department, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Giovanni Muscas
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Alessandro Della Puppa
- Neurosurgery Unit, Department of Neuroscience, Psychology, Pharmacology and Child Health, Careggi University Hospital, University of Florence, 50121 Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, 50134 Florence, Italy
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, 50121 Florence, Italy
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6
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Bell JB, Jin W, Goryawala MZ, Azzam GA, Abramowitz MC, Diwanji T, Ivan ME, del Pilar Guillermo Prieto Eibl M, de la Fuente MI, Mellon EA. Delineation of recurrent glioblastoma by whole brain spectroscopic magnetic resonance imaging. Radiat Oncol 2023; 18:37. [PMID: 36814267 PMCID: PMC9948314 DOI: 10.1186/s13014-023-02219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) cellularity correlates with whole brain spectroscopic MRI (sMRI) generated relative choline to N-Acetyl-Aspartate ratio (rChoNAA) mapping. In recurrent GBM (rGBM), tumor volume (TV) delineation is challenging and rChoNAA maps may assist with re-RT targeting. METHODS Fourteen rGBM patients underwent sMRI in a prospective study. Whole brain sMRI was performed to generate rChoNAA maps. TVs were delineated by the union of rChoNAA ratio over 2 (rChoNAA > 2) on sMRI and T1PC. rChoNAA > 2 volumes were compared with multiparametric MRI sequences including T1PC, T2/FLAIR, diffusion-restriction on apparent diffusion coefficient (ADC) maps, and perfusion relative cerebral blood volume (rCBV). RESULTS rChoNAA > 2 (mean 27.6 cc, range 6.6-79.1 cc) was different from other imaging modalities (P ≤ 0.05). Mean T1PC volumes were 10.7 cc (range 1.2-31.4 cc). The mean non-overlapping volume of rChoNAA > 2 and T1PC was 29.2 cm3. rChoNAA > 2 was 287% larger (range 23% smaller-873% larger) than T1PC. T2/FLAIR volumes (mean 111.7 cc, range 19.0-232.7 cc) were much larger than other modalities. rCBV volumes (mean 6.2 cc, range 0.2-19.1 cc) and ADC volumes were tiny (mean 0.8 cc, range 0-3.7 cc). Eight in-field failures were observed. Three patients failed outside T1PC but within rChoNAA > 2. No grade 3 toxicities attributable to re-RT were observed. Median progression-free and overall survival for re-RT patients were 6.5 and 7.1 months, respectively. CONCLUSIONS Treatment of rGBM may be optimized by sMRI, and failure patterns suggest benefit for dose-escalation within sMRI-delineated volumes. Dose-escalation and radiologic-pathologic studies are underway to confirm the utility of sMRI in rGBM.
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Affiliation(s)
- Jonathan B. Bell
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - William Jin
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Mohammed Z. Goryawala
- grid.26790.3a0000 0004 1936 8606Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Gregory A. Azzam
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Matthew C. Abramowitz
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Tejan Diwanji
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
| | - Michael E. Ivan
- grid.26790.3a0000 0004 1936 8606Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Maria del Pilar Guillermo Prieto Eibl
- grid.26790.3a0000 0004 1936 8606Department of Neurology and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Macarena I. de la Fuente
- grid.26790.3a0000 0004 1936 8606Department of Neurology and Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL USA
| | - Eric A. Mellon
- grid.26790.3a0000 0004 1936 8606Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, 1475 NW 12th Ave, Miami, FL 33136 USA
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7
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Du N, Shu W, Li K, Deng Y, Xu X, Ye Y, Tang F, Mao R, Lin G, Li S, Fang X. An initial study on the predictive value using multiple MRI characteristics for Ki-67 labeling index in glioma. J Transl Med 2023; 21:119. [PMID: 36774480 PMCID: PMC9922464 DOI: 10.1186/s12967-023-03950-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/01/2023] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND AND PURPOSE Ki-67 labeling index (LI) is an important indicator of tumor cell proliferation in glioma, which can only be obtained by postoperative biopsy at present. This study aimed to explore the correlation between Ki-67 LI and apparent diffusion coefficient (ADC) parameters and to predict the level of Ki-67 LI noninvasively before surgery by multiple MRI characteristics. METHODS Preoperative MRI data of 166 patients with pathologically confirmed glioma in our hospital from 2016 to 2020 were retrospectively analyzed. The cut-off point of Ki-67 LI for glioma grading was defined. The differences in MRI characteristics were compared between the low and high Ki-67 LI groups. The receiver operating characteristic (ROC) curve was used to estimate the accuracy of each ADC parameter in predicting the Ki-67 level, and finally a multivariate logistic regression model was constructed based on the results of ROC analysis. RESULTS ADCmin, ADCmean, rADCmin, rADCmean and Ki-67 LI showed a negative correlation (r = - 0.478, r = - 0.369, r = - 0.488, r = - 0.388, all P < 0.001). The Ki-67 LI of low-grade gliomas (LGGs) was different from that of high-grade gliomas (HGGs), and the cut-off point of Ki-67 LI for distinguishing LGGs from HGGs was 9.5%, with an area under the ROC curve (AUROC) of 0.962 (95%CI 0.933-0.990). The ADC parameters in the high Ki-67 group were significantly lower than those in the low Ki-67 group (all P < 0.05). The peritumoral edema (PTE) of gliomas in the high Ki-67 LI group was higher than that in the low Ki-67 LI group (P < 0.05). The AUROC of Ki-67 LI level assessed by the multivariate logistic regression model was 0.800 (95%CI 0.721-0.879). CONCLUSIONS There was a negative correlation between ADC parameters and Ki-67 LI, and the multivariate logistic regression model combined with peritumoral edema and ADC parameters could improve the prediction ability of Ki-67 LI.
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Affiliation(s)
- Ningfang Du
- grid.8547.e0000 0001 0125 2443Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China
| | - Weiquan Shu
- grid.8547.e0000 0001 0125 2443Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Kefeng Li
- grid.266100.30000 0001 2107 4242School of Medicine, University of California, San Diego, CA USA ,Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao SAR, China
| | - Yao Deng
- grid.8547.e0000 0001 0125 2443Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Xinxin Xu
- grid.8547.e0000 0001 0125 2443Clinical Research Center for Gerontology, Huadong Hospital, Fudan University, Shanghai, China
| | - Yao Ye
- grid.8547.e0000 0001 0125 2443Department of Pathology, Huadong Hospital, Fudan University, Shanghai, China
| | - Feng Tang
- grid.8547.e0000 0001 0125 2443Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Renling Mao
- grid.8547.e0000 0001 0125 2443Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China
| | - Guangwu Lin
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China.
| | - Shihong Li
- Department of Radiology, Huadong Hospital, Fudan University, Shanghai, China.
| | - Xuhao Fang
- Department of Neurosurgery, Huadong Hospital, Fudan University, Shanghai, China.
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8
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Henssen D, Meijer F, Verburg FA, Smits M. Challenges and opportunities for advanced neuroimaging of glioblastoma. Br J Radiol 2023; 96:20211232. [PMID: 36062962 PMCID: PMC10997013 DOI: 10.1259/bjr.20211232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 08/10/2022] [Accepted: 08/25/2022] [Indexed: 11/05/2022] Open
Abstract
Glioblastoma is the most aggressive of glial tumours in adults. On conventional magnetic resonance (MR) imaging, these tumours are observed as irregular enhancing lesions with areas of infiltrating tumour and cortical expansion. More advanced imaging techniques including diffusion-weighted MRI, perfusion-weighted MRI, MR spectroscopy and positron emission tomography (PET) imaging have found widespread application to diagnostic challenges in the setting of first diagnosis, treatment planning and follow-up. This review aims to educate readers with regard to the strengths and weaknesses of the clinical application of these imaging techniques. For example, this review shows that the (semi)quantitative analysis of the mentioned advanced imaging tools was found useful for assessing tumour aggressiveness and tumour extent, and aids in the differentiation of tumour progression from treatment-related effects. Although these techniques may aid in the diagnostic work-up and (post-)treatment phase of glioblastoma, so far no unequivocal imaging strategy is available. Furthermore, the use and further development of artificial intelligence (AI)-based tools could greatly enhance neuroradiological practice by automating labour-intensive tasks such as tumour measurements, and by providing additional diagnostic information such as prediction of tumour genotype. Nevertheless, due to the fact that advanced imaging and AI-diagnostics is not part of response assessment criteria, there is no harmonised guidance on their use, while at the same time the lack of standardisation severely hampers the definition of uniform guidelines.
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Affiliation(s)
- Dylan Henssen
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
| | - Frederick Meijer
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
| | - Frederik A. Verburg
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
| | - Marion Smits
- Department of Medical Imaging, Radboud university medical
center, Nijmegen, The Netherlands
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9
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Prognostic Value of Choline and Other Metabolites Measured Using 1H-Magnetic Resonance Spectroscopy in Gliomas: A Meta-Analysis and Systemic Review. Metabolites 2022; 12:metabo12121219. [PMID: 36557257 PMCID: PMC9788620 DOI: 10.3390/metabo12121219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Glioma is the most prevalent primary central nervous system malignant tumor, with high heterogeneity observed among different grades; therefore, non-invasive prediction of prognosis could improve the clinical management of patients with glioma. 1H-magnetic resonance spectroscopy (MRS) can estimate metabolite levels non-invasively. Multiple studies have investigated its prognostic value in gliomas; however, no consensus has been reached. PubMed and Embase databases were searched up to 20 October 2022 to identify studies investigating the prognostic value of metabolites using 1H-MRS in patients with glioma. Heterogeneity across studies was evaluated using the Q and I2 tests, and a fixed- or random-effects model was used to estimate the combined overall hazard ratio (HR). Funnel plots and Begg tests were used to assess publication bias. Higher choline levels were associated with shorter overall survival (HR = 2.69, 95% CI, 1.92−2.99; p < 0.001) and progression-free survival (HR = 2.20, 95% CI, 1.16−4.17; p = 0.02) in all patients; however, in pediatric gliomas, it showed no significant correlation with overall survival (HR = 1.60, 95% CI, 0.97−2.64; p = 0.06). The estimated choline level by 1H-MRS could be used to non-invasively predict the prognosis of patients with adult gliomas, and more studies are needed to evaluate the prognostic value of other metabolites.
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10
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Zhou Z, Li Q, Pan C, Liang T, Zhang T, Xu P. Magnetic resonance spectroscopy and gadolinium enhancement assist in the diagnosis of nonalcoholic Marchiafava-Bignami disease with necrosis lesions: a case description. Quant Imaging Med Surg 2022; 12:1652-1657. [PMID: 35111657 DOI: 10.21037/qims-21-632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/26/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Zhiwei Zhou
- Soochow University Medical College, Suzhou, China.,Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qinghui Li
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Chengyu Pan
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tao Liang
- Soochow University Medical College, Suzhou, China.,Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Tijiang Zhang
- Department of Radiology, Affiliated Hospital of Zunyi Medical University, Medical Imaging Center of Guizhou Province, Zunyi, China
| | - Ping Xu
- Soochow University Medical College, Suzhou, China.,Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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11
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Qiu J, Deng K, Wang P, Chen C, Luo Y, Yuan S, Wen J. Application of diffusion kurtosis imaging to the study of edema in solid and peritumoral areas of glioma. Magn Reson Imaging 2021; 86:10-16. [PMID: 34793876 DOI: 10.1016/j.mri.2021.11.001] [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: 04/23/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE When gliomas grow in an infiltrative form, high-grade malignant glioma tissue extends beyond the contrast-enhancing tumor boundary, and this diffuse non-enhancing tumor infiltration is not visible on conventional MRI. The purpose of this study was to evaluate the of diffusion kurtosis imaging (DKI)-derived parameters in a group of patients with pre-operative gliomas, evaluating changes in the solid tumor and peritumoral edema area, and investigating their use for evaluating the recurrence and prognosis of gliomas. METHODS In this retrospective study, 51 patients with gliomas who underwent biopsy or surgery underwent DKI scans before surgery. DKI scans were performed to generate DKI parameter maps of the solid tumor and peritumoral edema areas. In the solid tumor area, the kurtosis parameters showed the highest area under the curve (AUC), sensitivity, and specificity for distinguishing high- and low-grade gliomas (all P < 0.01). RESULTS In the peritumoral edema area, significant differences were found between groups with grade III and IV gliomas (P < 0.05). DKI parameters were found to correlate with clinical Ki-67 scores within the solid tumor area (MK: R2 = 0.288, P < 0.001; Kr: R2 = 0.270, P < 0.001; Ka: R2 = 0.274, P < 0.001; MD: R2 = 0.223, P < 0.001; FA: R2 = 0.098, P < 0.01). No significant correlations were found between Ki-67 and kurtosis parameters of peritumoral edema. CONCLUSIONS In this study, DKI showed potential utility for studying solid tumor and peritumoral edema of high grade gliomas.
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Affiliation(s)
- Jun Qiu
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Kexue Deng
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Peng Wang
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Chuanyu Chen
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Yi Luo
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Shuya Yuan
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Jie Wen
- Department of Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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12
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Martín-Noguerol T, Mohan S, Santos-Armentia E, Cabrera-Zubizarreta A, Luna A. Advanced MRI assessment of non-enhancing peritumoral signal abnormality in brain lesions. Eur J Radiol 2021; 143:109900. [PMID: 34412007 DOI: 10.1016/j.ejrad.2021.109900] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/24/2021] [Accepted: 08/03/2021] [Indexed: 12/30/2022]
Abstract
Evaluation of Central Nervous System (CNS) focal lesions has been classically made focusing on the assessment solid or enhancing component. However, the assessment of solitary peripherally enhancing lesions where the differential diagnosis includes High-Grade Gliomas (HGG) and metastasis, is usually challenging. Several studies have tried to address the characteristics of peritumoral non-enhancing areas, for better characterization of these lesions. Peritumoral hyperintense T2/FLAIR signal abnormality predominantly contains infiltrating tumor cells in HGG whereas CNS metastasis induce pure vasogenic edema. In addition, the accurate determination of the real extension of HGG is critical for treatment selection and outcome. Conventional MRI sequences are limited in distinguishing infiltrating neoplasm from vasogenic edema. Advanced MRI sequences like Diffusion Weighted Imaging (DWI), Diffusion Tensor Imaging (DTI), Perfusion Weighted Imaging (PWI) and MR spectroscopy (MRS) have all been utilized for this aim with acceptable results. Other advanced MRI approaches, less explored for this task such as Arterial Spin Labelling (ASL), Diffusion Kurtosis Imaging (DKI), T2 relaxometry or Amide Proton Transfer (APT) are also showning promising results in this scenario. In this article, we will discuss the physiopathological basis of peritumoral T2/FLAIR signal abnormality and review potential applications of advanced MRI sequences for its evaluation.
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Affiliation(s)
| | - Suyash Mohan
- Division of Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Medica, Jaén, Spain.
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