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Ziegenfeuter J, Delbridge C, Bernhardt D, Gempt J, Schmidt-Graf F, Hedderich D, Griessmair M, Thomas M, Meyer HS, Zimmer C, Meyer B, Combs SE, Yakushev I, Metz MC, Wiestler B. Resolving spatial response heterogeneity in glioblastoma. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06782-y. [PMID: 38837060 DOI: 10.1007/s00259-024-06782-y] [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: 02/28/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Spatial intratumoral heterogeneity poses a significant challenge for accurate response assessment in glioblastoma. Multimodal imaging coupled with advanced image analysis has the potential to unravel this response heterogeneity. METHODS Based on automated tumor segmentation and longitudinal registration with follow-up imaging, we categorized contrast-enhancing voxels of 61 patients with suspected recurrence of glioblastoma into either true tumor progression (TP) or pseudoprogression (PsP). To allow the unbiased analysis of semantically related image regions, adjacent voxels with similar values of cerebral blood volume (CBV), FET-PET, and contrast-enhanced T1w were automatically grouped into supervoxels. We then extracted first-order statistics as well as texture features from each supervoxel. With these features, a Random Forest classifier was trained and validated employing a 10-fold cross-validation scheme. For model evaluation, the area under the receiver operating curve, as well as classification performance metrics were calculated. RESULTS Our image analysis pipeline enabled reliable spatial assessment of tumor response. The predictive model reached an accuracy of 80.0% and a macro-weighted AUC of 0.875, which takes class imbalance into account, in the hold-out samples from cross-validation on supervoxel level. Analysis of feature importances confirmed the significant role of FET-PET-derived features. Accordingly, TP- and PsP-labeled supervoxels differed significantly in their 10th and 90th percentile, as well as the median of tumor-to-background normalized FET-PET. However, CBV- and T1c-related features also relevantly contributed to the model's performance. CONCLUSION Disentangling the intratumoral heterogeneity in glioblastoma holds immense promise for advancing precise local response evaluation and thereby also informing more personalized and localized treatment strategies in the future.
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Affiliation(s)
- Julian Ziegenfeuter
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany.
| | - Claire Delbridge
- Department of Pathology, Technical University of Munich, 81675, München, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Dennis Hedderich
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Michael Griessmair
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Marie Thomas
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Hanno S Meyer
- Department of Neurosurgery, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Marie-Christin Metz
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675, München, Germany
- TranslaTUM, Technical University of Munich, 81675, München, Germany
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Wongsawaeng D, Schwartz D, Li X, Muldoon LL, Stoller J, Stateler C, Holland S, Szidonya L, Rooney WD, Wyatt C, Ambady P, Fu R, Neuwelt EA, Barajas RF. Comparison of dynamic susceptibility contrast (DSC) using gadolinium and iron-based contrast agents in high-grade glioma at high-field MRI. Neuroradiol J 2024:19714009241242596. [PMID: 38544404 DOI: 10.1177/19714009241242596] [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] [Indexed: 04/12/2024] Open
Abstract
PURPOSE To compare DSC-MRI using Gadolinium (GBCA) and Ferumoxytol (FBCA) in high-grade glioma at 3T and 7T MRI field strengths. We hypothesized that using FBCA at 7T would enhance the performance of DSC, as measured by contrast-to-noise ratio (CNR). METHODS Ten patients (13 lesions) were assigned to 3T (6 patients, 6 lesions) or 7T (4 patients, 7 lesions). All lesions received 0.1 mmol/kg of GBCA on day 1. Ten lesions (4 at 3T and 6 at 7T) received a lower dose (0.6 mg/kg) of FBCA, followed by a higher dose (1.0-1.2 mg/kg), while 3 lesions (2 at 3T and 1 at 7T) received only a higher dose on Day 2. CBV maps with leakage correction for GBCA but not for FBCA were generated. The CNR and normalized CBV (nCBV) were analyzed on enhancing and non-enhancing high T2W lesions. RESULTS Regardless of FBCA dose, GBCA showed higher CNR than FBCA at 7T, which was significant for high-dose FBCA (p < .05). Comparable CNR between GBCA and high-dose FBCA was observed at 3T. There was a trend toward higher CNR for FBCA at 3T than 7T. GBCA also showed nCBV twice that of FBCA at both MRI field strengths with significance at 7T. CONCLUSION GBCA demonstrated higher image conspicuity, as measured by CNR, than FBCA on 7T. The stronger T2* weighting realized with higher magnetic field strength, combined with FBCA, likely results in more signal loss rather than enhanced performance on DSC. However, at clinical 3T, both GBCA and FBCA, particularly a dosage of 1.0-1.2 mg/kg (optimal for perfusion imaging), yielded comparable CNR.
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Affiliation(s)
- Doonyaporn Wongsawaeng
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Daniel Schwartz
- Advanced Imaging Research Center, Oregon Health and Science University, USA
| | - Xin Li
- Advanced Imaging Research Center, Oregon Health and Science University, USA
| | - Leslie L Muldoon
- Department of Neurology, Oregon Health & Science University, USA
| | - Jared Stoller
- Department of Radiology, Oregon Health & Science University, USA
| | | | - Samantha Holland
- Department of Neurology, Oregon Health & Science University, USA
| | - Laszlo Szidonya
- Department of Radiology, Oregon Health & Science University, USA
| | - William D Rooney
- Advanced Imaging Research Center, Oregon Health and Science University, USA
| | - Cory Wyatt
- Department of Radiology, Oregon Health & Science University, USA
| | | | - Rongwei Fu
- School of Public Health, Oregon Health & Science University, USA
| | - Edward A Neuwelt
- Department of Neurology, Oregon Health & Science University, USA
- Department of Neurosurgery, Oregon Health & Science University, USA
| | - Ramon F Barajas
- Advanced Imaging Research Center, Oregon Health and Science University, USA
- Department of Radiology, Oregon Health & Science University, USA
- Knight Cancer Institute, Oregon Health & Science University, USA
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Alafandi A, Tbalvandany SS, Arzanforoosh F, van Der Voort SR, Incekara F, Verhoef L, Warnert EAH, Kruizinga P, Smits M. Probing the glioma microvasculature: a case series of the comparison between perfusion MRI and intraoperative high-frame-rate ultrafast Doppler ultrasound. Eur Radiol Exp 2024; 8:13. [PMID: 38273190 PMCID: PMC10810769 DOI: 10.1186/s41747-023-00406-0] [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: 07/03/2023] [Accepted: 11/07/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND We aimed to describe the microvascular features of three types of adult-type diffuse glioma by comparing dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) with intraoperative high-frame-rate ultrafast Doppler ultrasound. METHODS Case series of seven patients with primary brain tumours underwent both DSC perfusion MRI and intra-operative high-frame-rate ultrafast Doppler ultrasound. From the ultrasound images, three-dimensional vessel segmentation was obtained of the tumour vascular bed. Relative cerebral blood volume (rCBV) maps were generated with leakage correction and normalised to the contralateral normal-appearing white matter. From tumour histograms, median, mean, and maximum rCBV ratios were extracted. RESULTS Low-grade gliomas (LGGs) showed lower perfusion than high-grade gliomas (HGGs), as expected. Within the LGG subgroup, oligodendroglioma showed higher perfusion than astrocytoma. In HGG, the median rCBV ratio for glioblastoma was 3.1 while astrocytoma grade 4 showed low perfusion with a median rCBV of 1.2. On the high-frame-rate ultrafast Doppler ultrasound images, all tumours showed a range of rich and organised vascular networks with visually apparent abnormal vessels, even in LGG. CONCLUSIONS This unique case series revealed in vivo insights about the microvascular architecture in both LGGs and HGGs. Ultrafast Doppler ultrasound revealed rich vascularisation, also in tumours with low perfusion at DSC MRI. These findings warrant further investigations using advanced MRI postprocessing, in particular for characterising adult-type diffuse glioma. RELEVANCE STATEMENT Our findings challenge the current assumption behind the estimation of relative cerebral blood volume that the distribution of blood vessels in a voxel is random. KEY POINTS • Ultrafast Doppler ultrasound revealed rich vascularity irrespective of perfusion dynamic susceptibility contrast MRI state. • Rich and organised vascularisation was also observed even in low-grade glioma. • These findings challenge the assumptions for cerebral blood volume estimation with MRI.
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Affiliation(s)
- Ahmad Alafandi
- Department of Radiology & Nuclear Medicine, Erasmus MC, Dr.Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sadaf Soloukey Tbalvandany
- Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Fatemeh Arzanforoosh
- Department of Radiology & Nuclear Medicine, Erasmus MC, Dr.Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Sebastian R van Der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, Dr.Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Fatih Incekara
- Department of Radiology & Nuclear Medicine, Erasmus MC, Dr.Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands
| | - Luuk Verhoef
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Esther A H Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, Dr.Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands
| | - Pieter Kruizinga
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, Dr.Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.
- Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
- Medical Delta, Delft, The Netherlands.
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Griessmair M, Delbridge C, Ziegenfeuter J, Jung K, Mueller T, Schramm S, Bernhardt D, Schmidt-Graf F, Kertels O, Thomas M, Zimmer C, Meyer B, Combs SE, Yakushev I, Wiestler B, Metz MC. Exploring molecular glioblastoma: Insights from advanced imaging for a nuanced understanding of the molecularly defined malignant biology. Neurooncol Adv 2024; 6:vdae106. [PMID: 39114182 PMCID: PMC11304596 DOI: 10.1093/noajnl/vdae106] [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: 08/10/2024] Open
Abstract
Background Molecular glioblastoma (molGB) does not exhibit the histologic hallmarks of a grade 4 glioma but is nevertheless diagnosed as glioblastoma when harboring specific molecular markers. MolGB can easily be mistaken for similar-appearing lower-grade astrocytomas. Here, we investigated how advanced imaging could reflect the underlying tumor biology. Methods Clinical and imaging data were collected for 7 molGB grade 4, 9 astrocytomas grade 2, and 12 astrocytomas grade 3. Four neuroradiologists performed VASARI-scoring of conventional imaging, and their inter-reader agreement was assessed using Fleiss κ coefficient. To evaluate the potential of advanced imaging, 2-sample t test, 1-way ANOVA, Mann-Whitney U, and Kruskal-Wallis test were performed to test for significant differences between apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) that were extracted fully automatically from the whole tumor volume. Results While conventional VASARI imaging features did not allow for reliable differentiation between glioma entities, rCBV was significantly higher in molGB compared to astrocytomas for the 5th and 95th percentile, mean, and median values (P < .05). ADC values were significantly lower in molGB than in astrocytomas for mean, median, and the 95th percentile (P < .05). Although no molGB showed contrast enhancement initially, we observed enhancement in the short-term follow-up of 1 patient. Discussion Quantitative analysis of diffusion and perfusion parameters shows potential in reflecting the malignant tumor biology of molGB. It may increase awareness of molGB in a nonenhancing, "benign" appearing tumor. Our results support the emerging hypothesis that molGB might present glioblastoma captured at an early stage of gliomagenesis.
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Affiliation(s)
- Michael Griessmair
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | | | - Julian Ziegenfeuter
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Kirsten Jung
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Tobias Mueller
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Severin Schramm
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | | | - Olivia Kertels
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Marie Thomas
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
| | - Marie-Christin Metz
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, Munich, Germany
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Arzanforoosh F, Van der Velden M, Berman AJL, Van der Voort SR, Bos EM, Schouten JW, Vincent AJPE, Kros JM, Smits M, Warnert EAH. MRI-Based Assessment of Brain Tumor Hypoxia: Correlation with Histology. Cancers (Basel) 2023; 16:138. [PMID: 38201565 PMCID: PMC10778427 DOI: 10.3390/cancers16010138] [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: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Cerebral hypoxia significantly impacts the progression of brain tumors and their resistance to radiotherapy. This study employed streamlined quantitative blood-oxygen-level-dependent (sqBOLD) MRI to assess the oxygen extraction fraction (OEF)-a measure of how much oxygen is being extracted from vessels, with higher OEF values indicating hypoxia. Simultaneously, we utilized vessel size imaging (VSI) to evaluate microvascular dimensions and blood volume. A cohort of ten patients, divided between those with glioma and those with brain metastases, underwent a 3 Tesla MRI scan. We generated OEF, cerebral blood volume (CBV), and vessel size maps, which guided 3-4 targeted biopsies per patient. Subsequent histological analyses of these biopsies used hypoxia-inducible factor 1-alpha (HIF-1α) for hypoxia and CD31 for microvasculature assessment, followed by a correlation analysis between MRI and histological data. The results showed that while the sqBOLD model was generally applicable to brain tumors, it demonstrated discrepancies in some metastatic tumors, highlighting the need for model adjustments in these cases. The OEF, CBV, and vessel size maps provided insights into the tumor's hypoxic condition, showing intertumoral and intratumoral heterogeneity. A significant relationship between MRI-derived measurements and histological data was only evident in the vessel size measurements (r = 0.68, p < 0.001).
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Affiliation(s)
- Fatemeh Arzanforoosh
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Maaike Van der Velden
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Avery J. L. Berman
- Department of Physics, Carleton University, Ottawa, ON K1S 5B6, Canada
- Institute of Mental Health Research, Royal Ottawa Mental Health Centre, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Sebastian R. Van der Voort
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Eelke M. Bos
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Joost W. Schouten
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Arnaud J. P. E. Vincent
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Johan M. Kros
- Department of Pathology, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Medical Delta, 2629 JH Delft, The Netherlands
| | - Esther A. H. Warnert
- Department of Radiology & Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumour Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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Ioannidis GS, Pigott LE, Iv M, Surlan-Popovic K, Wintermark M, Bisdas S, Marias K. Investigating the value of radiomics stemming from DSC quantitative biomarkers in IDH mutation prediction in gliomas. Front Neurol 2023; 14:1249452. [PMID: 38046592 PMCID: PMC10690367 DOI: 10.3389/fneur.2023.1249452] [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: 06/28/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Objective This study aims to assess the value of biomarker based radiomics to predict IDH mutation in gliomas. The patient cohort consists of 160 patients histopathologicaly proven of primary glioma (WHO grades 2-4) from 3 different centers. Methods To quantify the DSC perfusion signal two different mathematical modeling methods were used (Gamma fitting, leakage correction algorithms) considering the assumptions about the compartments contributing in the blood flow between the extra- and intra vascular space. Results The Mean slope of increase (MSI) and the K1 parameter of the bidirectional exchange model exhibited the highest performance with (ACC 74.3% AUROC 74.2%) and (ACC 75% AUROC 70.5%) respectively. Conclusion The proposed framework on DSC-MRI radiogenomics in gliomas has the potential of becoming a reliable diagnostic support tool exploiting the mathematical modeling of the DSC signal to characterize IDH mutation status through a more reproducible and standardized signal analysis scheme for facilitating clinical translation.
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Affiliation(s)
- Georgios S. Ioannidis
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology—Hellas (FORTH), Heraklion, Greece
| | - Laura Elin Pigott
- Institute of Health and Social Care, London South Bank University, London, United Kingdom
- Faculty of Brain Science, Queen Square Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery University College London, London, United Kingdom
| | - Michael Iv
- Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, CA, United States
| | - Katarina Surlan-Popovic
- Department of Radiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Neuroradiology, University Medical Centre, Ljubljana, Slovenia
| | - Max Wintermark
- Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University, Stanford, CA, United States
| | - Sotirios Bisdas
- Department of Brain Repair and Rehabilitation, Queen Square Institute of Neurology, UCL, London, United Kingdom
- Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom
| | - Kostas Marias
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology—Hellas (FORTH), Heraklion, Greece
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, Heraklion, Greece
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7
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Griessmair M, Delbridge C, Ziegenfeuter J, Bernhardt D, Gempt J, Schmidt-Graf F, Kertels O, Thomas M, Meyer HS, Zimmer C, Meyer B, Combs SE, Yakushev I, Wiestler B, Metz MC. Imaging the WHO 2021 Brain Tumor Classification: Fully Automated Analysis of Imaging Features of Newly Diagnosed Gliomas. Cancers (Basel) 2023; 15:2355. [PMID: 37190283 PMCID: PMC10136825 DOI: 10.3390/cancers15082355] [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: 01/22/2023] [Revised: 03/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The fifth version of the World Health Organization (WHO) classification of tumors of the central nervous system (CNS) in 2021 brought substantial changes. Driven by the enhanced implementation of molecular characterization, some diagnoses were adapted while others were newly introduced. How these changes are reflected in imaging features remains scarcely investigated. MATERIALS AND METHODS We retrospectively analyzed 226 treatment-naive primary brain tumor patients from our institution who received extensive molecular characterization by epigenome-wide methylation microarray and were diagnosed according to the 2021 WHO brain tumor classification. From multimodal preoperative 3T MRI scans, we extracted imaging metrics via a fully automated, AI-based image segmentation and processing pipeline. Subsequently, we examined differences in imaging features between the three main glioma entities (glioblastoma, astrocytoma, and oligodendroglioma) and particularly investigated new entities such as astrocytoma, WHO grade 4. RESULTS Our results confirm prior studies that found significantly higher median CBV (p = 0.00003, ANOVA) and lower median ADC in contrast-enhancing areas of glioblastomas, compared to astrocytomas and oligodendrogliomas (p = 0.41333, ANOVA). Interestingly, molecularly defined glioblastoma, which usually does not contain contrast-enhancing areas, also shows significantly higher CBV values in the non-enhancing tumor than common glioblastoma and astrocytoma grade 4 (p = 0.01309, ANOVA). CONCLUSIONS This work provides extensive insights into the imaging features of gliomas in light of the new 2021 WHO CNS tumor classification. Advanced imaging shows promise in visualizing tumor biology and improving the diagnosis of brain tumor patients.
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Affiliation(s)
- Michael Griessmair
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Claire Delbridge
- Department of Pathology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Julian Ziegenfeuter
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | | | - Olivia Kertels
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Marie Thomas
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Hanno S. Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Igor Yakushev
- Department of Nuclear Medicine, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
- TranslaTUM, TU Munich, 81675 Munich, Germany
| | - Marie-Christin Metz
- Department of Neuroradiology, Klinikum Rechts der Isar, TU Munich, 81675 Munich, Germany
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8
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Venugopal K, Arzanforoosh F, van Dorth D, Smits M, van Osch MJP, Hernandez-Tamames JA, Warnert EAH, Poot DHJ. MR Vascular Fingerprinting with Hybrid Gradient–Spin Echo Dynamic Susceptibility Contrast MRI for Characterization of Microvasculature in Gliomas. Cancers (Basel) 2023; 15:cancers15072180. [PMID: 37046841 PMCID: PMC10093700 DOI: 10.3390/cancers15072180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/08/2023] Open
Abstract
Characterization of tumor microvasculature is important in tumor assessment and studying treatment response. This is possible by acquiring vascular biomarkers with magnetic resonance imaging (MRI) based on dynamic susceptibility contrast (DSC). We propose magnetic resonance vascular fingerprinting (MRVF) for hybrid echo planar imaging (HEPI) acquired during the first passage of the contrast agent (CA). The proposed approach was evaluated in patients with gliomas, and we simultaneously estimated vessel radius and relative cerebral blood volume. These parameters were also compared to the respective values estimated using the previously introduced vessel size imaging (VSI) technique. The results of both methods were found to be consistent. MRVF was also found to be robust to noise in the estimation of the parameters. DSC-HEPI-based MRVF provides characterization of microvasculature in gliomas with a short acquisition time and can be further improved in several ways to increase our understanding of tumor physiology.
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Affiliation(s)
- Krishnapriya Venugopal
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Fatemeh Arzanforoosh
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Daniëlle van Dorth
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Matthias J. P. van Osch
- C. J. Gorter MRI Center, Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Juan A. Hernandez-Tamames
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Medical Imaging, Faculty of Applied Physics, Delft University of Technology, 2628 CD Delft, The Netherlands
| | - Esther A. H. Warnert
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Dirk H. J. Poot
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Erasmus MC Cancer Institute, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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9
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Arzanforoosh F, van der Voort SR, Incekara F, Vincent A, Van den Bent M, Kros JM, Smits M, Warnert EAH. Microvasculature Features Derived from Hybrid EPI MRI in Non-Enhancing Adult-Type Diffuse Glioma Subtypes. Cancers (Basel) 2023; 15:cancers15072135. [PMID: 37046796 PMCID: PMC10093697 DOI: 10.3390/cancers15072135] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/07/2023] Open
Abstract
In this study, we used the vessel size imaging (VSI) MRI technique to characterize the microvasculature features of three subtypes of adult-type diffuse glioma lacking enhancement. Thirty-eight patients with confirmed non-enhancing glioma were categorized into three subtypes: Oligo (IDH-mut&1p/19q-codeleted), Astro (IDH-mut), and GBM (IDH-wt). The VSI technique provided quantitative maps of cerebral blood volume (CBV), microvasculature (µCBV), and vessel size for each patient. Additionally, tissue samples of 21 patients were histopathologically analyzed, and microvasculature features were quantified. Both MRI- and histology-derived features were compared across the three glioma subtypes with ANOVA or Kruskal–Wallis tests. Group averages of CBV, μCBV, and vessel size were significantly different between the three glioma subtypes (p < 0.01). Astro (IDH-mut) had a significantly lower CBV and µCBV compared to Oligo (IDH-mut&1p/19q-codeleted) (p = 0.004 and p = 0.001, respectively), and a higher average vessel size compared to GBM (IDH-wt) (p = 0.01). The histopathological analysis showed that GBM (IDH-wt) possessed vessels with more irregular shapes than the two other subtypes (p < 0.05). VSI provides a good insight into the microvasculature characteristics of the three adult-type glioma subtypes even when lacking enhancement. Further investigations into the specificity of VSI to differentiate glioma subtypes are thus warranted.
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Affiliation(s)
- Fatemeh Arzanforoosh
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Sebastian R. van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
| | - Fatih Incekara
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Arnaud Vincent
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Neurosurgery, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Martin Van den Bent
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Neurology, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Johan M. Kros
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC, 3000 CB Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
- Medical Delta, 2629 JH Delft, The Netherlands
| | - Esther A. H. Warnert
- Department of Radiology and Nuclear Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
- Brain Tumor Center, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands
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Sequential and Hybrid PET/MRI Acquisition in Follow-Up Examination of Glioblastoma Show Similar Diagnostic Performance. Cancers (Basel) 2022; 15:cancers15010083. [PMID: 36612079 PMCID: PMC9817523 DOI: 10.3390/cancers15010083] [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] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022] Open
Abstract
Both positron emission tomography (PET) and magnetic resonance imaging (MRI), including dynamic susceptibility contrast perfusion (DSC-PWI), are crucial for treatment monitoring of patients with high-grade gliomas. In clinical practice, they are usually conducted at separate time points. Whether this affects their diagnostic performance is presently unclear. To this end, we retrospectively reviewed 38 patients with pathologically confirmed glioblastoma (IDH wild-type) and suspected tumor recurrence after radiotherapy. Only patients who received both a PET−MRI (where DSC perfusion was acquired simultaneously with a FET-PET) and a separate MRI exam (including DSC perfusion) were included. Tumors were automatically segmented into contrast-enhancing tumor (CET), necrosis, and edema. To compare the simultaneous as well as the sequential DSC perfusion to the FET-PET, we calculated Dice overlap, global mutual information as well as voxel-wise Spearman correlation of hotspot areas. For the joint assessment of PET and MRI, we computed logistic regression models for the differentiation between true progression (PD) and treatment-related changes (TRC) using simultaneously or sequentially acquired images as input data. We observed no significant differences between Dice overlap (p = 0.17; paired t-test), mutual information (p = 0.18; paired t-test) and Spearman correlation (p = 0.90; paired t-test) when comparing simultaneous PET−MRI and sequential PET/MRI acquisition. This also held true for the subgroup of patients with >14 days between exams. Importantly, for the diagnostic performance, ROC analysis showed similar AUCs for differentiation of PD and TRC (AUC simultaneous PET: 0.77; AUC sequential PET: 0.78; p = 0.83, DeLong’s test). We found no relevant differences between simultaneous and sequential acquisition of FET-PET and DSC perfusion, also regarding their diagnostic performance. Given the increasing attention to multi-parametric assessment of glioma treatment response, our results reassuringly suggest that sequential acquisition is clinically and scientifically acceptable.
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Hu Z, Li F, Shui J, Tang Y, Lin Q. A Novel Statistical Optimization Algorithm for Estimating Perfusion Curves in Susceptibility Contrast-Enhanced MRI. Front Neurosci 2021; 15:713893. [PMID: 34512247 PMCID: PMC8427443 DOI: 10.3389/fnins.2021.713893] [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: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022] Open
Abstract
Dynamic susceptibility contrast-enhanced magnetic resonance imaging is an important tool for evaluating intravascular indicator dynamics, which in turn is valuable for understanding brain physiology and pathophysiology. This procedure usually involves fitting a gamma-variate function to observed concentration-time curves in order to eliminate undesired effects of recirculation and the leakage of contrast agents. Several conventional curve-fitting approaches are routinely applied. The nonlinear optimization methods typically are computationally expensive and require reliable initial values to guarantee success, whereas a logarithmic linear least-squares (LL-LS) method is more stable and efficient, and does not suffer from the initial-value problem, but it can show degraded performance, especially when a few data or outliers are present. In this paper, we demonstrate, that the original perfusion curve-fitting problem can be transformed into a gamma-distribution-fitting problem by treating the concentration-time curves as a random sample from a gamma distribution with time as the random variable. A robust maximum-likelihood estimation (MLE) algorithm can then be readily adopted to solve this problem. The performance of the proposed method is compared with the nonlinear Levenberg-Marquardt (L-M) method and the LL-LS method using both synthetic and real data. The results show that the performance of the proposed approach is far superior to those of the other two methods, while keeping the advantages of the LL-LS method, such as easy implementation, low computational load, and dispensing with the need to guess the initial values. We argue that the proposed method represents an attractive alternative option for assessing intravascular indicator dynamics in clinical applications. Moreover, we also provide valuable suggestions on how to select valid data points and set the initial values in the two traditional approaches (LL-LS and nonlinear L-M methods) to achieve more reliable estimations.
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Affiliation(s)
- Zhenghui Hu
- Key Laboratory of Quantum Precision Measurement, College of Science, Zhejiang University of Technology, Hangzhou, China
| | - Fei Li
- Key Laboratory of Quantum Precision Measurement, College of Science, Zhejiang University of Technology, Hangzhou, China
- College of Information Engineering, Zhejiang University of Technology, Hangzhou, China
| | - Junhui Shui
- Key Laboratory of Quantum Precision Measurement, College of Science, Zhejiang University of Technology, Hangzhou, China
| | - Yituo Tang
- Key Laboratory of Quantum Precision Measurement, College of Science, Zhejiang University of Technology, Hangzhou, China
| | - Qiang Lin
- Key Laboratory of Quantum Precision Measurement, College of Science, Zhejiang University of Technology, Hangzhou, China
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