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Li Z, Zhang H, Wang X, Yang Y, Zhang Y, Zhuang Y, Wei Z, Yang Q, Gao E, Zhang Y, Cai S, Chen Z, Cai C, Bao J, Cheng J. Preoperative Subtyping of WHO Grade 1 Meningiomas Using a Single-Shot Ultrafast MR T2 Mapping. J Magn Reson Imaging 2024; 60:964-976. [PMID: 38112331 DOI: 10.1002/jmri.29183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Meningioma subtype is crucial in treatment planning and prognosis delineation, for grade 1 meningiomas. T2 relaxometry could provide detailed microscopic information but is often limited by long scanning times. PURPOSE To investigate the potential of T2 maps derived from multiple overlapping-echo detachment imaging (MOLED) for predicting meningioma subtypes and Ki-67 index, and to compare the diagnostic efficiency of two different region-of-interest (ROI) placements (whole-tumor and contrast-enhanced, respectively). STUDY TYPE Prospective. PHANTOM/SUBJECTS A phantom containing 11 tubes of MnCl2 at different concentrations, eight healthy volunteers, and 75 patients with grade 1 meningioma. FIELD STRENGTH/SEQUENCE 3 T scanner. MOLED, T2-weighted spin-echo sequence, T2-dark-fluid sequence, and postcontrast T1-weighted gradient echo sequence. ASSESSMENT Two ROIs were delineated: the whole-tumor area (ROI1) and contrast-enhanced area (ROI2). Histogram parameters were extracted from T2 maps. Meningioma subtypes and Ki-67 index were reviewed by a neuropathologist according to the 2021 classification criteria. STATISTICAL TESTS Linear regression, Bland-Altman analysis, Pearson's correlation analysis, independent t test, Mann-Whitney U test, Kruskal-Wallis test with Bonferroni correction, and multivariate logistic regression analysis with the P-value significance level of 0.05. RESULTS The MOLED T2 sequence demonstrated excellent accuracy for phantoms and volunteers (Meandiff = -1.29%, SDdiff = 1.25% and Meandiff = 0.36%, SDdiff = 2.70%, respectively), and good repeatability for volunteers (average coefficient of variance = 1.13%; intraclass correlation coefficient = 0.877). For both ROI1 and ROI2, T2 variance had the highest area under the curves (area under the ROC curve = 0.768 and 0.761, respectively) for meningioma subtyping. There was no significant difference between the two ROIs (P = 0.875). Significant correlations were observed between T2 parameters and Ki-67 index (r = 0.237-0.374). DATA CONCLUSION MOLED T2 maps can effectively differentiate between meningothelial, fibrous, and transitional meningiomas. Moreover, T2 histogram parameters were significantly correlated with the Ki-67 index. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Zongye Li
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongyan Zhang
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiao Wang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yijie Yang
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen, China
| | - Yue Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuchuan Zhuang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Zhiliang Wei
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Qinqin Yang
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen, China
| | - Eryuan Gao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuhui Cai
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen, China
| | - Zhong Chen
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen, China
| | - Congbo Cai
- Fujian Provincial Key Laboratory of Plasma and Magnetic Resonance Research, Xiamen University, Xiamen, China
| | - Jianfeng Bao
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Chekhonin IV, Cohen O, Otazo R, Young RJ, Holodny AI, Pronin IN. Magnetic resonance relaxometry in quantitative imaging of brain gliomas: A literature review. Neuroradiol J 2024; 37:267-275. [PMID: 37133228 PMCID: PMC11138331 DOI: 10.1177/19714009231173100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Magnetic resonance (MR) relaxometry is a quantitative imaging method that measures tissue relaxation properties. This review discusses the state of the art of clinical proton MR relaxometry for glial brain tumors. Current MR relaxometry technology also includes MR fingerprinting and synthetic MRI, which solve the inefficiencies and challenges of earlier techniques. Despite mixed results regarding its capability for brain tumor differential diagnosis, there is growing evidence that MR relaxometry can differentiate between gliomas and metastases and between glioma grades. Studies of the peritumoral zones have demonstrated their heterogeneity and possible directions of tumor infiltration. In addition, relaxometry offers T2* mapping that can define areas of tissue hypoxia not discriminated by perfusion assessment. Studies of tumor therapy response have demonstrated an association between survival and progression terms and dynamics of native and contrast-enhanced tumor relaxometric profiles. In conclusion, MR relaxometry is a promising technique for glial tumor diagnosis, particularly in association with neuropathological studies and other imaging techniques.
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Affiliation(s)
- Ivan V Chekhonin
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
- Federal State Budgetary Institution V.P. Serbsky National Medical Research Centre for Psychiatry and Narcology of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
| | - Ouri Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrei I Holodny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Weill Medical College of Cornell University, New York, NY, USA
- Department of Neuroscience, Weill Cornell Graduate School of the Medical Sciences, New York, NY, USA
| | - Igor N Pronin
- Federal State Autonomous Institution N.N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russian Federation
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Sun W, Xu D, Li H, Li S, Bao Q, Song X, Topgaard D, Xu H. Quantifying H&E staining results, grading and predicting IDH mutation status of gliomas using hybrid multi-dimensional MRI. MAGMA (NEW YORK, N.Y.) 2024:10.1007/s10334-024-01154-x. [PMID: 38578520 DOI: 10.1007/s10334-024-01154-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To assess the performance of hybrid multi-dimensional magnetic resonance imaging (HM-MRI) in quantifying hematoxylin and eosin (H&E) staining results, grading and predicting isocitrate dehydrogenase (IDH) mutation status of gliomas. MATERIALS AND METHODS Included were 71 glioma patients (mean age, 50.17 ± 13.38 years; 35 men). HM-MRI images were collected at five different echo times (80-200 ms) with seven b-values (0-3000 s/mm2). A modified three-compartment model with very-slow, slow and fast diffusion components was applied to calculate HM-MRI metrics, including fractions, diffusion coefficients and T2 values of each component. Pearson correlation analysis was performed between HM-MRI derived fractions and H&E staining derived percentages. HM-MRI metrics were compared between high-grade and low-grade gliomas, and between IDH-wild and IDH-mutant gliomas. Using receiver operational characteristic (ROC) analysis, the diagnostic performance of HM-MRI in grading and genotyping was compared with mono-exponential models. RESULTS HM-MRI metrics FDvery-slow and FDslow demonstrated a significant correlation with the H&E staining results (p < .05). Besides, FDvery-slow showed the highest area under ROC curve (AUC = 0.854) for grading, while Dslow showed the highest AUC (0.845) for genotyping. Furthermore, a combination of HM-MRI metrics FDvery-slow and T2Dslow improved the diagnostic performance for grading (AUC = 0.876). DISCUSSION HM-MRI can aid in non-invasive diagnosis of gliomas.
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Affiliation(s)
- Wenbo Sun
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Dan Xu
- Department of Nuclear Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Huan Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Sirui Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China
| | - Qingjia Bao
- State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, 430071, Hubei, People's Republic of China
| | - Xiaopeng Song
- Central Research Institute, United-Imaging Healthcare, Shanghai, China
| | - Daniel Topgaard
- Department of Chemistry, Lund University, P.O.B. 124, 221 00, Lund, Sweden.
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, People's Republic of China.
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Zhou L, Nguyen TD, Chiang GC, Wang XH, Xi K, Hu T, Tanzi EB, Butler TA, de Leon MJ, Li Y. Parenchymal CSF fraction is a measure of brain glymphatic clearance and positively associated with amyloid beta deposition on PET. Alzheimers Dement 2024; 20:2047-2057. [PMID: 38184796 PMCID: PMC10984424 DOI: 10.1002/alz.13659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Mapping of microscopic changes in the perivascular space (PVS) of the cerebral cortex, beyond magnetic resonance-visible PVS in white matter, may enhance our ability to diagnose Alzheimer's disease (AD) early. METHODS We used the cerebrospinal fluid (CSF) water fraction (CSFF), a magnetic resonance imaging-based biomarker, to characterize brain parenchymal CSF water, reflecting microscopic PVS in parenchyma. We measured CSFF and amyloid beta (Aβ) using 11 C Pittsburgh compound B positron emission tomography to investigate their relationship at both the subject and voxel levels. RESULTS Our research has demonstrated a positive correlation between the parenchymal CSFF, a non-invasive imaging biomarker indicative of parenchymal glymphatic clearance, and Aβ deposition, observed at both individual and voxel-based assessments in the posterior cingulate cortex. DISCUSSION This study shows that an increased parenchymal CSFF is associated with Aβ deposition, suggesting that CSFF could serve as a biomarker for brain glymphatic clearance, which can be used to detect early fluid changes in PVS predisposing individuals to the development of AD. HIGHLIGHTS Cerebrospinal fluid fraction (CSFF) could be a biomarker of parenchymal perivascular space. CSFF is positively associated with amyloid beta (Aβ) deposition at subject level. CSFF in an Aβ+ region is higher than in an Aβ- region in the posterior cingulate cortex. Correspondence is found between Aβ deposition and glymphatic clearance deficits measured by CSFF.
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Affiliation(s)
- Liangdong Zhou
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Thanh D. Nguyen
- Department of RadiologyMRI Research Institute (MRIRI)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Gloria C. Chiang
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
- Department of RadiologyDivision of NeuroradiologyWeill Cornell MedicineNew York‐Presbyterian HospitalNew YorkNew YorkUSA
| | - Xiuyuan H. Wang
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Ke Xi
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Tsung‐Wei Hu
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Emily B. Tanzi
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Tracy A. Butler
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Mony J. de Leon
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
| | - Yi Li
- Department of RadiologyBrain Health Imaging Institute (BHII)Weill Cornell MedicineNew YorkNew YorkUSA
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Bontempi P, Rozzanigo U, Marangoni S, Fogazzi E, Ravanelli D, Cazzoletti L, Giometto B, Farace P. Non-lesional white matter in relapsing-remitting multiple sclerosis assessed by multicomponent T2 relaxation. Brain Behav 2023; 13:e3334. [PMID: 38041516 PMCID: PMC10726908 DOI: 10.1002/brb3.3334] [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: 08/29/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 12/03/2023] Open
Abstract
INTRODUCTION The purpose of the study is to investigate, by T2 relaxation, non-lesional white matter (WM) in relapsing-remitting (RR) multiple sclerosis (MS). METHODS Twenty stable RR MS patients underwent 1.5T Magnetic Resonance Imaging (MRI) with 3D Fluid-Attenuated Inversion-Recovery (FLAIR), 3D-T1-weighted, and T2-relaxation multi-echo sequences. The Lesion Segmentation Tool processed FLAIR images to identify focal lesions (FLs), whereas T1 images were segmented to identify WM and FL sub-volumes with T1 hypo-intensity. Non-lesional WM was obtained as the segmented WM, excluding FL volumes. The multi-echo sequence allowed decomposition into myelin water, intra-extracellular water, and free water (Fw), which were evaluated on the segmented non-lesional WM. Correlation analysis was performed between the non-lesional WM relaxation parameters and Expanded Disability Status Scale (EDSS), disease duration, patient age, and T1 hypo-intense FL volumes. RESULTS The T1 hypo-intense FL volumes correlated with EDSS. On the non-lesional WM, the median Fw correlated with EDSS, disease duration, age, and T1 hypo-intense FL volumes. Bivariate EDSS correlation of FL volumes and WM T2-relaxation parameters did not improve significance. CONCLUSION T2 relaxation allowed identifying subtle WM alterations, which significantly correlated with EDSS, disease duration, and age but do not seem to be EDSS-predictors independent from FL sub-volumes in stable RR patients. Particularly, the increase in the Fw component is suggestive of an uninvestigated prodromal phenomenon in brain degeneration.
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Affiliation(s)
- Pietro Bontempi
- Department of Engineering for Innovation MedicineUniversity of VeronaVeronaItaly
| | - Umberto Rozzanigo
- Neuro‐radiology Unit, Hospital of TrentoAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
| | - Sabrina Marangoni
- Neurology Unit, Hospital of TrentoAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
| | - Elena Fogazzi
- Physics departmentUniversity of TrentoPovoTrentoItaly
| | - Daniele Ravanelli
- Medical Physics Department, Hospital of TrentoAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
| | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | - Bruno Giometto
- Neurology Unit, Hospital of TrentoAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
| | - Paolo Farace
- Medical Physics Department, Hospital of TrentoAzienda Provinciale per i Servizi Sanitari (APSS)TrentoItaly
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Ben-Atya H, Freiman M. P 2T 2: A physically-primed deep-neural-network approach for robust T 2 distribution estimation from quantitative T 2-weighted MRI. Comput Med Imaging Graph 2023; 107:102240. [PMID: 37224742 DOI: 10.1016/j.compmedimag.2023.102240] [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: 01/13/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
Estimating T2 relaxation time distributions from multi-echo T2-weighted MRI (T2W) data can provide valuable biomarkers for assessing inflammation, demyelination, edema, and cartilage composition in various pathologies, including neurodegenerative disorders, osteoarthritis, and tumors. Deep neural network (DNN) based methods have been proposed to address the complex inverse problem of estimating T2 distributions from MRI data, but they are not yet robust enough for clinical data with low Signal-to-Noise ratio (SNR) and are highly sensitive to distribution shifts such as variations in echo-times (TE) used during acquisition. Consequently, their application is hindered in clinical practice and large-scale multi-institutional trials with heterogeneous acquisition protocols. We propose a physically-primed DNN approach, called P2T2, that incorporates the signal decay forward model in addition to the MRI signal into the DNN architecture to improve the accuracy and robustness of T2 distribution estimation. We evaluated our P2T2 model in comparison to both DNN-based methods and classical methods for T2 distribution estimation using 1D and 2D numerical simulations along with clinical data. Our model improved the baseline model's accuracy for low SNR levels (SNR<80) which are common in the clinical setting. Further, our model achieved a ∼35% improvement in robustness against distribution shifts in the acquisition process compared to previously proposed DNN models. Finally, Our P2T2 model produces the most detailed Myelin-Water fraction maps compared to baseline approaches when applied to real human MRI data. Our P2T2 model offers a reliable and precise means of estimating T2 distributions from MRI data and shows promise for use in large-scale multi-institutional trials with heterogeneous acquisition protocols. Our source code is available at: https://github.com/Hben-atya/P2T2-Robust-T2-estimation.git.
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Affiliation(s)
- Hadas Ben-Atya
- Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Moti Freiman
- Faculty of Biomedical Engineering, Technion - Israel Institute of Technology, Haifa, Israel
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Wang S, Chen L, Feng Y, Yin T, Yu J, De Keyzer F, Peeters R, Van Ongeval C, Bormans G, Swinnen J, Soete J, Wevers M, Li Y, Ni Y. Development and characterization of a rat brain metastatic tumor model by multiparametric magnetic resonance imaging and histomorphology. Clin Exp Metastasis 2022; 39:479-493. [PMID: 35218457 DOI: 10.1007/s10585-022-10155-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 02/06/2023]
Abstract
To facilitate the development of new brain metastasis (BM) treatment, an easy-to-use and clinically relevant animal model with imaging platform is needed. Rhabdomyosarcoma BM was induced in WAG/Rij rats. Post-implantation surveillance and characterizations were systematically performed with multiparametric MRI including 3D T1 and T2 weighted imaging, diffusion-weighted imaging (DWI), T1 and T2 mapping, and perfusion-weighted imaging (PWI), which were validated by postmortem digital radiography (DR), µCT angiography and histopathology. The translational potential was exemplified by the application of a vascular disrupting agent (VDA). BM was successfully induced in most rats of both genders (18/20). Multiparametric MRI revealed significantly higher T2 value, pre-contrast-enhanced (preCE) T1 value, DWI-derived apparent diffusion coefficient (ADC) and CE ratio, but a lower post-contrast-enhanced (postCE) T1 value in BM lesions than in adjacent brain (p < 0.01). PWI showed the dynamic and higher contrast agent uptake in the BM compared with the adjacent brain. DR, µCT and histopathology characterized the BM as hypervascular tumors. After VDA treatment, the BM showed drug-related perfusion changes and partial necrosis as evidenced by anatomical, functional MRI parameters and postmortem findings. The present BM model and imaging modalities represent a feasible and translational platform for developing BM-targeting therapeutics.
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Affiliation(s)
- Shuncong Wang
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium
| | - Lei Chen
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium
| | - Yuanbo Feng
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium
| | - Ting Yin
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium.,MR Collaborations, Siemens Healthineers Ltd, Shanghai, China
| | - Jie Yu
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium
| | - Frederik De Keyzer
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Ronald Peeters
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Chantal Van Ongeval
- Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Guy Bormans
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium
| | - Johan Swinnen
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium
| | - Jeroen Soete
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001, Leuven, Belgium
| | - Martine Wevers
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, 3001, Leuven, Belgium
| | - Yue Li
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium. .,Shanghai Key Laboratory of Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
| | - Yicheng Ni
- KU Leuven, Biomedical Group, Campus Gasthuisberg, 3000, Leuven, Belgium. .,Department of Radiology, University Hospitals Leuven, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Silva M, Vivancos C, Duffau H. The Concept of «Peritumoral Zone» in Diffuse Low-Grade Gliomas: Oncological and Functional Implications for a Connectome-Guided Therapeutic Attitude. Brain Sci 2022; 12:brainsci12040504. [PMID: 35448035 PMCID: PMC9032126 DOI: 10.3390/brainsci12040504] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/22/2022] Open
Abstract
Diffuse low-grade gliomas (DLGGs) are heterogeneous and poorly circumscribed neoplasms with isolated tumor cells that extend beyond the margins of the lesion depicted on MRI. Efforts to demarcate the glioma core from the surrounding healthy brain led us to define an intermediate region, the so-called peritumoral zone (PTZ). Although most studies about PTZ have been conducted on high-grade gliomas, the purpose here is to review the cellular, metabolic, and radiological characteristics of PTZ in the specific context of DLGG. A better delineation of PTZ, in which glioma cells and neural tissue strongly interact, may open new therapeutic avenues to optimize both functional and oncological results. First, a connectome-based “supratotal” surgical resection (i.e., with the removal of PTZ in addition to the tumor core) resulted in prolonged survival by limiting the risk of malignant transformation, while improving the quality of life, thanks to a better control of seizures. Second, the timing and order of (neo)adjuvant medical treatments can be modulated according to the pattern of peritumoral infiltration. Third, the development of new drugs specifically targeting the PTZ could be considered from an oncological (such as immunotherapy) and epileptological perspective. Further multimodal investigations of PTZ are needed to maximize long-term outcomes in DLGG patients.
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Affiliation(s)
- Melissa Silva
- Department of Neurosurgery, Hospital Garcia de Orta, 2805-267 Almada, Portugal;
| | - Catalina Vivancos
- Department of Neurosurgery, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 34295 Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors”, Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM) U1191, University of Montpellier, 34295 Montpellier, France
- Correspondence:
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Bontempi P, Scartoni D, Amelio D, Cianchetti M, Turkaj A, Amichetti M, Farace P. Multicomponent T 2 relaxometry reveals early myelin white matter changes induced by proton radiation treatment. Magn Reson Med 2021; 86:3236-3245. [PMID: 34268786 DOI: 10.1002/mrm.28913] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/21/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate MRI myelin water imaging (MWI) by multicomponent T2 relaxometry as a quantitative imaging biomarker for brain radiation-induced changes and to compare it with DTI. METHODS Sixteen patients underwent fractionated proton therapy (PT) receiving dose to the healthy tissue because of direct or indirect (base skull tumors) irradiation. MWI was performed by a multi-echo sequence with 32 equally spaced echoes (10-320 ms). Decay data were processed to identify 3 T2 compartments: myelin water (Mw) below 40 ms, intra-extracellular water (IEw) between 40 and 250 ms, and free water (CSFw) above 250 ms. Both MWI and DTI scans were acquired pre (pre)-treatment and immediately at the end (end) of PT. After image registration, voxel-wise difference maps, obtained by subtracting MWI and DTI pre from those acquired at the end of PT, were compared with the corresponding biological equivalent dose (BED). RESULTS Mw difference showed a positive correlation and IEw difference showed a negative correlation with BED considering end-pre changes (P < .01). The changes in CSFw were not significantly correlated with the delivered BED. The changes in DTI data, considering end-pre acquisitions, showed a positive correlation between fractional anisotropy and the delivered BED. CONCLUSION MWI might detect early white matter radiation-induced alterations, providing additional information to DTI, which might improve the understanding of the pathogenesis of the radiation damage.
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Affiliation(s)
- Pietro Bontempi
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Daniele Scartoni
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Dante Amelio
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Marco Cianchetti
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Ana Turkaj
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Maurizio Amichetti
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Paolo Farace
- Proton Therapy Unit, Hospital of Trento, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
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