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Familiar AM, Fathi Kazerooni A, Vossough A, Ware JB, Bagheri S, Khalili N, Anderson H, Haldar D, Storm PB, Resnick AC, Kann BH, Aboian M, Kline C, Weller M, Huang RY, Chang SM, Fangusaro JR, Hoffman LM, Mueller S, Prados M, Nabavizadeh A. Towards consistency in pediatric brain tumor measurements: Challenges, solutions, and the role of artificial intelligence-based segmentation. Neuro Oncol 2024; 26:1557-1571. [PMID: 38769022 PMCID: PMC11376457 DOI: 10.1093/neuonc/noae093] [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: 02/13/2024] [Indexed: 05/22/2024] Open
Abstract
MR imaging is central to the assessment of tumor burden and changes over time in neuro-oncology. Several response assessment guidelines have been set forth by the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working groups in different tumor histologies; however, the visual delineation of tumor components using MRIs is not always straightforward, and complexities not currently addressed by these criteria can introduce inter- and intra-observer variability in manual assessments. Differentiation of non-enhancing tumors from peritumoral edema, mild enhancement from absence of enhancement, and various cystic components can be challenging; particularly given a lack of sufficient and uniform imaging protocols in clinical practice. Automated tumor segmentation with artificial intelligence (AI) may be able to provide more objective delineations, but rely on accurate and consistent training data created manually (ground truth). Herein, this paper reviews existing challenges and potential solutions to identifying and defining subregions of pediatric brain tumors (PBTs) that are not explicitly addressed by current guidelines. The goal is to assert the importance of defining and adopting criteria for addressing these challenges, as it will be critical to achieving standardized tumor measurements and reproducible response assessment in PBTs, ultimately leading to more precise outcome metrics and accurate comparisons among clinical studies.
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Affiliation(s)
- Ariana M Familiar
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Anahita Fathi Kazerooni
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- AI2D Center for AI and Data Science for Integrated Diagnostics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Arastoo Vossough
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jeffrey B Ware
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sina Bagheri
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nastaran Khalili
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hannah Anderson
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Debanjan Haldar
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Phillip B Storm
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam C Resnick
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Benjamin H Kann
- Department of Radiation Oncology, Dana-Farber Cancer Institute | Brigham and Women's Hospital | Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mariam Aboian
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Cassie Kline
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susan M Chang
- Division of Neuro-Oncology, Department of Neurosurgery, University of California, San Francisco, California, USA
| | - Jason R Fangusaro
- The Aflac Cancer Center, Children's Healthcare of Atlanta and the Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lindsey M Hoffman
- Division of Hematology/Oncology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Sabine Mueller
- Department of Neurology, Neurosurgery and Pediatrics, University of California, San Francisco, California, USA
| | - Michael Prados
- Department of Neurosurgery and Pediatrics, University of California, San Francisco, California, USA
| | - Ali Nabavizadeh
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Data-Driven Discovery in Biomedicine (D3b), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Phantom-Less Nonlinear Magnetic Resonance Imaging Calibration With Multiple Input Blood Flow Model. Top Magn Reson Imaging 2023; 32:5-13. [PMID: 36735623 DOI: 10.1097/rmr.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/08/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous work used phantoms to calibrate the nonlinear relationship between the gadolinium contrast concentration and the intensity of the magnetic resonance imaging signal. This work proposes a new nonlinear calibration procedure without phantoms and considers the variation of contrast agent mass minimum combined with the multiple input blood flow system. This also proposes a new single-input method with meaningful variables that is not influenced by reperfusion or noise generated by aliasing. The reperfusion in the lung is usually neglected and is not considered by the indicator dilution method. However, in cases of lung cancer, reperfusion cannot be neglected. A new multiple input method is formulated, and the contribution of the pulmonary artery and bronchial artery to lung perfusion can be considered and evaluated separately. METHODS The calibration procedure applies the minimum variation of contrast agent mass in 3 different regions: (1) pulmonary artery, (2) left atrium, and (3) aorta. It was compared with four dimensional computerized tomography with iodine, which has a very high proportional relationship between contrast agent concentration and signal intensity. RESULTS Nonlinear calibration was performed without phantoms, and it is in the range of phantom calibration. It successfully separated the contributions of the pulmonary and bronchial arteries. The proposed multiple input method was verified in 6 subjects with lung cancer, and perfusion from the bronchial artery, rich in oxygen, was identified as very high in the cancer region. CONCLUSIONS Nonlinear calibration of the contrast agent without phantoms is possible. Separate contributions of the pulmonary artery and aorta can be determined.
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Xia ZY, Bruguier C, Dedouit F, Grabherr S, Augsburger M, Liu BB. Oleic Acid (OA), A Potential Dual Contrast Agent for Postmortem MR Angiography (PMMRA): A Pilot Study. Curr Med Sci 2020; 40:786-794. [PMID: 32862391 DOI: 10.1007/s11596-020-2244-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 05/19/2020] [Indexed: 01/31/2023]
Abstract
Choosing proper perfusates as contrast agents is an important aspect for postmortem magnetic resonance angiography (PMMRA). However, in this emerging field, the number of suitable kinds of liquid is still very limited. The objective of this research is to compare MR images of oleic acid (OA) with paraffin oil (PO) in vitro and in ex situ animal hearts, in order to evaluate the feasibility to use OA as a novel contrast agent for PMMRA. In vitro, OA, PO and water (control) were introduced into three tubes separately and T1weighted-spin echo (T1w-SE) and T2w-SE images were acquired on a 1.5T MR scanner. In the second experiment, OA and PO were injected into left coronary artery (LCA) and left ventricle (LV) of ex situ bovine hearts and their T1w-SE, T2w-SE, T1w-multipoint Dixon (T1w-mDixon) and 3DT2w-mDixon images were acquired. The overall results indicate that OA may have a potential to be used as a dual (T1 and T2 based) contrast agent for PMMRA when proper sequence parameters are utilized. However, as the pilot study was based on limited number of animal hearts, more researches using OA in cadavers are needed to validate our findings.
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Affiliation(s)
- Zhi-Yuan Xia
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law (CUPL), Key Laboratory of Evidence Law and Forensic Science, Ministry of Education, Beijing, 100088, China.
| | - Christine Bruguier
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Fabrice Dedouit
- Service de Médecine Légale, Hôpital de Rangueil, Toulouse, 50032, France
| | - Silke Grabherr
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Marc Augsburger
- University Center of Legal Medicine, Lausanne-Geneva (CURML), Lausanne, CH1000, Switzerland
| | - Bei-Bei Liu
- Dian Research Center for Postmortem Imaging & Angiography, Beijing, 100192, China
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