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Deike K, Decker A, Scheyhing P, Harten J, Zimmermann N, Paech D, Peters O, Freiesleben SD, Schneider LS, Preis L, Priller J, Spruth E, Altenstein S, Lohse A, Fliessbach K, Kimmich O, Wiltfang J, Bartels C, Hansen N, Jessen F, Rostamzadeh A, Düzel E, Glanz W, Incesoy EI, Butryn M, Buerger K, Janowitz D, Ewers M, Perneczky R, Rauchmann BS, Teipel S, Kilimann I, Goerss D, Laske C, Munk MH, Spottke A, Roy N, Wagner M, Roeske S, Heneka MT, Brosseron F, Ramirez A, Dobisch L, Wolfsgruber S, Kleineidam L, Yakupov R, Stark M, Schmid MC, Berger M, Hetzer S, Dechent P, Scheffler K, Petzold GC, Schneider A, Effland A, Radbruch A. Machine Learning-Based Perivascular Space Volumetry in Alzheimer Disease. Invest Radiol 2024:00004424-990000000-00211. [PMID: 38652067 DOI: 10.1097/rli.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Impaired perivascular clearance has been suggested as a contributing factor to the pathogenesis of Alzheimer disease (AD). However, it remains unresolved when the anatomy of the perivascular space (PVS) is altered during AD progression. Therefore, this study investigates the association between PVS volume and AD progression in cognitively unimpaired (CU) individuals, both with and without subjective cognitive decline (SCD), and in those clinically diagnosed with mild cognitive impairment (MCI) or mild AD. MATERIALS AND METHODS A convolutional neural network was trained using manually corrected, filter-based segmentations (n = 1000) to automatically segment the PVS in the centrum semiovale from interpolated, coronal T2-weighted magnetic resonance imaging scans (n = 894). These scans were sourced from the national German Center for Neurodegenerative Diseases Longitudinal Cognitive Impairment and Dementia Study. Convolutional neural network-based segmentations and those performed by a human rater were compared in terms of segmentation volume, identified PVS clusters, as well as Dice score. The comparison revealed good segmentation quality (Pearson correlation coefficient r = 0.70 with P < 0.0001 for PVS volume, detection rate in cluster analysis = 84.3%, and Dice score = 59.0%). Subsequent multivariate linear regression analysis, adjusted for participants' age, was performed to correlate PVS volume with clinical diagnoses, disease progression, cerebrospinal fluid biomarkers, lifestyle factors, and cognitive function. Cognitive function was assessed using the Mini-Mental State Examination, the Comprehensive Neuropsychological Test Battery, and the Cognitive Subscale of the 13-Item Alzheimer's Disease Assessment Scale. RESULTS Multivariate analysis, adjusted for age, revealed that participants with AD and MCI, but not those with SCD, had significantly higher PVS volumes compared with CU participants without SCD (P = 0.001 for each group). Furthermore, CU participants who developed incident MCI within 4.5 years after the baseline assessment showed significantly higher PVS volumes at baseline compared with those who did not progress to MCI (P = 0.03). Cognitive function was negatively correlated with PVS volume across all participant groups (P ≤ 0.005 for each). No significant correlation was found between PVS volume and any of the following parameters: cerebrospinal fluid biomarkers, sleep quality, body mass index, nicotine consumption, or alcohol abuse. CONCLUSIONS The very early changes of PVS volume may suggest that alterations in PVS function are involved in the pathophysiology of AD. Overall, the volumetric assessment of centrum semiovale PVS represents a very early imaging biomarker for AD.
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Affiliation(s)
- Katerina Deike
- From the German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (K.D., A.D., K.F., O.K., F.J., Annika Spottke, N.R., M.W., S.R., M.T.H., F.B., Alfredo Ramirez, S.W., L.K., M.S., M.C.S., G.C.P., Anja Schneider, Alexander Radbruch); Department of Neuroradiology, University Hospital, Bonn, Germany (K.D., P.S., D.P., Alexander Radbruch); Department of Neurodegenerative Disease and Geriatric Psychiatry/Psychiatry, University Hospital Bonn, Bonn, Germany (J.H., N.Z., K.F., M.W., Alfredo Ramirez, S.W., L.K., Anja Schneider); Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (D.P.); German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany (O.P., S.D.F., J.P., E.S., S.A.); Institute of Psychiatry and Psychotherapy, Charité-Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany (O.P., S.D.F., L.-S.S., L.P.); Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany (J.P., E.S., S.A., A.L.); Department of Psychiatry and Psychotherapy, School of Medicine, Munich, Germany (J.P.); University of Edinburgh and UK DRI, Edinburgh, United Kingdom (J.P.); German Center for Neurodegenerative Diseases (DZNE), Goettingen, Germany (J.W.); Department of Psychiatry and Psychotherapy, University Medical Center, Goettingen, Germany (J.W., C.B., N.H.); Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal (J.W.); Department of Psychiatry, University of Cologne, Cologne, Germany (F.J., Ayda Rostamzadeh); Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany (F.J., Alfredo Ramirez); German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany (E.D., W.G., E.I.I., Michaela Butryn, L.D., R.Y.); Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany (E.D., W.G., E.I.I., Michaela Butryn); Department for Psychiatry and Psychotherapy, University Clinic Magdeburg, Magdeburg, Germany (E.I.I.); German Center for Neurodegenerative Diseases (DZNE), Munich, Germany (K.B., M.E., R.P.); Institute for Stroke and Dementia Research, LMU Munich, Germany (K.B., D.J., M.E.); Department of Psychiatry and Psychotherapy, LMU Munich, Germany (R.P., B.-S.R.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (R.P.); Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom (R.P.); Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, United Kingdom (R.P., B.-S.R.); Department of Neuroradiology, University Hospital Munich, Munich, Germany (B.-S.R.); German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany (S.T., I.K., D.G.); Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany (S.T., I.K., D.G.); German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany (C.L., M.H.M.); Section for Dementia Research, Hertie Institute for Clinical Brain Research and Department of Psychiatry and Psychotherapy, Tübingen, Germany (C.L.); Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen Germany (M.H.M.); Department of Neurology, University of Bonn, Bonn, Germany (Annika Spottke); Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry and Psychotherapy, Cologne, Germany (Alfredo Ramirez); Department of Psychiatry and Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, San Antonio, TX (Alfredo Ramirez); Institute for Medical Biometry, Informatics, and Epidemiology, University Hospital Bonn, Bonn, Germany (M.C.S., Moritz Berger); Berlin Center for Advanced Neuroimaging, Charité-Universitätsmedizin, Berlin, Germany (S.H.); MR-Research in Neurosciences, Department of Cognitive Neurology, Göttingen, Germany (P.D.); Department for Biomedical Magnetic Resonance, University of Tübingen, Tübingen, Germany (K.S.); Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany (G.C.P.); and Institute for Applied Mathematics, University of Bonn, Bonn, Germany (A.E.)
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Röhrich M, Rosales JJ, Hoppner J, Kvacskay P, Blank N, Loi L, Paech D, Schreckenberger M, Giesel F, Kauczor HU, Lorenz HM, Haberkorn U, Merkt W. Fibroblast Activation Protein Inhibitor-Positron Emission Tomography in Aortitis: Fibroblast pathology in active inflammation and remission. Rheumatology (Oxford) 2024:keae225. [PMID: 38648749 DOI: 10.1093/rheumatology/keae225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/29/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVES Epigenetically modified fibroblasts contribute to chronicity in inflammatory diseases. Reasons for the relapsing character of large vessel vasculitis (LVV) remain obscure, including the role of fibroblasts, in part due to limited access to biopsies of involved tissue.68Ga FAPI-46 (FAPI)-PET/CT detects activated fibroblasts in vivo. In this exploratory pilot study, we tested the detection of fibroblast activation in vessel walls using FAPI-PET/CT in LVV with aortitis. METHODS 8 LVV patients with aortitis and 8 age- and gender-matched controls were included. Distribution of FAPI uptake was evaluated in the aorta and large vessels. FAPI-uptake was compared with MRI inflammatory activity scores. Imaging results were compared with clinical parameters such as serum inflammatory markers, time of remission and medication. RESULTS Three aortitis patients were clinically active, five in remission. Irrespective of activity, FAPI uptake was significantly enhanced in aortitis compared with controls. Patients in remission had a mean duration of remission of 2.8 years (range 1-4 years), yet significant FAPI uptake in the vessel wall was found.In remitted aortitis, MRI inflammatory scores were close to be negative, while in 4/5 patients visually identifiable FAPI uptake was observed. CONCLUSIONS This pilot feasibility study shows significant tracer uptake in the aortic walls in LVV. FAPI positivity indicates ongoing fibroblast pathology in clinically remitted LVV.
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Affiliation(s)
- M Röhrich
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - J J Rosales
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, University Clinic Of Navarra, Pamplona, Spain
| | - J Hoppner
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - P Kvacskay
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - N Blank
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - L Loi
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuroradiology, Bonn University Hospital, Bonn, Germany
| | - M Schreckenberger
- Department of Nuclear Medicine, Mainz University Hospital, Mainz, Germany
| | - F Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Department of Nuclear Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Düsseldorf, Düsseldorf, Germany
- Institute for Radiation Sciences, Osaka University, Osaka, Japan
| | - H U Kauczor
- Department of Diagnostic & Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - H M Lorenz
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - U Haberkorn
- Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research DZL, Heidelberg, Germany
| | - W Merkt
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
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Haase R, Lehnen NC, Schmeel FC, Deike K, Rüber T, Radbruch A, Paech D. External evaluation of a deep learning-based approach for automated brain volumetry in patients with huntington's disease. Sci Rep 2024; 14:9243. [PMID: 38649395 PMCID: PMC11035562 DOI: 10.1038/s41598-024-59590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
A crucial step in the clinical adaptation of an AI-based tool is an external, independent validation. The aim of this study was to investigate brain atrophy in patients with confirmed, progressed Huntington's disease using a certified software for automated volumetry and to compare the results with the manual measurement methods used in clinical practice as well as volume calculations of the caudate nuclei based on manual segmentations. Twenty-two patients were included retrospectively, consisting of eleven patients with Huntington's disease and caudate nucleus atrophy and an age- and sex-matched control group. To quantify caudate head atrophy, the frontal horn width to intercaudate distance ratio and the intercaudate distance to inner table width ratio were obtained. The software mdbrain was used for automated volumetry. Manually measured ratios and automatically measured volumes of the groups were compared using two-sample t-tests. Pearson correlation analyses were performed. The relative difference between automatically and manually determined volumes of the caudate nuclei was calculated. Both ratios were significantly different between the groups. The automatically and manually determined volumes of the caudate nuclei showed a high level of agreement with a mean relative discrepancy of - 2.3 ± 5.5%. The Huntington's disease group showed significantly lower volumes in a variety of supratentorial brain structures. The highest degree of atrophy was shown for the caudate nucleus, putamen, and pallidum (all p < .0001). The caudate nucleus volume and the ratios were found to be strongly correlated in both groups. In conclusion, in patients with progressed Huntington's disease, it was shown that the automatically determined caudate nucleus volume correlates strongly with measured ratios commonly used in clinical practice. Both methods allowed clear differentiation between groups in this collective. The software additionally allows radiologists to more objectively assess the involvement of a variety of brain structures that are less accessible to standard semiquantitative methods.
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Affiliation(s)
- Robert Haase
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Katerina Deike
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Lehnen NC, Schievelkamp AH, Gronemann C, Haase R, Krause I, Gansen M, Fleckenstein T, Dorn F, Radbruch A, Paech D. Impact of an AI software on the diagnostic performance and reading time for the detection of cerebral aneurysms on time of flight MR-angiography. Neuroradiology 2024:10.1007/s00234-024-03351-w. [PMID: 38619571 DOI: 10.1007/s00234-024-03351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/29/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE To evaluate the impact of an AI-based software trained to detect cerebral aneurysms on TOF-MRA on the diagnostic performance and reading times across readers with varying experience levels. METHODS One hundred eighty-six MRI studies were reviewed by six readers to detect cerebral aneurysms. Initially, readings were assisted by the CNN-based software mdbrain. After 6 weeks, a second reading was conducted without software assistance. The results were compared to the consensus reading of two neuroradiological specialists and sensitivity (lesion and patient level), specificity (patient level), and false positives per case were calculated for the group of all readers, for the subgroup of physicians, and for each individual reader. Also, reading times for each reader were measured. RESULTS The dataset contained 54 aneurysms. The readers had no experience (three medical students), 2 years experience (resident in neuroradiology), 6 years experience (radiologist), and 12 years (neuroradiologist). Significant improvements of overall specificity and the overall number of false positives per case were observed in the reading with AI support. For the physicians, we found significant improvements of sensitivity on lesion and patient level and false positives per case. Four readers experienced reduced reading times with the software, while two encountered increased times. CONCLUSION In the reading with the AI-based software, we observed significant improvements in terms of specificity and false positives per case for the group of all readers and significant improvements of sensitivity and false positives per case for the physicians. Further studies are needed to investigate the effects of the AI-based software in a prospective setting.
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Affiliation(s)
- Nils C Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany.
- Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
| | - Arndt-Hendrik Schievelkamp
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Christian Gronemann
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Robert Haase
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Inga Krause
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Max Gansen
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Tobias Fleckenstein
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
- Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127, Bonn, Germany
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Lehnen NC, Dorn F, Wiest IC, Zimmermann H, Radbruch A, Kather JN, Paech D. Data Extraction from Free-Text Reports on Mechanical Thrombectomy in Acute Ischemic Stroke Using ChatGPT: A Retrospective Analysis. Radiology 2024; 311:e232741. [PMID: 38625006 DOI: 10.1148/radiol.232741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Background Procedural details of mechanical thrombectomy in patients with ischemic stroke are important predictors of clinical outcome and are collected for prospective studies or national stroke registries. To date, these data are collected manually by human readers, a labor-intensive task that is prone to errors. Purpose To evaluate the use of the large language models (LLMs) GPT-4 and GPT-3.5 to extract data from neuroradiology reports on mechanical thrombectomy in patients with ischemic stroke. Materials and Methods This retrospective study included consecutive reports from patients with ischemic stroke who underwent mechanical thrombectomy between November 2022 and September 2023 at institution 1 and between September 2016 and December 2019 at institution 2. A set of 20 reports was used to optimize the prompt, and the ability of the LLMs to extract procedural data from the reports was compared using the McNemar test. Data manually extracted by an interventional neuroradiologist served as the reference standard. Results A total of 100 internal reports from 100 patients (mean age, 74.7 years ± 13.2 [SD]; 53 female) and 30 external reports from 30 patients (mean age, 72.7 years ± 13.5; 18 male) were included. All reports were successfully processed by GPT-4 and GPT-3.5. Of 2800 data entries, 2631 (94.0% [95% CI: 93.0, 94.8]; range per category, 61%-100%) data points were correctly extracted by GPT-4 without the need for further postprocessing. With 1788 of 2800 correct data entries, GPT-3.5 produced fewer correct data entries than did GPT-4 (63.9% [95% CI: 62.0, 65.6]; range per category, 14%-99%; P < .001). For the external reports, GPT-4 extracted 760 of 840 (90.5% [95% CI: 88.3, 92.4]) correct data entries, while GPT-3.5 extracted 539 of 840 (64.2% [95% CI: 60.8, 67.4]; P < .001). Conclusion Compared with GPT-3.5, GPT-4 more frequently extracted correct procedural data from free-text reports on mechanical thrombectomy performed in patients with ischemic stroke. © RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Nils C Lehnen
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
| | - Franziska Dorn
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
| | - Isabella C Wiest
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
| | - Hanna Zimmermann
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
| | - Alexander Radbruch
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
| | - Jakob Nikolas Kather
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
| | - Daniel Paech
- From the Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany (N.C.L., F.D., A.R., D.P.); Research Group Clinical Neuroimaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany (N.C.L., A.R.); Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany (I.C.W.); Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany (I.C.W., J.N.K.); Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany (H.Z.); and Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (D.P.)
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Laupichler MC, Tavakoli AA, Raupach T, Paech D. [Future skills-AI competencies for radiologists : Fostering AI knowledge and skills in undergraduate medical education]. Radiologie (Heidelb) 2024; 64:316-320. [PMID: 37994912 DOI: 10.1007/s00117-023-01237-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Matthias Carl Laupichler
- Institut für Medizindidaktik, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | | | - Tobias Raupach
- Institut für Medizindidaktik, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Daniel Paech
- Klinik für Neuroradiologie, Universitätsklinikum Bonn, Bonn, Deutschland
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Banat M, Potthoff AL, Hamed M, Borger V, Scorzin JE, Lampmann T, Asoglu H, Khalafov L, Schmeel FC, Paech D, Radbruch A, Nitsch L, Weller J, Herrlinger U, Toma M, Gielen GH, Vatter H, Schneider M. Synchronous versus metachronous spinal metastasis: a comparative study of survival outcomes following neurosurgical treatment. J Cancer Res Clin Oncol 2024; 150:136. [PMID: 38502313 PMCID: PMC10951012 DOI: 10.1007/s00432-024-05657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Patients with spinal metastases (SM) from solid neoplasms typically exhibit progression to an advanced cancer stage. Such metastases can either develop concurrently with an existing cancer diagnosis (termed metachronous SM) or emerge as the initial indication of an undiagnosed malignancy (referred to as synchronous SM). The present study investigates the prognostic implications of synchronous compared to metachronous SM following surgical resection. METHODS From 2015 to 2020, a total of 211 individuals underwent surgical intervention for SM at our neuro-oncology facility. We conducted a survival analysis starting from the date of the neurosurgical procedure, comparing those diagnosed with synchronous SM against those with metachronous SM. RESULTS The predominant primary tumor types included lung cancer (23%), prostate cancer (21%), and breast cancer (11.3%). Of the participants, 97 (46%) had synchronous SM, while 114 (54%) had metachronous SM. The median overall survival post-surgery for those with synchronous SM was 13.5 months (95% confidence interval (CI) 6.1-15.8) compared to 13 months (95% CI 7.7-14.2) for those with metachronous SM (p = 0.74). CONCLUSIONS Our findings suggest that the timing of SM diagnosis (synchronous versus metachronous) does not significantly affect survival outcomes following neurosurgical treatment for SM. These results support the consideration of neurosurgical procedures regardless of the temporal pattern of SM manifestation.
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Affiliation(s)
- Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany.
| | - Anna-Laura Potthoff
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Jasmin E Scorzin
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Tim Lampmann
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Harun Asoglu
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Logman Khalafov
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | | | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Louisa Nitsch
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Johannes Weller
- Department of Neurology, University Hospital Bonn, 53127, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Marieta Toma
- Institute of Pathology, University Hospital Bonn, Bonn, Germany
| | - Gerrit H Gielen
- Institute for Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, Building 81, 53127, Bonn, Germany
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8
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Heitkamp C, Winkelmeier L, Heit JJ, Albers GW, Lansberg MG, Kniep H, Broocks G, Stracke CP, Schell M, Guenego A, Paech D, Wintermark M, Fiehler J, Faizy TD. Early neurological deterioration in patients with acute ischemic stroke is linked to unfavorable cerebral venous outflow. Eur Stroke J 2024; 9:162-171. [PMID: 38069665 PMCID: PMC10916832 DOI: 10.1177/23969873231208277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/29/2023] [Indexed: 03/06/2024] Open
Abstract
INTRODUCTION Early neurological deterioration (END) is associated with poor outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). Causes of END after mechanical thrombectomy (MT) include unsuccessful recanalization and reperfusion hemorrhages. However, little is known about END excluding the aforementioned causes. We aimed to investigate factors associated with unexplained END (ENDunexplained) with regard to the cerebral collateral status. PATIENTS AND METHODS Multicenter retrospective study of AIS-LVO patients with successful MT (mTICI 2b-3). On admission CT angiography (CTA), pial arterial collaterals and venous outflow (VO) were assessed using the modified Tan-Scale and the Cortical Vein Opacification Score (COVES), respectively. ENDunexplained was defined as an increase in NIHSS score of ⩾ 4 within the first 24 hours after MT without parenchymal hemorrhage on follow-up imaging. Multivariable regression analyses were performed to examine factors of ENDunexplained and unfavorable functional outcome (modified Rankin Scale score 3-6). RESULTS A total of 620 patients met the inclusion criteria. ENDunexplained occurred in 10% of patients. While there was no significant difference in pial arterial collaterals, patients with ENDunexplained exhibited more often unfavorable VO (81% vs. 53%; P < 0.001). Unfavorable VO (aOR [95% CI]; 2.56 [1.02-6.40]; P = 0.045) was an independent predictor of ENDunexplained. ENDunexplained was independently associated with unfavorable functional outcomes at 90 days (aOR [95% CI]; 6.25 [2.06-18.94]; P = 0.001). DISCUSSION AND CONCLUSION Unfavorable VO on admission CTA was associated with ENDunexplained. ENDunexplained was independently linked to unfavorable functional outcomes at 90 days. Identifying AIS-LVO patients at risk of ENDunexplained may help to select patients for intensified monitoring and guide to optimal treatment regimes.
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Affiliation(s)
- Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Christian Paul Stracke
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
- Department of Neuroradiology, University Hospital Muenster, Muenster, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Adrien Guenego
- Department of Neuroradiology, Erasme Medical Center, Brussels, Belgium
| | - Daniel Paech
- Clinic for Neuroradiology, University Hospital Bonn, Germany
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, TX, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany
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9
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Winkelmeier L, Heit JJ, Broocks G, Prüter J, Heitkamp C, Schell M, Albers GW, Lansberg MG, Wintermark M, Kemmling A, Stracke CP, Guenego A, Paech D, Fiehler J, Faizy TD. Association between occlusion location, net water uptake and ischemic lesion growth in large vessel anterior circulation strokes. J Cereb Blood Flow Metab 2024:271678X241232193. [PMID: 38329032 DOI: 10.1177/0271678x241232193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Ischemic lesion net water uptake (NWU) represents a quantitative imaging biomarker for cerebral edema in acute ischemic stroke. Data on NWU for distinct occlusion locations remain scarce, but might help to improve the prognostic value of NWU. In this retrospective multicenter cohort study, we compared NWU between patients with proximal large vessel occlusion (pLVO; ICA or proximal M1) and distal large vessel occlusion (dLVO; distal M1 or M2). NWU was quantified by densitometric measurements of the early ischemic region. Arterial collateral status was assessed using the Maas scale. Regression analysis was used to investigate the relationship between occlusion location, NWU and ischemic lesion growth. A total of 685 patients met inclusion criteria. Early ischemic lesion NWU was higher in patients with pLVO compared with dLVO (7.7% vs 3.9%, P < .001). The relationship between occlusion location and NWU was partially mediated by arterial collateral status. NWU was associated with absolute ischemic lesion growth between admission and follow-up imaging (β estimate, 5.50, 95% CI, 3.81-7.19, P < .001). This study establishes a framework for the relationship between occlusion location, arterial collateral status, early ischemic lesion NWU and ischemic lesion growth. Future prognostic thresholds for NWU might be optimized by adjusting for the occlusion location.
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Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy J Heit
- Department of Neuroradiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Prüter
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, Texas, USA
| | - André Kemmling
- Department of Neuroradiology, University Marburg, Marburg, Germany
| | | | - Adrien Guenego
- Department of Neuroradiology, Erasme Medical Center, Brussels, Belgium
| | - Daniel Paech
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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10
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Franke VL, Breitling J, Boyd PS, Feignier A, Bangert R, Weckesser N, Schlemmer HP, Ladd ME, Bachert P, Paech D, Korzowski A. A versatile look-up algorithm for mapping pH values and magnesium ion content using 31 P MRSI. NMR Biomed 2024:e5113. [PMID: 38316107 DOI: 10.1002/nbm.5113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 11/21/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024]
Abstract
31 P MRSI allows for the non-invasive mapping of pH and magnesium ion content (Mg) in vivo, by translating the chemical shifts of inorganic phosphate and adenosine-5'-triphosphate (ATP) to pH and Mg via suitable calibration equations, such as the modified Henderson-Hasselbalch equation. However, the required constants in these calibration equations are typically only determined for physiological conditions, posing a particular challenge for their application to diseased tissue, where the biochemical conditions might change manyfold. In this article, we propose a multi-parametric look-up algorithm aiming at the condition-independent determination of pH and Mg by employing multiple quantifiable 31 P spectral properties simultaneously. To generate entries for an initial look-up table, measurements from 114 model solutions prepared with varying chemical properties were made at 9.4 T. The number of look-up table entries was increased by inter- and extrapolation using a multi-dimensional function developed based on the Hill equation. The assignment of biochemical parameters, that is, pH and Mg, is realized using probability distributions incorporating specific measurement uncertainties on the quantified spectral parameters, allowing for an estimation of most plausible output values. As proof of concept, we applied a version of the look-up algorithm employing only the chemical shifts of γ- and β-ATP for the determination of pH and Mg to in vivo 3D 31 P MRSI data acquired at 7 T from (i) the lower leg muscles of healthy volunteers and (ii) the brains of patients with glioblastoma. The resulting volumetric maps showed plausible values for pH and Mg, partly revealing differences from maps generated using the conventional calibration equations.
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Affiliation(s)
- Vanessa L Franke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Johannes Breitling
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philip S Boyd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Antoine Feignier
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Renate Bangert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina Weckesser
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Ebersberger L, Kratzer FJ, Franke VL, Nagel AM, Niesporek SC, Korzowski A, Ladd ME, Schlemmer HP, Paech D, Platt T. First implementation of dynamic oxygen-17 ( 17O) magnetic resonance imaging at 7 Tesla during neuronal stimulation in the human brain. MAGMA 2024; 37:27-38. [PMID: 37737942 PMCID: PMC10876824 DOI: 10.1007/s10334-023-01119-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE First implementation of dynamic oxygen-17 (17O) MRI at 7 Tesla (T) during neuronal stimulation in the human brain. METHODS Five healthy volunteers underwent a three-phase 17O gas (17O2) inhalation experiment. Combined right-side visual stimulus and right-hand finger tapping were used to achieve neuronal stimulation in the left cerebral hemisphere. Data analysis included the evaluation of the relative partial volume (PV)-corrected time evolution of absolute 17O water (H217O) concentration and of the relative signal evolution without PV correction. Statistical analysis was performed using a one-tailed paired t test. Blood oxygen level-dependent (BOLD) experiments were performed to validate the stimulation paradigm. RESULTS The BOLD maps showed significant activity in the stimulated left visual and sensorimotor cortex compared to the non-stimulated right side. PV correction of 17O MR data resulted in high signal fluctuations with a noise level of 10% due to small regions of interest (ROI), impeding further quantitative analysis. Statistical evaluation of the relative H217O signal with PV correction (p = 0.168) and without (p = 0.382) did not show significant difference between the stimulated left and non-stimulated right sensorimotor ROI. DISCUSSION The change of cerebral oxygen metabolism induced by sensorimotor and visual stimulation is not large enough to be reliably detected with the current setup and methodology of dynamic 17O MRI at 7 T.
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Affiliation(s)
- Louise Ebersberger
- German Cancer Research Center (DKFZ) Heidelberg, Division of Radiology, Heidelberg, Germany
- Faculty of Medicine, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
- Department of Pediatrics, Bern University Hospital, Bern, Switzerland
| | - Fabian J Kratzer
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany
| | - Vanessa L Franke
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany
- Faculty of Physics and Astronomy, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Armin M Nagel
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany
- Institute of Radiology, Friedrich-Alexander University Hospital Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Sebastian C Niesporek
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany
| | - Andreas Korzowski
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany
| | - Mark E Ladd
- Faculty of Medicine, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany
- Faculty of Physics and Astronomy, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- German Cancer Research Center (DKFZ) Heidelberg, Division of Radiology, Heidelberg, Germany
| | - Daniel Paech
- German Cancer Research Center (DKFZ) Heidelberg, Division of Radiology, Heidelberg, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Tanja Platt
- German Cancer Research Center (DKFZ) Heidelberg, Division of Medical Physics in Radiology, Heidelberg, Germany.
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12
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Paech D, Weckesser N, Franke VL, Breitling J, Görke S, Deike-Hofmann K, Wick A, Scherer M, Unterberg A, Wick W, Bendszus M, Bachert P, Ladd ME, Schlemmer HP, Korzowski A. Whole-Brain Intracellular pH Mapping of Gliomas Using High-Resolution 31P MR Spectroscopic Imaging at 7.0 T. Radiol Imaging Cancer 2024; 6:e220127. [PMID: 38133553 PMCID: PMC10825708 DOI: 10.1148/rycan.220127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/24/2023] [Accepted: 11/02/2023] [Indexed: 12/23/2023]
Abstract
Malignant tumors commonly exhibit a reversed pH gradient compared with normal tissue, with a more acidic extracellular pH and an alkaline intracellular pH (pHi). In this prospective study, pHi values in gliomas were quantified using high-resolution phosphorous 31 (31P) spectroscopic MRI at 7.0 T and were used to correlate pHi alterations with histopathologic findings. A total of 12 participants (mean age, 58 years ± 18 [SD]; seven male, five female) with histopathologically proven, newly diagnosed glioma were included between September 2018 and November 2019. The 31P spectroscopic MRI scans were acquired using a double-resonant 31P/1H phased-array head coil together with a three-dimensional (3D) 31P chemical shift imaging sequence (5.7-mL voxel volume) performed with a 7.0-T whole-body system. The 3D volumetric segmentations were performed for the whole-tumor volumes (WTVs); tumor subcompartments of necrosis, gadolinium enhancement, and nonenhancing T2 (NCE T2) hyperintensity; and normal-appearing white matter (NAWM), and pHi values were compared. Spearman correlation was used to assess association between pHi and the proliferation index Ki-67. For all study participants, mean pHi values were higher in the WTV (7.057 ± 0.024) compared with NAWM (7.006 ± 0.012; P < .001). In eight participants with high-grade gliomas, pHi was increased in all tumor subcompartments (necrosis, 7.075 ± 0.033; gadolinium enhancement, 7.075 ± 0.024; NCE T2 hyperintensity, 7.043 ± 0.015) compared with NAWM (7.004 ± 0.014; all P < .01). The pHi values of WTV positively correlated with Ki-67 (R2 = 0.74, r = 0.78, P = .001). In conclusion, 31P spectroscopic MRI at 7.0 T enabled high-resolution quantification of pHi in gliomas, with pHi alteration associated with the Ki-67 proliferation index, and may aid in diagnosis and treatment monitoring. Keywords: 31P MRSI, pH, Glioma, Glioblastoma, Ultra-High-Field MRI, Imaging Biomarker, 7 Tesla Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
| | | | - Vanessa L. Franke
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Johannes Breitling
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Steffen Görke
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Katerina Deike-Hofmann
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Antje Wick
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Scherer
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Unterberg
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Bachert
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Mark E. Ladd
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Korzowski
- From the Divisions of Radiology (D.P., N.W., K.D.H., H.P.S.) and
Medical Physics in Radiology (V.L.F., J.B., S.G., P.B., M.E.L., A.K.), German
Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg,
Germany; Faculties of Medicine (N.W., M.E.L.) and Physics and Astronomy (V.L.F.,
P.B., M.E.L.), University of Heidelberg, Heidelberg, Germany; and Departments of
Neurology (A.W., W.W.), Neurosurgery (M.S., A.U.), and Neuroradiology (M.B.),
Heidelberg University Hospital, Heidelberg, Germany
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13
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Zeyen T, Paech D, Weller J, Schäfer N, Tzaridis T, Duffy C, Nitsch L, Schneider M, Potthoff AL, Steinbach JP, Hau P, Schlegel U, Seidel C, Krex D, Grauer O, Goldbrunner R, Zeiner PS, Tabatabai G, Galldiks N, Stummer W, Hattingen E, Glas M, Radbruch A, Herrlinger U, Schaub C. Correction to: Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses. J Neurooncol 2023; 165:387. [PMID: 37921974 PMCID: PMC10689511 DOI: 10.1007/s11060-023-04488-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
- Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Cathrina Duffy
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Louisa Nitsch
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Uwe Schlegel
- Department of Neurology, Klinik Hirslanden, Zürich, Switzerland
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Roland Goldbrunner
- Center of Neurosurgery Department of General, Neurosurgery University of Cologne, Cologne, Germany
| | - Pia Susan Zeiner
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, HertieTübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany and Research Center Juelich, Inst. of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Medicine Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
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14
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Zeyen T, Paech D, Weller J, Schäfer N, Tzaridis T, Duffy C, Nitsch L, Schneider M, Potthoff AL, Steinbach JP, Hau P, Schlegel U, Seidel C, Krex D, Grauer O, Goldbrunner R, Zeiner PS, Tabatabai G, Galldiks N, Stummer W, Hattingen E, Glas M, Radbruch A, Herrlinger U, Schaub C. Undetected pseudoprogressions in the CeTeG/NOA-09 trial: hints from postprogression survival and MRI analyses. J Neurooncol 2023; 164:607-616. [PMID: 37728779 PMCID: PMC10589172 DOI: 10.1007/s11060-023-04444-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE In the randomized CeTeG/NOA-09 trial, lomustine/temozolomide (CCNU/TMZ) was superior to TMZ therapy regarding overall survival (OS) in MGMT promotor-methylated glioblastoma. Progression-free survival (PFS) and pseudoprogression rates (about 10%) were similar in both arms. Further evaluating this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at first progression according to modified RANO criteria (mRANO). METHODS We classified the patients of the CeTeG/NOA-09 trial according to long vs. short PPS employing a cut-off of 18 months and compared baseline characteristics and survival times. In patients with available MRIs and confirmed progression, the increase in T1-enhancing, FLAIR hyperintense lesion volume and the change in ADC mean value of contrast-enhancing tumor upon progression were determined. RESULTS Patients with long PPS in the CCNU/TMZ arm had a particularly short PFS (5.6 months). PFS in this subgroup was shorter than in the long PPS subgroup of the TMZ arm (11.1 months, p = 0.01). At mRANO-defined progression, patients of the CCNU/TMZ long PPS subgroup had a significantly higher increase of mean ADC values (p = 0.015) and a tendency to a stronger volumetric increase in T1-enhancement (p = 0.22) as compared to long PPS patients of the TMZ arm. CONCLUSION The combination of survival and MRI analyses identified a subgroup of CCNU/TMZ-treated patients with features that sets them apart from other patients in the trial: short first PFS despite long PPS and significant increase in mean ADC values upon mRANO-defined progression. The observed pattern is compatible with the features commonly observed in pseudoprogression suggesting mRANO-undetected pseudoprogressions in the CCNU/TMZ arm of CeTeG/NOA-09.
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Affiliation(s)
- Thomas Zeyen
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Cathrina Duffy
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Louisa Nitsch
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | | | | | - Peter Hau
- Department of Neurology and Wilhelm Sander NeuroOncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Uwe Schlegel
- Department of Neurology, Klinik Hirslanden, Zürich, Switzerland
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | - Roland Goldbrunner
- Center of Neurosurgery Department of General, Neurosurgery University of Cologne, Cologne, Germany
| | - Pia Susan Zeiner
- Dr. Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, Institute for Clinical Brain Research, University Hospital Tübingen, Eberhard Karls University Tübingen, HertieTübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany and Research Center Juelich, Inst. of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, 60590, Frankfurt Am Main, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Medicine Essen, University Duisburg-Essen, Essen, Germany
- German Cancer Consortium (DKTK), Partner Site University Medicine Essen, Hufelandstr. 55, 45147, Essen, Germany
| | | | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany.
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15
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Zidan M, Ghaei S, Bode FJ, Weller JM, Krueger N, Lehnen NC, Petzold GC, Radbruch A, Dorn F, Paech D. Clinical significance and prevalence of subarachnoid hyperdensities on flat detector CT after mechanical thrombectomy: does it really matter? J Neurointerv Surg 2023:jnis-2023-020661. [PMID: 37648432 DOI: 10.1136/jnis-2023-020661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Subarachnoid hyperdensities after mechanical thrombectomy (MT) are a common finding. However, it is often regarded as clinically insignificant. OBJECTIVE With this single-center investigation, to identify the prevalence of subarachnoid hyperdensities following MT, associated predictors, and the impact on the clinical outcome of the patients. METHODS 383 patients from the stroke registry were analyzed for the presence of subarachnoid hyperdensities on flat detector CT (FDCT) directly after the completion of MT, and on follow-up dual-energy CT, then classified according to a visual grading scale. 178 patients were included with anterior circulation occlusions. Regression analysis was performed to identify significant predictors, and Kruskal-Wallis analysis and Χ2 test were performed to test the variables among the different groups. The primary outcome was the modified Rankin Scale (mRS) score at 90 days and was analyzed with the Wilcoxon-Mann-Whitney rank-sum test. RESULTS The prevalence of subarachnoid hyperdensities on FDCT was (66/178, 37.1%) with patients experiencing a significant unfavorable outcome (P=0.035). Significantly fewer patients with subarachnoid hyperdensities achieved a mRS score of ≤3 at 90 days 25/66 (37.9%) vs 60/112 (53.6%), P=0.043). In addition, mortality was significantly higher in the subarachnoid hyperdensities group (34.8% vs 19.6%, P=0.024). Distal occlusions and a higher number of device passes were significantly associated with subarachnoid hyperdensities (P=0.026) and (P=0.001), respectively. Patients who received intravenous tissue plasminogen activator had significantly fewer subarachnoid hyperdensities (P=0.029). CONCLUSIONS Postinterventional subarachnoid hyperdensities are a frequent finding after MT and are associated with neurological decline and worse functional outcome. They are more common with distal occlusions and multiple device passes.
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Affiliation(s)
- Mousa Zidan
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Shiwa Ghaei
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Felix J Bode
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | | | - Nadine Krueger
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Gabor C Petzold
- Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
- Department of Neuroradiology, LMU Klinikum der Universität München Medizinische Klinik und Poliklinik IV, Munchen, Bayern, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Nordrhein-Westfalen, Germany
- Department of Radiology, German Cancer Research Centre, Heidelberg, Germany
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16
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von Knebel Doeberitz N, Kroh F, König L, Boyd PS, Graß S, Bauspieß C, Scherer M, Unterberg A, Bendszus M, Wick W, Bachert P, Debus J, Ladd ME, Schlemmer HP, Goerke S, Korzowski A, Paech D. Post-Surgical Depositions of Blood Products Are No Major Confounder for the Diagnostic and Prognostic Performance of CEST MRI in Patients with Glioma. Biomedicines 2023; 11:2348. [PMID: 37760790 PMCID: PMC10525358 DOI: 10.3390/biomedicines11092348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
Amide proton transfer (APT) and semi-solid magnetization transfer (ssMT) imaging can predict clinical outcomes in patients with glioma. However, the treatment of brain tumors is accompanied by the deposition of blood products within the tumor area in most cases. For this reason, the objective was to assess whether the diagnostic interpretation of the APT and ssMT is affected by methemoglobin (mHb) and hemosiderin (Hs) depositions at the first follow-up MRI 4 to 6 weeks after the completion of radiotherapy. A total of 34 participants underwent APT and ssMT imaging by applying reconstruction methods described by Zhou et al. (APTwasym), Goerke et al. (MTRRexAPT and MTRRexMT) and Mehrabian et al. (MTconst). Contrast-enhancing tumor (CE), whole tumor (WT), mHb and Hs were segmented on contrast-enhanced T1wCE, T2w-FLAIR, T1w and T2*w images. ROC-analysis, Kaplan-Meier analysis and the log rank test were used to test for the association of mean contrast values with therapy response and overall survival (OS) before (WT and CE) and after correcting tumor volumes for mHb and Hs (CEC and WTC). CEC showed higher associations of the MTRRexMT with therapy response (CE: AUC = 0.677, p = 0.081; CEC: AUC = 0.705, p = 0.044) and of the APTwasym with OS (CE: HR = 2.634, p = 0.040; CEC: HR = 2.240, p = 0.095). In contrast, WTC showed a lower association of the APTwasym with survival (WT: HR = 2.304, p = 0.0849; WTC: HR = 2.990, p = 0.020). Overall, a sophisticated correction for blood products did not substantially influence the clinical performance of APT and ssMT imaging in patients with glioma early after radiotherapy.
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Affiliation(s)
| | - Florian Kroh
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Philip S. Boyd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Svenja Graß
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Cora Bauspieß
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Martin Bendszus
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Neuroradiology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Wolfgang Wick
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Neurology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Mark E. Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, 69120 Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
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17
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Haase R, Pinetz T, Kobler E, Paech D, Effland A, Radbruch A, Deike-Hofmann K. Artificial Contrast: Deep Learning for Reducing Gadolinium-Based Contrast Agents in Neuroradiology. Invest Radiol 2023; 58:539-547. [PMID: 36822654 DOI: 10.1097/rli.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
ABSTRACT Deep learning approaches are playing an ever-increasing role throughout diagnostic medicine, especially in neuroradiology, to solve a wide range of problems such as segmentation, synthesis of missing sequences, and image quality improvement. Of particular interest is their application in the reduction of gadolinium-based contrast agents, the administration of which has been under cautious reevaluation in recent years because of concerns about gadolinium deposition and its unclear long-term consequences. A growing number of studies are investigating the reduction (low-dose approach) or even complete substitution (zero-dose approach) of gadolinium-based contrast agents in diverse patient populations using a variety of deep learning methods. This work aims to highlight selected research and discusses the advantages and limitations of recent deep learning approaches, the challenges of assessing its output, and the progress toward clinical applicability distinguishing between the low-dose and zero-dose approach.
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Affiliation(s)
| | - Thomas Pinetz
- Institute of Applied Mathematics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Erich Kobler
- From the Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn
| | | | - Alexander Effland
- Institute of Applied Mathematics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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18
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Fischbach L, Bauer T, Diers K, Witt JA, Brugues M, Borger V, Schidlowski M, Rácz A, Baumgartner T, von Wrede R, Paech D, Weber B, Radbruch A, Vatter H, Becker AJ, Huppertz HJ, Helmstaedter C, Surges R, Reuter M, Rüber T. A novel geometry-based analysis of hippocampal morphometry in mesial temporal lobe epilepsy. Hum Brain Mapp 2023. [PMID: 37347650 PMCID: PMC10365234 DOI: 10.1002/hbm.26392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 05/17/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023] Open
Abstract
Hippocampal volumetry is an essential tool in researching and diagnosing mesial temporal lobe epilepsy (mTLE). However, it has a limited ability to detect subtle alterations in hippocampal morphometry. Here, we establish and apply a novel geometry-based tool that enables point-wise morphometric analysis based on an intrinsic coordinate system of the hippocampus. We hypothesized that this point-wise analysis uncovers structural alterations not measurable by volumetry, but associated with histological underpinnings and the neuropsychological profile of mTLE. We conducted a retrospective study in 204 individuals with mTLE and 57 age- and gender-matched healthy subjects. FreeSurfer-based segmentations of hippocampal subfields in 3T-MRI were subjected to a geometry-based analysis that resulted in a coordinate system of the hippocampal mid-surface and allowed for point-wise measurements of hippocampal thickness and other features. Using point-wise analysis, we found significantly lower thickness and higher FLAIR signal intensity in the entire affected hippocampus of individuals with hippocampal sclerosis (HS-mTLE). In the contralateral hippocampus of HS-mTLE and the affected hippocampus of MRI-negative mTLE, we observed significantly lower thickness in the presubiculum. Impaired verbal memory was associated with lower thickness in the left presubiculum. In HS-mTLE histological subtype 3, we observed higher curvature than in subtypes 1 and 2 (all p < .05). These findings could not be observed using conventional volumetry (Bonferroni-corrected p < .05). We show that point-wise measures of hippocampal morphometry can uncover structural alterations not measurable by volumetry while also reflecting histological underpinnings and verbal memory. This substantiates the prospect of their clinical application.
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Affiliation(s)
- Laura Fischbach
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Tobias Bauer
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Kersten Diers
- AI in Medical Imaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Mar Brugues
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Attila Rácz
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | | | - Randi von Wrede
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Bernd Weber
- Institute of Experimental Epileptology and Cognition Research, University Hospital Bonn, Bonn, Germany
| | | | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Albert J Becker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
| | - Martin Reuter
- AI in Medical Imaging, German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA
| | - Theodor Rüber
- Department of Epileptology, University Hospital Bonn, Bonn, Germany
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19
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Ebersberger L, Kratzer FJ, Potreck A, Niesporek SC, Keymling M, Nagel AM, Bendszus M, Wick W, Ladd ME, Schlemmer HP, Hoffmann A, Platt T, Paech D. First application of dynamic oxygen-17 magnetic resonance imaging at 7 Tesla in a patient with early subacute stroke. Front Neurosci 2023; 17:1186558. [PMID: 37404469 PMCID: PMC10317041 DOI: 10.3389/fnins.2023.1186558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/26/2023] [Indexed: 07/06/2023] Open
Abstract
Dynamic oxygen-17 (17O) magnetic resonance imaging (MRI) is an imaging method that enables a direct and non-invasive assessment of cerebral oxygen metabolism and thus potentially the distinction between viable and non-viable tissue employing a three-phase inhalation experiment. The purpose of this investigation was the first application of dynamic 17O MRI at 7 Tesla (T) in a patient with stroke. In this proof-of-concept experiment, dynamic 17O MRI was applied during 17O inhalation in a patient with early subacute stroke. The analysis of the relative 17O water (H217O) signal for the affected stroke region compared to the healthy contralateral side revealed no significant difference. However, the technical feasibility of 17O MRI has been demonstrated paving the way for future investigations in neurovascular diseases.
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Affiliation(s)
- Louise Ebersberger
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Fabian J. Kratzer
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Arne Potreck
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian C. Niesporek
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Myriam Keymling
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Armin M. Nagel
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen University Hospital, Erlangen, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Mark E. Ladd
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | | | - Angelika Hoffmann
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
- Department of Neuroradiology, Bern University Hospital, Bern, Switzerland
| | - Tanja Platt
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuroradiology, Bonn University Hospital, Bonn, Germany
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20
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Kroh F, von Knebel Doeberitz N, Breitling J, Maksimovic S, König L, Adeberg S, Scherer M, Unterberg A, Bendszus M, Wick W, Bachert P, Debus J, Ladd ME, Schlemmer HP, Korzowski A, Goerke S, Paech D. Semi-solid MT and APTw CEST-MRI predict clinical outcome of patients with glioma early after radiotherapy. Magn Reson Med 2023. [PMID: 37317562 DOI: 10.1002/mrm.29746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/20/2023] [Accepted: 05/18/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study was to compare the potential of asymmetry-based (APTwasym ), Lorentzian-fit-based (PeakAreaAPT and MTconst ), and relaxation-compensated (MTRRex APT and MTRRex MT) CEST contrasts of the amide proton transfer (APT) and semi-solid magnetization transfer (ssMT) for early response assessment and prediction of progression-free survival (PFS) in patients with glioma. METHODS Seventy-two study participants underwent CEST-MRI at 3T from July 2018 to December 2021 in a prospective clinical trial four to 6 wk after the completion of radiotherapy for diffuse glioma. Tumor segmentations were performed on T2w -FLAIR and contrast-enhanced T1w images. Therapy response assessment and determination of PFS were performed according to response assessment in neuro oncology (RANO) criteria using clinical follow-up data with a median observation time of 9.2 mo (range, 1.6-40.8) and compared to CEST MRI metrics. Statistical testing included receiver operating characteristic analyses, Mann-Whitney-U-test, Kaplan-Meier analyses, and logrank-test. RESULTS MTconst (AUC = 0.79, p < 0.01) showed a stronger association with RANO response assessment compared to PeakAreaAPT (AUC = 0.71, p = 0.02) and MTRRex MT (AUC = 0.71, p = 0.02), and enabled differentiation of participants with pseudoprogression (n = 8) from those with true progression (AUC = 0.79, p = 0.02). Furthermore, MTconst (HR = 3.04, p = 0.01), PeakAreaAPT (HR = 0.39, p = 0.03), and APTwasym (HR = 2.63, p = 0.02) were associated with PFS. MTRRex APT was not associated with any outcome. CONCLUSION MTconst , PeakAreaAPT, and APTwasym imaging predict clinical outcome by means of progression-free survival. Furthermore, MTconst enables differentiation of radiation-induced pseudoprogression from disease progression. Therefore, the assessed metrics may have synergistic potential for supporting clinical decision making during follow-up of patients with glioma.
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Affiliation(s)
- Florian Kroh
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | | | - Johannes Breitling
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Srdjan Maksimovic
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Andreas Unterberg
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Neurosurgery, Heidelberg, Germany
| | - Martin Bendszus
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
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21
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Jiang S, Wen Z, Ahn SS, Cai K, Paech D, Eberhart CG, Zhou J. Applications of chemical exchange saturation transfer magnetic resonance imaging in identifying genetic markers in gliomas. NMR Biomed 2023; 36:e4731. [PMID: 35297117 PMCID: PMC10557022 DOI: 10.1002/nbm.4731] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 05/23/2023]
Abstract
Chemical exchange saturation transfer (CEST) imaging is an important molecular magnetic resonance imaging technique that can image numerous low-concentration biomolecules with water-exchangeable protons (such as cellular proteins) and tissue pH. CEST, or more specially amide proton transfer-weighted imaging, has been widely used for the detection, diagnosis, and response assessment of brain tumors, and its feasibility in identifying molecular markers in gliomas has also been explored in recent years. In this paper, after briefing on the basic principles and quantification methods of CEST imaging, we review its early applications in identifying isocitrate dehydrogenase mutation status, MGMT methylation status, 1p/19q deletion status, and H3K27M mutation status in gliomas. Finally, we discuss the limitations or weaknesses in these studies.
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Affiliation(s)
- Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Kejia Cai
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | | | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
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22
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Haase R, Pinetz T, Bendella Z, Kobler E, Paech D, Block W, Effland A, Radbruch A, Deike-Hofmann K. Reduction of Gadolinium-Based Contrast Agents in MRI Using Convolutional Neural Networks and Different Input Protocols: Limited Interchangeability of Synthesized Sequences With Original Full-Dose Images Despite Excellent Quantitative Performance. Invest Radiol 2023; 58:420-430. [PMID: 36735399 DOI: 10.1097/rli.0000000000000955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The purpose of this study was to implement a state-of-the-art convolutional neural network used to synthesize artificial T1-weighted (T1w) full-dose images from corresponding noncontrast and low-dose images (using various settings of input sequences) and test its performance on a patient population acquired prospectively. MATERIALS AND METHODS In this monocentric, institutional review board-approved study, a total of 138 participants were included who received an adapted imaging protocol with acquisition of a T1w low dose after administration of 10% of the standard dose and acquisition of a T1w full dose after administration of the remaining 90% of the standard dose of a gadolinium-containing contrast agent. A total of 83 participants formed the training sample (51.7 ± 16.5 years, 36 women), 25 the validation sample (55.3 ± 16.4 years, 11 women), and 30 the test sample (55.0 ± 15.0 years, 9 women). Four input settings were differentiated: only the T1w noncontrast and T1w low-dose images (standard setting), only the T1w noncontrast and T1w low-dose images with a prolonged postinjection time of 5 minutes (5-minute setting), multiple noncontrast sequences (T1w, T2w, diffusion) and the T1w low-dose images (extended setting), and only noncontrast sequences (T1w, T2w, diffusion) were used (zero-dose setting). For each setting, a deep neural network was trained to synthesize artificial T1w full-dose images, which were assessed on the test sample using an objective evaluation based on quantitative metrics and a subjective evaluation through a reader-based study. Three readers scored the overall image quality, the interchangeability in regard to the clinical conclusion compared with the true T1w full-dose sequence, the contrast enhancement of lesions, and their conformity to the respective references in the true T1w full dose. RESULTS Quantitative analysis of the artificial T1w full-dose images of the standard setting provided a peak signal-to-noise ratio of 33.39 ± 0.62 (corresponding to an average improvement of the low-dose sequences of 5.2 dB) and a structural similarity index measure of 0.938 ± 0.005. In the 4-fold cross-validation, the extended setting yielded similar performance to the standard setting in terms of peak signal-to-noise ratio ( P = 0.20), but a slight improvement in structural similarity index measure ( P < 0.0001). For all settings, the reader study found comparable overall image quality between the original and artificial T1w full-dose images. The proportion of scans scored as fully or mostly interchangeable was 55%, 58%, 43%, and 3% and the average counts of false positives per case were 0.42 ± 0.83, 0.34 ± 0.71, 0.82 ± 1.15, and 2.00 ± 1.07 for the standard, 5-minute, extended, and zero-dose setting, respectively. Using a 5-point Likert scale (0 to 4, 0 being the worst), all settings of synthesized full-dose images showed significantly poorer contrast enhancement of lesions compared with the original full-dose sequence (difference of average degree of contrast enhancement-standard: -0.97 ± 0.83, P = <0.001; 5-minute: -0.93 ± 0.91, P = <0.001; extended: -0.96 ± 0.97, P = <0.001; zero-dose: -2.39 ± 1.14, P = <0.001). The average scores of conformity of the lesions compared with the original full-dose sequence were 2.25 ± 1.21, 2.22 ± 1.27, 2.24 ± 1.25, and 0.73 ± 0.93 for the standard, 5-minute, extended, and zero-dose setting, respectively. CONCLUSIONS The tested deep learning algorithm for synthesis of artificial T1w full-dose sequences based on images after administration of only 10% of the standard dose of a gadolinium-based contrast agent showed very good quantitative performance. Despite good image quality in all settings, both false-negative and false-positive signals resulted in significantly limited interchangeability of the synthesized sequences with the original full-dose sequences.
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Affiliation(s)
| | - Thomas Pinetz
- Institute of Applied Mathematics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - Zeynep Bendella
- From the Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn
| | - Erich Kobler
- From the Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn
| | | | - Wolfgang Block
- From the Department of Neuroradiology, University Medical Center Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn
| | - Alexander Effland
- Institute of Applied Mathematics, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
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23
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Bendella Z, Widmann CN, Layer JP, Layer YL, Haase R, Sauer M, Bieler L, Lehnen NC, Paech D, Heneka MT, Radbruch A, Schmeel FC. Brain Volume Changes after COVID-19 Compared to Healthy Controls by Artificial Intelligence-Based MRI Volumetry. Diagnostics (Basel) 2023; 13:diagnostics13101716. [PMID: 37238200 DOI: 10.3390/diagnostics13101716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Cohort studies that quantify volumetric brain data among individuals with different levels of COVID-19 severity are presently limited. It is still uncertain whether there exists a potential correlation between disease severity and the effects of COVID-19 on brain integrity. Our objective was to assess the potential impact of COVID-19 on measured brain volume in patients with asymptomatic/mild and severe disease after recovery from infection, compared with healthy controls, using artificial intelligence (AI)-based MRI volumetry. A total of 155 participants were prospectively enrolled in this IRB-approved analysis of three cohorts with a mild course of COVID-19 (n = 51, MILD), a severe hospitalised course (n = 48, SEV), and healthy controls (n = 56, CTL) all undergoing a standardised MRI protocol of the brain. Automated AI-based determination of various brain volumes in mL and calculation of normalised percentiles of brain volume was performed with mdbrain software, using a 3D T1-weighted magnetisation-prepared rapid gradient echo (MPRAGE) sequence. The automatically measured brain volumes and percentiles were analysed for differences between groups. The estimated influence of COVID-19 and demographic/clinical variables on brain volume was determined using multivariate analysis. There were statistically significant differences in measured brain volumes and percentiles of various brain regions among groups, even after the exclusion of patients undergoing intensive care, with significant volume reductions in COVID-19 patients, which increased with disease severity (SEV > MILD > CTL) and mainly affected the supratentorial grey matter, frontal and parietal lobes, and right thalamus. Severe COVID-19 infection, in addition to established demographic parameters such as age and sex, was a significant predictor of brain volume loss upon multivariate analysis. In conclusion, neocortical brain degeneration was detected in patients who had recovered from SARS-CoV-2 infection compared to healthy controls, worsening with greater initial COVID-19 severity and mainly affecting the fronto-parietal brain and right thalamus, regardless of ICU treatment. This suggests a direct link between COVID-19 infection and subsequent brain atrophy, which may have major implications for clinical management and future cognitive rehabilitation strategies.
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Affiliation(s)
- Zeynep Bendella
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Catherine Nichols Widmann
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Yonah Lucas Layer
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Robert Haase
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Malte Sauer
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Luzie Bieler
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, 4367 Luxembourg, Luxembourg
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
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24
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Knebel Doeberitz NV, Kroh F, Breitling J, König L, Maksimovic S, Graß S, Adeberg S, Scherer M, Unterberg A, Bendszus M, Wick W, Bachert P, Debus J, Ladd ME, Schlemmer HP, Korzowski A, Goerke S, Paech D. CEST Imaging of the APT and ssMT predict the overall survival of patients with glioma at the first follow-up after completion of radiotherapy at 3T. Radiother Oncol 2023; 184:109694. [PMID: 37150450 DOI: 10.1016/j.radonc.2023.109694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND AND PURPOSE Outcome prediction of patients with glioma early after the completion of radiotherapy represents a major clinical challenge. Previously, the prognostic value of chemical exchange saturation transfer (CEST) imaging has been demonstrated in patients with newly diagnosed glioma. The objective of this study was to assess the potential of amide proton transfer (APT)-, relayed nuclear Overhauser effect (rNOE)- and semi-solid magnetization transfer (ssMT)-imaging according to Zhou et al. (APTwasym), Goerke et al. (MTRRexAPT, MTRRexNOE and MTRRexMT) and Mehrabian et al. (PeakAreaAPT, PeakAreaNOE and MTconst) for the prognostication of the overall survival (OS) of patients with glioma at the first follow-up after the completion of radiotherapy. MATERIALS AND METHODS 49 of 72 participants with diffuse glioma, who underwent CEST MRI at 3T between July 2018 and December 2021 4 to 6 weeks after the completion of radiotherapy, were analyzed. Contrast-enhancing tumor (CE) and whole tumor (WT) volumes were segmented on T2w-FLAIR and contrast-enhanced T1w images. Kaplan-Meier analysis and logrank-test were used for statistical analyses. RESULTS APTw imaging demonstrated the strongest association with OS (HR=4.66, p<0.001). The MTconst (HR=2.54, p=0.044) was associated with the OS of participants with residual contrast-enhancing glioma tissue, whilst the MTRRexAPT (HR=2.44, p=0.056) showed a trend in this sub-cohort. The MTRRexNOE, MTRRexMT and PeakAreaNOE were not associated with survival. CONCLUSION Imaging of the APT and ssMT at the first follow-up 4 to 6 weeks after the completion of radiotherapy at 3T were associated with the overall survival of patients with glioma.
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Affiliation(s)
| | - Florian Kroh
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Johannes Breitling
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Srdjan Maksimovic
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Svenja Graß
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Moritz Scherer
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Neuroradiology, University Hospital Bonn, Bonn, Germany.
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25
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Stösser S, Bode FJ, Meissner JN, Weller JM, Kindler C, Sauer M, Paech D, Riegler C, Nolte CH, Pourian A, Röther J, Selo N, Ernemann U, Poli S, Eckert RM, Bohner G, Scherling K, Dorn F, Petzold GC. Outcome of Stroke Patients with Unknown Onset and Unknown Time Last Known Well Undergoing Endovascular Therapy. Clin Neuroradiol 2023; 33:107-112. [PMID: 35796854 PMCID: PMC10014703 DOI: 10.1007/s00062-022-01188-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Endovascular treatment (ET) in patients with large vessel occlusion stroke (LVOS) with unknown onset or an extended time window can be safe and effective if patients are selected by defined clinical and imaging criteria; however, it is unclear if these criteria should also be applied to patients with unknown onset and unknown time last known well. In this study, we aimed to assess whether absent information on the time patients were last known to be well impacts outcome in patients with unknown onset LVOS. METHODS We analyzed patients who were enrolled in the German Stroke Registry-Endovascular Treatment between 2015 and 2019. Patients with unknown onset and unknown time last known well (LKWu) were compared to patients with known onset (KO) and to patients with unknown onset but known time last known well (LKWk) regarding clinical and imaging baseline characteristics and outcome. RESULTS Out of 5909 patients, 561 presented with LKWu (9.5%), 1849 with LKWk (31.3%) and 3499 with KO (59.2%). At 90 days, functional independency was less frequent in LKWu (27.0%) compared to KO (42.6%) and LKWk patients (31.8%). These differences were not significant after adjusting for confounders. A main confounder was the initial Alberta stroke program early CT score. CONCLUSION The LKWu patients had a similar outcome after ET as KO and LKWk patients after adjusting for confounders. Thus, ET should not be withheld if the time last known well is unknown. Instead, LKWu patients may be selected for ET using the same criteria as in LKWk patients.
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Affiliation(s)
- Sebastian Stösser
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Felix J Bode
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Julius N Meissner
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Johannes M Weller
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Christine Kindler
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Malte Sauer
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Christoph Riegler
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Amitis Pourian
- Department of Neurology, Asklepios Hospital Hamburg Altona, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Hospital Hamburg Altona, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Nadja Selo
- Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, University Hospital Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Rosa Marie Eckert
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Korbinian Scherling
- Department of Neuroradiology, Ludwig Maximilians University Munich, Campus Grosshadern, Munich, Germany
| | - Franziska Dorn
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Gabor C Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Mesropyan N, Khorsandian L, Faron A, Sprinkart AM, Dorn F, Paech D, Isaak A, Kuetting D, Pieper CC, Radbruch A, Attenberger UI, Reimann J, Bode FJ, Kornblum C, Luetkens JA. Computed tomography derived cervical fat-free muscle fraction as an imaging-based outcome marker in patients with acute ischemic stroke: a pilot study. BMC Neurol 2023; 23:86. [PMID: 36855093 PMCID: PMC9971678 DOI: 10.1186/s12883-023-03132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 02/19/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Outcome assessment in stroke patients is essential for evidence-based stroke care planning. Computed tomography (CT) is the mainstay of diagnosis in acute stroke. This study aimed to investigate whether CT-derived cervical fat-free muscle fraction (FFMF) as a biomarker of muscle quality is associated with outcome parameters after acute ischemic stroke. METHODS In this retrospective study, 66 patients (mean age: 76 ± 13 years, 30 female) with acute ischemic stroke in the anterior circulation who underwent CT, including CT-angiography, and endovascular mechanical thrombectomy of the middle cerebral artery between August 2016 and January 2020 were identified. Based on densitometric thresholds, cervical paraspinal muscles covered on CT-angiography were separated into areas of fatty and lean muscle and FFMF was calculated. The study cohort was binarized based on median FFMF (cutoff value: < 71.6%) to compare clinical variables and outcome data between two groups. Unpaired t test and Mann-Whitney U test were used for statistical analysis. RESULTS National Institute of Health Stroke Scale (NIHSS) (12.2 ± 4.4 vs. 13.6 ± 4.5, P = 0.297) and modified Rankin scale (mRS) (4.3 ± 0.9 vs. 4.4 ± 0.9, P = 0.475) at admission, and pre-stroke mRS (1 ± 1.3 vs. 0.9 ± 1.4, P = 0.489) were similar between groups with high and low FFMF. NIHSS and mRS at discharge were significantly better in patients with high FFMF compared to patients with low FFMF (NIHSS: 4.5 ± 4.4 vs. 9.5 ± 6.7; P = 0.004 and mRS: 2.9 ± 2.1 vs.3.9 ± 1.8; P = 0.049). 90-day mRS was significantly better in patients with high FFMF compared to patients with low FFMF (3.3 ± 2.2 vs. 4.3 ± 1.9, P = 0.045). CONCLUSION Cervical FFMF obtained from routine clinical CT might be a new imaging-based muscle quality biomarker for outcome prediction in stroke patients.
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Affiliation(s)
- Narine Mesropyan
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Louisa Khorsandian
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Anton Faron
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany ,Radiologische Allianz, Andreas-Knack-Ring 16, 22307 Hamburg, Germany
| | - Alois M. Sprinkart
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franziska Dorn
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Paech
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Isaak
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Daniel Kuetting
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - Claus C. Pieper
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Radbruch
- grid.15090.3d0000 0000 8786 803XDepartment of Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Ulrike I. Attenberger
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Jens Reimann
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix J. Bode
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Cornelia Kornblum
- grid.15090.3d0000 0000 8786 803XDepartment of Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Julian A. Luetkens
- grid.15090.3d0000 0000 8786 803XDepartment of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany ,Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
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Potthoff AL, Heimann M, Lehmann F, Ilic I, Paech D, Borger V, Radbruch A, Schäfer N, Schuss P, Vatter H, Herrlinger U, Schneider M. Survival after resection of brain metastasis: impact of synchronous versus metachronous metastatic disease. J Neurooncol 2023; 161:539-545. [PMID: 36695975 PMCID: PMC9992001 DOI: 10.1007/s11060-023-04242-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/07/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE Patients with brain metastasis (BM) from solid tumors are in an advanced stage of cancer. BM may occur during a known oncological disease (metachronous BM) or be the primary manifestation of previously unknown cancer (synchronous BM). The time of diagnosis might decisively impact patient prognosis and further treatment stratification. In the present study, we analyzed the prognostic impact of synchronous versus (vs.) metachronous BM occurrence following resection of BM. METHODS Between 2013 and 2018, 353 patients had undergone surgical therapy for BM at the authors' neuro-oncological center. Survival stratification calculated from the day of neurosurgical resection was performed for synchronous vs. metachronous BM diagnosis. RESULTS Non-small-cell lung carcinoma (NSCLC) was the most common tumor entity of primary site (43%) followed by gastrointestinal cancer (14%) and breast cancer (13%). Synchronous BM occurrence was present in 116 of 353 patients (33%), metachronous BM occurrence was present in 237 of 353 patients (67%). NSCLC was significantly more often diagnosed via resection of the BM (56% synchronous vs. 44% metachronous situation, p = 0.0001). The median overall survival for patients with synchronous BM diagnosis was 12 months (95% confidence interval (CI) 7.5-16.5) compared to 13 months (95% CI 9.6-16.4) for patients with metachronous BM diagnosis (p = 0.97). CONCLUSIONS The present study indicates that time of BM diagnosis (synchronous vs. metachronous) does not significantly impact patient survival following surgical therapy of BM. These results suggest that the indication for neurosurgical BM resection should be made regardless of a synchronous or a metachronous time of BM occurrence.
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Affiliation(s)
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital, Bonn, Germany
| | - Felix Lehmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Inja Ilic
- Department of Neurosurgery, University Hospital, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital, Bonn, Germany
| | | | - Niklas Schäfer
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital, Bonn, Germany.,Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
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Paech D, Lehnen N, Lakghomi A, Schievelkamp A, Gronemann C, Bode FJ, Radbruch A, Dorn F. School of Thrombectomy-A 3-Step Approach to Perform Acute Stroke Treatment with Simulator Training and Virtual Supervision by Remote Streaming Support (RESS). Clin Neuroradiol 2022; 33:529-535. [PMID: 36520188 PMCID: PMC9753868 DOI: 10.1007/s00062-022-01242-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022]
Abstract
As the number of neurointerventional procedures continues to increase, so does the need for well-trained neurointerventionalists. The purpose of this work was to establish and assess a systematic 3‑step approach to perform acute stroke treatment including simulator training and virtual supervision by remote streaming support (RESS). Five trainees (four men, one women) who have completed the 3‑step approach have answered an 11-item questionnaire (5-point Likert scale) in order to evaluate training step 1 (simulator). Furthermore, all trainees and one supervisor (female) answered a standardized questionnaire following the initial 15 consecutive thrombectomies for each trainee, corresponding to a total of 75 thrombectomies. The simulator training yielded learning benefits and confidence gain to perform MT on patients. The RESS approach facilitated the translation during the first independently performed thrombectomies on patients. In summary, the presented 3‑step approach increases the level of safety, as reported by the trainees and supervisor in this study and may enable an accelerated training of neurointerventionalists.
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Affiliation(s)
- Daniel Paech
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Nils Lehnen
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Asadeh Lakghomi
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Arndt Schievelkamp
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Christian Gronemann
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Felix J. Bode
- grid.15090.3d0000 0000 8786 803XClinic for Neurology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Alexander Radbruch
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Franziska Dorn
- grid.15090.3d0000 0000 8786 803XClinic for Neuroradiology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
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Lehnen NC, Paech D, Zülow S, Bode FJ, Petzold GC, Radbruch A, Dorn F. First Experience with the Nimbus Stentretriever. Clin Neuroradiol 2022; 33:491-497. [DOI: 10.1007/s00062-022-01237-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
Abstract
Purpose
To share our first experience with the Nimbus stentretriever, a multizone device designed to assist neurointerventionalists in handling fibrin-rich clots in endovascular stroke treatment.
Methods
We retrospectively analyzed the data of patients who were treated with the Nimbus stentretriever at our high-volume stroke center between May 2021 and May 2022. We evaluated the number of passes before Nimbus was used, the number of passes with nimbus, as well as the recanalization success before and after Nimbus according to the modified treatment in cerebral ischemia (mTICI) scale. Also, patient characteristics, procedural times and clinical outcomes were documented.
Results
A total of 21 consecutive patients were included in the study. An mTICI 2b/3 could be achieved in 76.2% and mTICI 2c/3 could be achieved in 57.1%. The mean number of passes was 3.4 before the use of Nimbus, 2.2 with Nimbus, and 5.4 for all passes with and without Nimbus and 4 occlusions (19.0%) were successfully recanalized with direct aspiration after the use of Nimbus. We observed seven subarachnoid hemorrhages (33.3%) and two cases of vasospasm.
Conclusion
In our series, the use of Nimbus resulted in successful recanalization in half of the patients after otherwise unsuccessful thrombectomy maneuvers; therefore, it should be considered as a rescue option if the maneuver with conventional stent retrievers was unsuccessful.
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30
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Lehnen NC, Haase R, Schmeel FC, Vatter H, Dorn F, Radbruch A, Paech D. Automated Detection of Cerebral Aneurysms on TOF-MRA Using a Deep Learning Approach: An External Validation Study. AJNR Am J Neuroradiol 2022; 43:1700-1705. [PMID: 36357154 DOI: 10.3174/ajnr.a7695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/05/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral aneurysms yield the risk of rupture, severe disability and death. Thus, early detection of cerebral aneurysms is crucial to ensure timely treatment, if necessary. AI-based software tools are expected to enhance radiologists' performance in detecting pathologies like cerebral aneurysms in the future. Our aim was to evaluate the diagnostic performance of an artificial intelligence-based software designed to detect intracranial aneurysms on TOF-MRA. MATERIALS AND METHODS One hundred ninety-one MR imaging data sets were analyzed using the software mdbrain for the presence of intracranial aneurysms on TOF-MRA obtained using two 3T MR imaging scanners or a 1.5T MR imaging scanner according to our clinical standard protocol. The results were compared with the reading of an experienced radiologist as a criterion standard to measure the sensitivity, specificity, positive and negative predictive values, and accuracy of the software. Additionally, detection rates depending on size, morphology, and location of the aneurysms were evaluated. RESULTS Fifty-four aneurysms were detected by the expert reader. The overall sensitivity of the software for the detection of cerebral aneurysms was 72.6%, the specificity was 87.2%, and the accuracy was 82.6%. The positive predictive value was 67.9%, and the negative predictive value was 88.5%. We observed a sensitivity of 100% for saccular aneurysms of >5 mm without signs of thrombosis and low detection rates for fusiform or thrombosed aneurysms of 33.3% and 16.7%, respectively. Of 8 aneurysms that were not included in the initial written reports but were detected by the expert reader, retrospectively, 4 were detected by the software. CONCLUSIONS Our data suggest that the software can assist radiologists in reporting TOF-MRA. The software was highly reliable in detecting saccular aneurysms, while for fusiform or thrombosed aneurysms, further improvements are needed. Further studies are necessary to investigate the impact of the software on detection rates, interrater reliability, and reading times.
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Affiliation(s)
- N C Lehnen
- From the Departments of Neuroradiology (N.C.L., R.H., F.C.S., F.D., A.R., D.P.)
| | - R Haase
- From the Departments of Neuroradiology (N.C.L., R.H., F.C.S., F.D., A.R., D.P.)
| | - F C Schmeel
- From the Departments of Neuroradiology (N.C.L., R.H., F.C.S., F.D., A.R., D.P.)
| | - H Vatter
- Neurosurgery (H.V.), University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany
| | - F Dorn
- From the Departments of Neuroradiology (N.C.L., R.H., F.C.S., F.D., A.R., D.P.)
| | - A Radbruch
- From the Departments of Neuroradiology (N.C.L., R.H., F.C.S., F.D., A.R., D.P.)
| | - D Paech
- From the Departments of Neuroradiology (N.C.L., R.H., F.C.S., F.D., A.R., D.P.)
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31
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Laupichler MC, Hadizadeh DR, Wintergerst MWM, von der Emde L, Paech D, Dick EA, Raupach T. Effect of a flipped classroom course to foster medical students' AI literacy with a focus on medical imaging: a single group pre-and post-test study. BMC Med Educ 2022; 22:803. [PMID: 36397110 PMCID: PMC9672614 DOI: 10.1186/s12909-022-03866-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The use of artificial intelligence applications in medicine is becoming increasingly common. At the same time, however, there are few initiatives to teach this important and timely topic to medical students. One reason for this is the predetermined medical curriculum, which leaves very little room for new topics that were not included before. We present a flipped classroom course designed to give undergraduate medical students an elaborated first impression of AI and to increase their "AI readiness". METHODS The course was tested and evaluated at Bonn Medical School in Germany with medical students in semester three or higher and consisted of a mixture of online self-study units and online classroom lessons. While the online content provided the theoretical underpinnings and demonstrated different perspectives on AI in medical imaging, the classroom sessions offered deeper insight into how "human" diagnostic decision-making differs from AI diagnoses. This was achieved through interactive exercises in which students first diagnosed medical image data themselves and then compared their results with the AI diagnoses. We adapted the "Medical Artificial Intelligence Scale for Medical Students" to evaluate differences in "AI readiness" before and after taking part in the course. These differences were measured by calculating the so called "comparative self-assessment gain" (CSA gain) which enables a valid and reliable representation of changes in behaviour, attitudes, or knowledge. RESULTS We found a statistically significant increase in perceived AI readiness. While values of CSA gain were different across items and factors, the overall CSA gain regarding AI readiness was satisfactory. CONCLUSION Attending a course developed to increase knowledge about AI in medical imaging can increase self-perceived AI readiness in medical students.
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Affiliation(s)
- Matthias C Laupichler
- Institute of Medical Education, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Dariusch R Hadizadeh
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn, Germany
| | | | - Leon von der Emde
- Department of Ophthalmology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Elizabeth A Dick
- Imperial College NHS Trust and Imperial College London, St. Marys Hospital London, London, UK
| | - Tobias Raupach
- Institute of Medical Education, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Giordano F, Layer J, Leonardelli S, Friker L, Schaub C, Turiello R, Sperk E, Mildenberger I, Grau F, Paech D, Pietsch T, Mueller W, Grauer O, Renovanz M, Tabatabai G, Kebir S, Glas M, Bisdas S, Hambsch P, Seidel C, Hölzel M, Herrlinger U. CTNI-67. DUAL INHIBITION OF POST-RADIOGENIC ANGIO-VASCULOGENESIS BY OLAPTESED PEGOL (NOX-A12) AND BEVACIZUMAB IN GLIOBLASTOMA – INTERIM DATA FROM THE FIRST EXPANSION ARM OF THE GERMAN PHASE 1/2 GLORIA TRIAL. Neuro Oncol 2022. [PMCID: PMC9661069 DOI: 10.1093/neuonc/noac209.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
We recently reported favorable safety, promising clinical efficacy and immunohistochemical indicators of response after radiotherapy (RT) plus escalating doses of the CXCL12-neutralizing RNA-Spiegelmer olaptesed pegol (NOX-A12) for glioblastoma in the German multicenter phase 1/2 GLORIA trial (NCT04121455). Here, we report outcomes after RT plus dual inhibition of vasculogenesis (NOX-A12) and angiogenesis (bevacizumab).
METHODS
After establishing safety in the monotherapy arm, we enrolled six patients with incompletely resected GBM, ECOG ≤ 2, age ≥ 18 and without MGMT promoter hypermethylation into a pre-planned expansion arm. Patients received standard RT (60 Gy in 30 fractions), continuous i.v. infusions of NOX-A12 (600 mg/week) and i.v. infusions of bevacizumab (10 mg/kg q2w). The primary endpoint was safety. Secondary endpoints included radiographic response, perfusion/diffusion imaging and neurologic performance.
RESULTS
Dual treatment was well-tolerated and safe. Of all G ≥ 2 AEs (n = 37), two G2 events (5.4%) were deemed related to NOX-A12. There were no dose-limiting toxicities and no treatment-related deaths. Longitudinal NANO assessment revealed stable neurologic functioning in all patients. Five out of six patients achieved partial responses (PRs) as per mRANO in week 9. All PRs remained durable at a median follow up of 5.6 months (range 3.6 to 9.3 months). No progression occurred. The mean best response was -65.9% (-13.3% to -99.9%) for target lesion sums and -92.1% (-76.2% to -100%) for non-target lesion (NTL) sums. In all three patients with NTL at least one lesion disappeared. The mean best change from baseline of the highly perfused-tumor fraction was -84.5% (-51.9% to -100%) and the mean best change of the apparent diffusion coefficient was 20.1% (-24.5% to 59.1%).
CONCLUSION
Interim data of the ongoing trial confirm the previously established safety profile of NOX-A12 and suggest improved efficacy of dual inhibition of post-radiogenic angio- and vasculogenesis by the addition of bevacizumab.
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Affiliation(s)
- Frank Giordano
- Department of Radiation Oncology, University Hospital Bonn , Bonn , Germany
| | - Julian Layer
- Department of Radiation Oncology, University Hospital Bonn , Bonn , Germany
| | - Sonia Leonardelli
- Institute of Experimental Oncology, University Hospital Bonn , Bonn , Germany
| | - Lea Friker
- Department of Neuropathology, University Hospital Bonn , Bonn , Germany
| | - Christina Schaub
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Roberta Turiello
- Institute of Experimental Oncology, University Hospital Bonn , Bonn , Germany
| | - Elena Sperk
- Department of Radiation Oncology, Medical Faculty Mannheim, University of Heidelberg , Mannheim , Germany
| | - Iris Mildenberger
- Department of Neurology, Medical Faculty Mannheim, University of Heidelberg , Mannheim , Germany
| | - Franziska Grau
- Department of Neuroradiology, University Hospital Bonn , Bonn , Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn , Bonn , Germany
| | - Torsten Pietsch
- Department of Neuropathology, University Hospital Bonn , Bonn , Germany
| | - Wolf Mueller
- Institute of Neuropathology, University Hospital Leipzig , Leipzig , Germany
| | - Oliver Grauer
- Department of Neurology, University Hospital Münster , Münster , Germany
| | - Mirjam Renovanz
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen , Essen , Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen , Essen , Germany
| | - Sotirios Bisdas
- Department of Neuroradiology at the National Hospital for Neurology , London, London , United Kingdom
| | - Peter Hambsch
- Department of Radiotherapy, University Hospital Leipzig , Leipzig , Germany
| | - Clemens Seidel
- Department of Radiotherapy, University Hospital Leipzig , Leipzig , Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn , Bonn , Germany
| | - Ulrich Herrlinger
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
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Zeyen T, Paech D, Weller J, Schäfer N, Tzaridis T, Duffy C, Nitsch L, Schneider M, Steinbach J, Hau P, Schlegel U, Seidel C, Krex D, Grauer O, Goldbrunner R, Zeiner P, Tabatabai G, Galldiks N, Stummer W, Hattingen E, Glas M, Radbruch A, Herrlinger U, Schaub C. NIMG-32. POSTPROGRESSION SURVIVAL AND MRI FEATURES AT PROGRESSION IN MGMT-METHYLATED GLIOBLASTOMA FOLLOWING TEMOZOLOMIDE (TMZ) OR CCNU/TMZ THERAPY - AN ANALYSIS OF THE CETEG/NOA-09-TRIAL. Neuro Oncol 2022. [PMCID: PMC9660969 DOI: 10.1093/neuonc/noac209.650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
INTRODUCTION
In the randomized CeTeG/NOA-09 trial, combined CCNU/TMZ was superior to TMZ therapy regarding overall survival (OS) in newly diagnosed patients with MGMT-methylated glioblastoma. Using modified RANO criteria, however, progression-free survival (PFS) and pseudoprogression rates were similar in both arms. Exploring the hypothesis of undetected pseudoprogressions being accountable for this discrepancy, we analyzed patterns of postprogression survival (PPS) and MRI features at RANO-defined progression.
METHODS
86 CeTeG/NOA-09 patients with progression (modified RANO criteria) and MRI evaluable for standardized T1 and FLAIR volumetry at baseline and progression were included. Patients were further subdivided to short PPS (< 24 months) or long PPS (> 24 months) and a PPS/PFS ratio was calculated.
RESULTS
In the CCNU/TMZ arm, long PPS patients (n=10) tended to a shorter PFS (median 7.3 months) than short PPS patients in the same arm (n=33, 14 months, p=0.089, logrank test) and long PPS patients in the TMZ arm (n=9, 12.7 months, p=0.21). The mean PPS/PFS ratio in the long PPS group was markedly higher in the CCNU/TMZ arm (5.8) compared to the TMZ arm (3.3, p=0.043, Mann-Whitney test). Patients with long PPS of the CCNU/TMZ arm showed a nonsignificant tendency to a stronger volumetric increase in T1 enhancement (mean delta 6184,86 vs. 697.5 mm³) and FLAIR–T1-enhancement (mean delta 42671 vs 16860 mm³) at progression as compared to long PPS patients of the TMZ arm.
CONCLUSION
Combining a substantially increased PPS/PFS ratio (long OS despite particularly short PFS according to RANO) with indications for increased contrast enhancement and FLAIR volume at progression, the patients with long PPS in the CCNU/TMZ arm appear to differ from those in the TMZ arm. These observations support the hypothesis that this group (~25% of CCNU/TMZ-treated patients) contained patients with pseudoprogression undetected by modified RANO criteria.
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Affiliation(s)
- Thomas Zeyen
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn , Bonn , Germany
| | - Johannes Weller
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Niklas Schäfer
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | | | - Cathrina Duffy
- Division of neurooncology, Universitiy hospital Bonn , Bonn , Germany
| | - Louisa Nitsch
- Division of neurooncology, Universitiy hospital Bonn , Bonn , Germany
| | | | | | - Peter Hau
- Universitätsklinikum Regensburg , Regensburg , Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr–University Bochum , Bochum , Germany
| | - Clemens Seidel
- Department of Radiotherapy, University Hospital Leipzig , Leipzig , Germany
| | | | - Oliver Grauer
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster , Münster , Germany
| | - Roland Goldbrunner
- Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | - Pia Zeiner
- Dr. Senckenberg Institute of Neurooncology , Frankfurt , Germany
| | - Ghazaleh Tabatabai
- Department of Neurology & Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research , Tübingen , Germany
| | - Norbert Galldiks
- Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne , Cologne , Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital , Münster , Germany
| | - Elke Hattingen
- Institute of Neuroradiology, University Hospital Frankfurt, Frankfurt, Germany , Frankfurt , Germany
| | - Martin Glas
- Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), Division of Clinical Neurooncology, University Medicine Essen, University Duisburg-Essen, Essen, Germany , Essen , Germany
| | - Alexander Radbruch
- Department of Neuroradiology, universitiy hospital Bonn , Bonn , Germany
| | - Ulrich Herrlinger
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
| | - Christina Schaub
- Division of Neurooncology, Department of Neurology, University Hospital Bonn , Bonn , Germany
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Klopries K, Tavakoli AA, Doll S, Kuner T, Paech D. [Post-mortem computed tomography in macroscopic anatomy teaching : Close cooperation between anatomy and radiology]. Radiologie (Heidelb) 2022; 62:977-980. [PMID: 35838767 DOI: 10.1007/s00117-022-01046-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Kerstin Klopries
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Essen, Essen, Deutschland
- Institut für Anatomie und Zellbiologie, Universität Heidelberg, Heidelberg, Deutschland
| | | | - Sara Doll
- Institut für Anatomie und Zellbiologie, Universität Heidelberg, Heidelberg, Deutschland
| | - Thomas Kuner
- Institut für Anatomie und Zellbiologie, Universität Heidelberg, Heidelberg, Deutschland
| | - Daniel Paech
- Institut für Anatomie und Zellbiologie, Universität Heidelberg, Heidelberg, Deutschland.
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum Bonn, Bonn, Deutschland.
- 7-Tesla-MRT, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland.
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von Knebel Doeberitz N, Paech D, Sturm D, Pusch S, Turcan S, Saunthararajah Y. Changing paradigms in oncology: Toward noncytotoxic treatments for advanced gliomas. Int J Cancer 2022; 151:1431-1446. [PMID: 35603902 PMCID: PMC9474618 DOI: 10.1002/ijc.34131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022]
Abstract
Glial-lineage malignancies (gliomas) recurrently mutate and/or delete the master regulators of apoptosis p53 and/or p16/CDKN2A, undermining apoptosis-intending (cytotoxic) treatments. By contrast to disrupted p53/p16, glioma cells are live-wired with the master transcription factor circuits that specify and drive glial lineage fates: these transcription factors activate early-glial and replication programs as expected, but fail in their other usual function of forcing onward glial lineage-maturation-late-glial genes have constitutively "closed" chromatin requiring chromatin-remodeling for activation-glioma-genesis disrupts several epigenetic components needed to perform this work, and simultaneously amplifies repressing epigenetic machinery instead. Pharmacologic inhibition of repressing epigenetic enzymes thus allows activation of late-glial genes and terminates glioma self-replication (self-replication = replication without lineage-maturation), independent of p53/p16/apoptosis. Lineage-specifying master transcription factors therefore contrast with p53/p16 in being enriched in self-replicating glioma cells, reveal a cause-effect relationship between aberrant epigenetic repression of late-lineage programs and malignant self-replication, and point to specific epigenetic targets for noncytotoxic glioma-therapy.
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Affiliation(s)
| | - Daniel Paech
- Division of RadiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
- Department of NeuroradiologyBonn University HospitalBonnGermany
| | - Dominik Sturm
- Hopp Children's Cancer Center (KiTZ) HeidelbergHeidelbergGermany
- Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK)HeidelbergGermany
- Department of Pediatric Oncology, Hematology & ImmunologyHeidelberg University HospitalHeidelbergGermany
| | - Stefan Pusch
- Department of NeuropathologyInstitute of Pathology, Ruprecht‐Karls‐University HeidelbergHeidelbergGermany
- German Cancer Consortium (DKTK), Clinical Cooperation Unit (CCU) Neuropathology, German Cancer Research Center (DKFZ)HeidelbergGermany
| | - Sevin Turcan
- Department of NeurologyHeidelberg University HospitalHeidelbergGermany
| | - Yogen Saunthararajah
- Department of Translational Hematology and Oncology ResearchTaussig Cancer Institute, Cleveland ClinicClevelandOhioUSA
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36
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Ilic I, Potthoff AL, Borger V, Heimann M, Paech D, Giordano FA, Schmeel LC, Radbruch A, Schuss P, Schäfer N, Herrlinger U, Vatter H, Lakghomi A, Schneider M. Bone Mineral Density as an Individual Prognostic Biomarker in Patients with Surgically-Treated Brain Metastasis from Lung Cancer (NSCLC). Cancers (Basel) 2022; 14:cancers14194633. [PMID: 36230556 PMCID: PMC9562667 DOI: 10.3390/cancers14194633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 01/09/2023] Open
Abstract
Patients with BM are in advanced stages of systemic cancer, which may translate into significant alterations of body composition biomarkers, such as BMD. The present study investigated the prognostic value of BMD on overall survival (OS) of 95 patients with surgically-treated BM related to NSCLC. All patients were treated in a large tertiary care neuro-oncological center between 2013 and 2018. Preoperative BMD was determined from the first lumbar vertebrae (L1) from routine preoperative staging computed tomography (CT) scans. Results were stratified into pathologic and physiologic values according to recently published normative reference ranges and correlated with survival parameters. Median preoperative L1-BMD was 99 Hounsfield units (HU) (IQR 74-195) compared to 140 HU (IQR 113-159) for patients with pathological and physiologic BMD (p = 0.03), with a median OS of 6 versus 15 months (p = 0.002). Multivariable analysis revealed pathologic BMD as an independent prognostic predictor for increased 1-year mortality (p = 0.03, OR 0.5, 95% CI 0.2-1.0). The present study suggests that decreased preoperative BMD values may represent a previously unrecognized negative prognostic factor in patients of BM requiring surgery for NSCLC. Based on guideline-adherent preoperative staging, BMD may prove to be a highly individualized, readily available biomarker for prognostic assessment and treatment guidance in affected patients.
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Affiliation(s)
- Inja Ilic
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16500
| | | | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Muriel Heimann
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
| | | | | | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, BG Klinikum Unfallkrankenhaus Berlin, 12683 Berlin, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Bonn, 53127 Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Asadeh Lakghomi
- Department of Neuroradiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
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37
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Paech D, Regnery S, Platt T, Behl N, Weckesser N, Ladd M, Schlemmer PH, Debus J, Adeberg S. Natrium-MRT bei 7 Tesla: Untersuchung des diagnostischen Nutzens als Prädiktor für Therapieansprechen und Überleben bei Glioblastompatienten. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- D Paech
- Universitätsklinikum Bonn, Klinik für Neuroradiologie, Bonn
| | | | | | | | | | | | | | - J Debus
- Universitätsklinikum Heidelberg
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38
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Breitling J, Korzowski A, Kempa N, Boyd PS, Paech D, Schlemmer HP, Ladd ME, Bachert P, Goerke S. Motion correction for three-dimensional chemical exchange saturation transfer imaging without direct water saturation artifacts. NMR Biomed 2022; 35:e4720. [PMID: 35233847 DOI: 10.1002/nbm.4720] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/25/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
In chemical exchange saturation transfer (CEST) MRI, motion correction is compromised by the drastically changing image contrast at different frequency offsets, particularly at the direct water saturation. In this study, a simple extension for conventional image registration algorithms is proposed, enabling robust and accurate motion correction of CEST-MRI data. The proposed method uses weighted averaging of motion parameters from a conventional rigid image registration to identify and mitigate erroneously misaligned images. Functionality of the proposed method was verified by ground truth datasets generated from 10 three-dimensional in vivo measurements at 3 T with simulated realistic random rigid motion patterns and noise. Performance was assessed using two different criteria: the maximum image misalignment as a measure for the robustness against direct water saturation artifacts, and the spectral error as a measure of the overall accuracy. For both criteria, the proposed method achieved the best scores compared with two motion-correction algorithms specifically developed to handle the varying contrasts in CEST-MRI. Compared with a straightforward linear interpolation of the motion parameters at frequency offsets close to the direct water saturation, the proposed method offers better performance in the absence of artifacts. The proposed method for motion correction in CEST-MRI allows identification and mitigation of direct water saturation artifacts that occur with conventional image registration algorithms. The resulting improved robustness and accuracy enable reliable motion correction, which is particularly crucial for an automated and carefree evaluation of spectral CEST-MRI data, e.g., for large patient cohorts or in clinical routines.
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Affiliation(s)
- Johannes Breitling
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas Korzowski
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Neele Kempa
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Philip S Boyd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
- Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Bachert
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Steffen Goerke
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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39
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Giordano FA, Layer JP, Leonardelli S, Friker LL, Seidel C, Schaub C, Turiello R, Sperk E, Grau F, Paech D, Link B, Mueller W, Tabatabai G, Sahm K, Kebir S, Pietsch T, Glas M, Bisdas S, Herrlinger U, Hölzel M. Radiotherapy and olaptesed pegol (NOX-A12) in partially resected or biopsy-only MGMT-unmethylated glioblastoma: Interim data from the German multicenter phase 1/2 GLORIA trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2050 Background: Pre-clinical studies consistently demonstrate that inhibition of the CXCL12/CXCR4/CXCR7 axis abrogates recruitment of pro-vasculogenic bone marrow-derived cells after radiotherapy (RT) of glioblastoma (GBM) and promotes T cell exclusion from the tumor microenvironment (TME). The German multicenter phase 1/2 trial GLORIA (NCT04121455) assesses safety of RT plus escalating dose levels (DL) of the CXCL12-neutralizing RNA-Spiegelmer Olaptesed pegol (OLA; NOX-A12) in patients with chemotherapy-resistant GBM. Methods: Until now, GLORIA enrolled 10 patients newly diagnosed with incompletely resected (n = 8) or biopsied (n = 2) GBM with ECOG≤2, age ≥18 and without MGMT promoter hypermethylation. All patients receive standard RT (60 Gy in 30 fractions or 40.05 Gy in 15 fractions) and continuous (24/7) i.v. infusions of either 200 mg (DL1; n = 3), 400 mg (DL2; n = 3) or 600 mg (DL3; n = 4) per week of OLA for 26 weeks. The primary endpoint (EP) is safety as per incidence of treatment-related adverse events (AE). Secondary EPs include radiographic response as per mRANO criteria, dynamic susceptibility contrast perfusion (DSC) and the fraction of highly-perfused tumor (FTBhigh) as well as the apparent diffusion coefficient (ADC). Target lesions (TL) and non-target lesions (NTL, i.e. in-field satellite lesions) are analyzed separately. Tumor tissue is assessed by high-plex immunofluorescence imaging (co-detection by indexing; CODEX). Matched reference cohorts serve as controls for MRI (n = 14) and CODEX (n = 8) data. Results: Combination of RT and OLA was well-tolerated and safe. Of all G ≥ 2 AEs (n = 77), 3 (4%) were deemed to be solely OLA-related, including 1 grade 3 AE at DL3. There were no dose limiting toxicities and no treatment-related deaths. In total, eight of the nine patients (89%) with TLs at baseline showed a TL response during OLA therapy, with four (40%) reaching partial remission (PR) as per radiologic mRANO criteria (n = 2 at DL1 and n = 2 at DL3). All three patients treated at DL1 and all four of DL3 reached PR of one or more NTLs. In three cases (n = 2 at DL1; n = 1 at DL3), at least one NTL completely disappeared. Under OLA, radiographic responses of NTL were best at the highest DL (DL1 +49.5/DL2 +488.3/DL3 -59%), as was the increase in diffusion (mean ADC increase +46.4/+28.2/+56.7%) and the decrease in FTBhigh (mean -33.5/-32.8/-47.7%). Matched pre-/post-surgery CODEX of a confirmed pseudoprogression revealed intralesional clusters of proliferating cytotoxic T cells. Analysis of tissue from a non-responding patient showed T-cell encapsulation by M2-polarized macrophages in an immune-cell enriched TME. Additional follow-up is ongoing. Conclusions: Interim data from the ongoing GLORIA trial demonstrates safety of RT plus OLA and suggests promising clinical efficacy of a new class of drugs targeting CXCL12 in GBM. Clinical trial information: NCT04121455.
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Affiliation(s)
| | - Julian Philipp Layer
- Department of Radiation Oncology and Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Sonia Leonardelli
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Lea Lydia Friker
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Clemens Seidel
- Department of Radiotherapy, University Hospital Leipzig, Leipzig, Germany
| | - Christina Schaub
- Division of Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Roberta Turiello
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Elena Sperk
- Department of Radiation Oncology,Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Franziska Grau
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Barbara Link
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Wolf Mueller
- Institute of Neuropathology, University Hospital Leipzig, Bonn, Germany
| | - Ghazaleh Tabatabai
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Tübingen, Tübingen, Germany
| | - Katharina Sahm
- Department of Neurology, University Hospital Mannheim, Mannheim, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Sotiros Bisdas
- Department of Neuroradiology at the National Hospital for Neurology, London, London, United Kingdom
| | - Ulrich Herrlinger
- Division of Neurooncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
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Loi L, Goerke S, Zimmermann F, Korzowski A, Meissner JE, Breitling J, Schott S, Bachert P, Ladd ME, Schlemmer HP, Bickelhaupt S, Paech D. Assessing the influence of the menstrual cycle on APT CEST-MRI in the human breast. Magn Reson Imaging 2022; 91:24-31. [PMID: 35550841 DOI: 10.1016/j.mri.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE In fibroglandular breast tissue, conventional dynamic contrast-enhanced MR-mammography is known to be affected by water content changes during the menstrual cycle. Likewise, amide proton transfer (APT) chemical exchange saturation transfer (CEST)-MRI might be inherently prone to the menstrual cycle, as CEST signals are indirectly detected via the water signal. The purpose of this study was to investigate the influence of the menstrual cycle on APT CEST-MRI in fibroglandular breast tissue. METHOD Ten healthy premenopausal women (19-34 years) were included in this IRB approved prospective study and examined twice during their menstrual cycle. Examination one and two were performed during the first half (day 2-8) and the second half (day 15-21) of the menstrual cycle, respectively. As a reference for the APT signal in malignant breast tumor tissue, previously reported data of nine breast cancer patients were included in this study. CEST-MRI (B1 = 0.7μT) was performed on a 7 T whole-body scanner followed by a multi-Lorentzian fit analysis. The APT signal was corrected for B0/B1-field inhomogeneities, fat signal contribution, and relaxation effects of the water signal and evaluated in the fibroglandular breast tissue. Intra-individual APT signal differences between examination one and two were compared using the Wilcoxon signed-rank test. The level of significance was set at p < 0.05. RESULTS The APT signal showed no significant difference in the fibroglandular breast tissue of healthy premenopausal volunteers throughout the menstrual cycle (p = 1.00) (examination 1 vs. examination 2: mean and standard deviation = 3.24 ± 0.68%Hz vs. 3.30 ± 0.73%Hz, median and IQR = 3.36%Hz and 0.87%Hz vs. 3.38%Hz and 0.71%Hz). CONCLUSION The present study provides an important basis for the clinical application of APT CEST-MRI as an additional contrast mechanism in MR-mammography, as menstrual cycle-related APT signal fluctuations seem to be negligible compared to the APT signal increase in breast cancer tissue.
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Affiliation(s)
- Lisa Loi
- German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Steffen Goerke
- German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Ferdinand Zimmermann
- German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andreas Korzowski
- German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Jan-Eric Meissner
- German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Johannes Breitling
- German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Sarah Schott
- University Hospital Heidelberg, Department of Gynecology and Obstetrics, Im Neuenheimer Feld 440, 69120 Heidelberg, Germany
| | - Peter Bachert
- German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany
| | - Mark E Ladd
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany; German Cancer Research Center, Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Sebastian Bickelhaupt
- German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; German Cancer Research Center, Junior Group Medical Imaging and Radiology - Cancer Prevention, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Daniel Paech
- German Cancer Research Center, Department of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
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Zhou J, Zaiss M, Knutsson L, Sun PZ, Ahn SS, Aime S, Bachert P, Blakeley JO, Cai K, Chappell MA, Chen M, Gochberg DF, Goerke S, Heo HY, Jiang S, Jin T, Kim SG, Laterra J, Paech D, Pagel MD, Park JE, Reddy R, Sakata A, Sartoretti-Schefer S, Sherry AD, Smith SA, Stanisz GJ, Sundgren PC, Togao O, Vandsburger M, Wen Z, Wu Y, Zhang Y, Zhu W, Zu Z, van Zijl PCM. Review and consensus recommendations on clinical APT-weighted imaging approaches at 3T: Application to brain tumors. Magn Reson Med 2022; 88:546-574. [PMID: 35452155 PMCID: PMC9321891 DOI: 10.1002/mrm.29241] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 12/16/2022]
Abstract
Amide proton transfer-weighted (APTw) MR imaging shows promise as a biomarker of brain tumor status. Currently used APTw MRI pulse sequences and protocols vary substantially among different institutes, and there are no agreed-on standards in the imaging community. Therefore, the results acquired from different research centers are difficult to compare, which hampers uniform clinical application and interpretation. This paper reviews current clinical APTw imaging approaches and provides a rationale for optimized APTw brain tumor imaging at 3 T, including specific recommendations for pulse sequences, acquisition protocols, and data processing methods. We expect that these consensus recommendations will become the first broadly accepted guidelines for APTw imaging of brain tumors on 3 T MRI systems from different vendors. This will allow more medical centers to use the same or comparable APTw MRI techniques for the detection, characterization, and monitoring of brain tumors, enabling multi-center trials in larger patient cohorts and, ultimately, routine clinical use.
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Affiliation(s)
- Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Moritz Zaiss
- Magnetic Resonance Center, Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Institute of Neuroradiology, University Hospital Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Linda Knutsson
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Medical Radiation Physics, Lund University, Lund, Sweden.,F.M. Kirby Research Center for Functional Brain Imaging, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| | - Phillip Zhe Sun
- Yerkes Imaging Center, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Silvio Aime
- Molecular Imaging Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy
| | - Peter Bachert
- Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany.,Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Jaishri O Blakeley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kejia Cai
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael A Chappell
- Mental Health and Clinical Neurosciences and Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham Biomedical Research Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Daniel F Gochberg
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Physics, Vanderbilt University, Nashville, Tennessee, USA
| | - Steffen Goerke
- Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Hye-Young Heo
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Shanshan Jiang
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tao Jin
- Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Seong-Gi Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science and Department of Biomedical Engineering, Sungkyunkwan University, Suwon, South Korea
| | - John Laterra
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center, Heidelberg, Germany.,Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Mark D Pagel
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Ravinder Reddy
- Center for Advance Metabolic Imaging in Precision Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Akihiko Sakata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - A Dean Sherry
- Advanced Imaging Research Center and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Department of Chemistry and Biochemistry, University of Texas at Dallas, Richardson, Texas, USA
| | - Seth A Smith
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Greg J Stanisz
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Pia C Sundgren
- Department of Diagnostic Radiology/Clinical Sciences Lund, Lund University, Lund, Sweden.,Lund University Bioimaging Center, Lund University, Lund, Sweden.,Department of Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Osamu Togao
- Department of Molecular Imaging and Diagnosis, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yin Wu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenzhen Zhu
- Department of Radiology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhongliang Zu
- Vanderbilt University Institute of Imaging Science (VUIIS), Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Peter C M van Zijl
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,F.M. Kirby Research Center for Functional Brain Imaging, Hugo W. Moser Research Institute at Kennedy Krieger, Baltimore, Maryland, USA
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Lingl JP, Wunderlich A, Goerke S, Paech D, Ladd ME, Liebig P, Pala A, Kim SY, Braun M, Schmitz BL, Beer M, Rosskopf J. The Value of APTw CEST MRI in Routine Clinical Assessment of Human Brain Tumor Patients at 3T. Diagnostics (Basel) 2022; 12:diagnostics12020490. [PMID: 35204583 PMCID: PMC8871436 DOI: 10.3390/diagnostics12020490] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022] Open
Abstract
Background. With fast-growing evidence in literature for clinical applications of chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI), this prospective study aimed at applying amide proton transfer-weighted (APTw) CEST imaging in a clinical setting to assess its diagnostic potential in differentiation of intracranial tumors at 3 tesla (T). Methods. Using the asymmetry magnetization transfer ratio (MTRasym) analysis, CEST signals were quantitatively investigated in the tumor areas and in a similar sized region of the normal-appearing white matter (NAWM) on the contralateral hemisphere of 27 patients with intracranial tumors. Area under curve (AUC) analyses were used and results were compared to perfusion-weighted imaging (PWI). Results. Using APTw CEST, contrast-enhancing tumor areas showed significantly higher APTw CEST metrics than contralateral NAWM (AUC = 0.82; p < 0.01). In subgroup analyses of each tumor entity vs. NAWM, statistically significant effects were yielded for glioblastomas (AUC = 0.96; p < 0.01) and for meningiomas (AUC = 1.0; p < 0.01) but not for lymphomas as well as metastases (p > 0.05). PWI showed results comparable to APTw CEST in glioblastoma (p < 0.01). Conclusions. This prospective study confirmed the high diagnostic potential of APTw CEST imaging in a routine clinical setting to differentiate brain tumors.
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Affiliation(s)
- Julia P. Lingl
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
| | - Arthur Wunderlich
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
| | - Steffen Goerke
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (S.G.); (M.E.L.)
| | - Daniel Paech
- German Cancer Research Center (DKFZ), Division of Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
- Department of Neuroradiology, Venusberg-Campus 1, Bonn University, 53127 Bonn, Germany
| | - Mark E. Ladd
- German Cancer Research Center (DKFZ), Department of Medical Physics in Radiology, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; (S.G.); (M.E.L.)
- Faculty of Medicine, University of Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
- Faculty of Physics and Astronomy, University of Heidelberg, Im Neuenheimer Feld 226, 69120 Heidelberg, Germany
| | - Patrick Liebig
- Siemens Healthcare GmbH, Henkestraße 127, 91052 Erlangen, Germany;
| | - Andrej Pala
- Department of Neurosurgery, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany;
| | - Soung Yung Kim
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
| | - Michael Braun
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
| | - Bernd L. Schmitz
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
| | - Meinrad Beer
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
| | - Johannes Rosskopf
- Department of Radiology, Ulm University, Albert-Einstein-Allee 23, 89081 Ulm, Germany; (J.P.L.); (A.W.); (S.Y.K.); (M.B.); (B.L.S.); (M.B.)
- Section of Neuroradiology, Bezirkskrankenhaus Guenzburg, Lindenallee 2, 89312 Guenzburg, Germany
- Correspondence:
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Korzowski A, Weckesser N, Franke VL, Breitling J, Goerke S, Schlemmer HP, Ladd ME, Bachert P, Paech D. Mapping an Extended Metabolic Profile of Gliomas Using High-Resolution 31P MRSI at 7T. Front Neurol 2022; 12:735071. [PMID: 35002914 PMCID: PMC8733158 DOI: 10.3389/fneur.2021.735071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Phosphorus magnetic resonance spectroscopic imaging (31P MRSI) is of particular interest for investigations of patients with brain tumors as it enables to non-invasively assess altered energy and phospholipid metabolism in vivo. However, the limited sensitivity of 31P MRSI hampers its broader application at clinical field strengths. This study aimed to identify the additional value of 31P MRSI in patients with glioma at ultra-high B0 = 7T, where the increase in signal-to-noise ratio may foster its applicability for clinical research. High-quality, 3D 31P MRSI datasets with an effective voxel size of 5.7 ml were acquired from the brains of seven patients with newly diagnosed glioma. An optimized quantification model was implemented to reliably extract an extended metabolic profile, including low-concentrated metabolites such as extracellular inorganic phosphate, nicotinamide adenine dinucleotide [NAD(H)], and uridine diphosphoglucose (UDPG), which may act as novel tumor markers; a background signal was extracted as well, which affected measures of phosphomonoesters beneficially. Application of this model to the MRSI datasets yielded high-resolution maps of 12 different 31P metabolites, showing clear metabolic differences between white matter (WM) and gray matter, and between healthy and tumor tissues. Moreover, differences between tumor compartments in patients with high-grade glioma (HGG), i.e., gadolinium contrast-enhancing/necrotic regions (C+N) and peritumoral edema, could also be suggested from these maps. In the group of patients with HGG, the most significant changes in metabolite intensities were observed in C+N compared to WM, i.e., for phosphocholine +340%, UDPG +54%, glycerophosphoethanolamine −45%, and adenosine-5′-triphosphate −29%. Furthermore, a prominent signal from mobile phospholipids appeared in C+N. In the group of patients with low-grade glioma, only the NAD(H) intensity changed significantly by −28% in the tumor compared to WM. Besides the potential of 31P MRSI at 7T to provide novel insights into the biochemistry of gliomas in vivo, the attainable spatial resolutions improve the interpretability of 31P metabolite intensities obtained from malignant tissues, particularly when only subtle differences compared to healthy tissues are expected. In conclusion, this pilot study demonstrates that 31P MRSI at 7T has potential value for the clinical research of glioma.
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Affiliation(s)
- Andreas Korzowski
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nina Weckesser
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Vanessa L Franke
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Johannes Breitling
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Goerke
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Mark E Ladd
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany.,Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Peter Bachert
- Department of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy, University of Heidelberg, Heidelberg, Germany
| | - Daniel Paech
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Paech D, Klopries K, Nawrotzki R, Schlemmer HP, Giesel FL, Kirsch J, Schultz JH, Kuner T, Doll S. Strengths and Weaknesses of Non-enhanced and Contrast-enhanced Cadaver Computed Tomography Scans in the Teaching of Gross Anatomy in an Integrated Curriculum. Anat Sci Educ 2022; 15:143-154. [PMID: 33170986 DOI: 10.1002/ase.2034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
Cadaver-specific postmortem computed tomography (PMCT) has become an integral part in anatomy teaching at several universities. Recently, the feasibility of contrast-enhanced (CE)-PMCT has been demonstrated. The purpose of this study was to identify particular strengths and weaknesses of both non-enhanced and contrast-enhanced PMCT compared to conventional cadaver dissection. First, the students' perception of the learning effectiveness of the three different modalities have been assessed using a 34-item survey (five-point Likert scale) covering all anatomy course modules. Results were compared using the nonparametric Friedman Test. Second, the most frequent artifacts in cadaver CT scans, were systematically analyzed in 122 PMCT and 31 CE-PMCT data sets to quantify method-related limitations and characteristics. Perfusion quality was assessed in 57 vascular segments (38 arterial and 19 venous). The survey was answered by n = 257/320 (80.3%) students. Increased learning benefits of PMCT/ CE-PMCT compared to cadaver dissection were found in osteology (2/3 categories, P < 0.001), head and neck (2/5 categories, P < 0.01), and brain anatomy (3/3 categories, P < 0.01). Contrast-enhanced-PMCT was perceived particularly useful in learning vascular anatomy (10/10 categories, P < 0.01). Cadaver dissection received significantly higher scores compared to PMCT and CE-PMCT in all categories of the abdomen and thorax (7/7 categories, P < 0.001), as well as the majority of muscular anatomy (5/6 categories, P < 0.001). Frequent postmortem artifacts (total n = 28, native-phase n = 21, contrast injection-related n = 7) were identified and assessed. The results of this work contribute to the understanding of the value of integrating cadaver-specific PMCT in anatomy teaching.
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Affiliation(s)
- Daniel Paech
- Institute of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
- Division of Radiology, German Cancer Research Center, Heidelberg, Germany
| | - Kerstin Klopries
- Institute of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
- Department of Radiology, University Hospital Essen, Essen, Germany
| | - Ralph Nawrotzki
- Institute of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | | | - Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Kirsch
- Institute of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Kuner
- Institute of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Sara Doll
- Institute of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
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45
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Paech D, Regnery S, Platt T, Behl NGR, Weckesser N, Windisch P, Deike-Hofmann K, Wick W, Bendszus M, Rieken S, König L, Ladd ME, Schlemmer HP, Debus J, Adeberg S. Assessment of Sodium MRI at 7 Tesla as Predictor of Therapy Response and Survival in Glioblastoma Patients. Front Neurosci 2021; 15:782516. [PMID: 34924945 PMCID: PMC8671745 DOI: 10.3389/fnins.2021.782516] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
The purpose of this work was to prospectively investigate sodium (23Na) MRI at 7 Tesla (T) as predictor of therapy response and survival in patients with glioblastoma (GBM). Thus, 20 GBM patients underwent 23Na MRI at 7T before, immediately after and 6 weeks after chemoradiotherapy (CRT). The median tissue sodium concentration (TSC) inside the whole tumor excluding necrosis was determined. Initial response to CRT was assessed employing the updated response assessment in neuro-oncology working group (RANO) criteria. Clinical parameters, baseline TSC and longitudinal TSC differences were compared between patients with initial progressive disease (PD) and patients with initial stable disease (SD) using Fisher’s exact tests and Mann-Whitney-U-tests. Univariate proportional hazard models for progression free survival (PFS) and overall survival (OS) were calculated using clinical parameters and TSC metrics as predictor variables. The analyses demonstrated that TSC developed heterogeneously over all patients following CRT. None of the TSC metrics differed significantly between cases of initial SD and initial PD. Furthermore, TSC metrics did not yield a significant association with PFS or OS. Conversely, the initial response according to the RANO criteria could significantly predict PFS [univariate HR (95%CI) = 0.02 (0.0001–0.21), p < 0.001] and OS [univariate HR = 0.17 (0.04–0.65), p = 0.005]. In conclusion, TSC showed treatment-related changes in GBM following CRT, but did not significantly correlate with the initial response according to the RANO criteria, PFS or OS. In contrast, the initial response according to the RANO criteria was a significant predictor of PFS and OS. Future investigations need to elucidate the reasons for treatment-related changes in TSC and their clinical value for response prediction in glioblastoma patients receiving CRT.
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Affiliation(s)
- Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tanja Platt
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicolas G R Behl
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Siemens Healthcare GmbH, Erlangen, Germany
| | - Nina Weckesser
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Paul Windisch
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mark E Ladd
- Division of Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Physics and Astronomy and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | | | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Radbruch A, Paech D, Gassenmaier S, Luetkens J, Isaak A, Herrmann J, Othman A, Schäfer J, Nikolaou K. 1.5 vs 3 Tesla Magnetic Resonance Imaging: A Review of Favorite Clinical Applications for Both Field Strengths-Part 2. Invest Radiol 2021; 56:692-704. [PMID: 34417406 DOI: 10.1097/rli.0000000000000818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
ABSTRACT The second part of this review deals with experiences in neuroradiological and pediatric examinations using modern magnetic resonance imaging systems with 1.5 T and 3 T, with special attention paid to experiences in pediatric cardiac imaging. In addition, whole-body examinations, which are widely used for diagnostic purposes in systemic diseases, are compared with respect to the image quality obtained in different body parts at both field strengths. A systematic overview of the technical differences at 1.5 T and 3 T has been presented in part 1 of this review, as well as several organ-based magnetic resonance imaging applications including musculoskeletal imaging, abdominal imaging, and prostate diagnostics.
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Affiliation(s)
- Alexander Radbruch
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Daniel Paech
- From the Clinic for Diagnostic and Interventional Neuroradiology, University Hospital Bonn, Bonn
| | - Sebastian Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Julian Luetkens
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Alexander Isaak
- Clinic for Diagnostic and Interventional Radiology, University Hospital Bonn, Bonn
| | - Judith Herrmann
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | | | - Jürgen Schäfer
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
| | - Konstantin Nikolaou
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen
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Platt T, Ladd ME, Paech D. 7 Tesla and Beyond: Advanced Methods and Clinical Applications in Magnetic Resonance Imaging. Invest Radiol 2021; 56:705-725. [PMID: 34510098 PMCID: PMC8505159 DOI: 10.1097/rli.0000000000000820] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/07/2021] [Accepted: 08/07/2021] [Indexed: 12/15/2022]
Abstract
ABSTRACT Ultrahigh magnetic fields offer significantly higher signal-to-noise ratio, and several magnetic resonance applications additionally benefit from a higher contrast-to-noise ratio, with static magnetic field strengths of B0 ≥ 7 T currently being referred to as ultrahigh fields (UHFs). The advantages of UHF can be used to resolve structures more precisely or to visualize physiological/pathophysiological effects that would be difficult or even impossible to detect at lower field strengths. However, with these advantages also come challenges, such as inhomogeneities applying standard radiofrequency excitation techniques, higher energy deposition in the human body, and enhanced B0 field inhomogeneities. The advantages but also the challenges of UHF as well as promising advanced methodological developments and clinical applications that particularly benefit from UHF are discussed in this review article.
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Affiliation(s)
- Tanja Platt
- From the Medical Physics in Radiology, German Cancer Research Center (DKFZ)
| | - Mark E. Ladd
- From the Medical Physics in Radiology, German Cancer Research Center (DKFZ)
- Faculty of Physics and Astronomy
- Faculty of Medicine, University of Heidelberg, Heidelberg
- Erwin L. Hahn Institute for MRI, University of Duisburg-Essen, Essen
| | - Daniel Paech
- Division of Radiology, German Cancer Research Center (DKFZ), Heidelberg
- Clinic for Neuroradiology, University of Bonn, Bonn, Germany
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48
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Deike-Hofmann K, Dancs D, Paech D, Schlemmer HP, Maier-Hein K, Bäumer P, Radbruch A, Götz M. Pre-examinations Improve Automated Metastases Detection on Cranial MRI. Invest Radiol 2021; 56:320-327. [PMID: 33259442 DOI: 10.1097/rli.0000000000000745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
MATERIALS AND METHODS Our local ethics committee approved this retrospective monocenter study.First, a dual-time approach was assessed, for which the CNN was provided sequences of the MRI that initially depicted new MM (diagnosis MRI) as well as of a prediagnosis MRI: inclusion of only contrast-enhanced T1-weighted images (CNNdual_ce) was compared with inclusion of also the native T1-weighted images, T2-weighted images, and FLAIR sequences of both time points (CNNdual_all).Second, results were compared with the corresponding single time approaches, in which the CNN was provided exclusively the respective sequences of the diagnosis MRI.Casewise diagnostic performance parameters were calculated from 5-fold cross-validation. RESULTS In total, 94 cases with 494 MMs were included. Overall, the highest diagnostic performance was achieved by inclusion of only the contrast-enhanced T1-weighted images of the diagnosis and of a prediagnosis MRI (CNNdual_ce, sensitivity = 73%, PPV = 25%, F1-score = 36%). Using exclusively contrast-enhanced T1-weighted images as input resulted in significantly less false-positives (FPs) compared with inclusion of further sequences beyond contrast-enhanced T1-weighted images (FPs = 5/7 for CNNdual_ce/CNNdual_all, P < 1e-5). Comparison of contrast-enhanced dual and mono time approaches revealed that exclusion of prediagnosis MRI significantly increased FPs (FPs = 5/10 for CNNdual_ce/CNNce, P < 1e-9).Approaches with only native sequences were clearly inferior to CNNs that were provided contrast-enhanced sequences. CONCLUSIONS Automated MM detection on contrast-enhanced T1-weighted images performed with high sensitivity. Frequent FPs due to artifacts and vessels were significantly reduced by additional inclusion of prediagnosis MRI, but not by inclusion of further sequences beyond contrast-enhanced T1-weighted images. Future studies might investigate different change detection architectures for computer-aided detection.
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Affiliation(s)
| | - Dorottya Dancs
- From the Department of Radiology, German Cancer Research Center, Heidelberg
| | - Daniel Paech
- From the Department of Radiology, German Cancer Research Center, Heidelberg
| | | | - Klaus Maier-Hein
- Department for Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
| | - Philipp Bäumer
- From the Department of Radiology, German Cancer Research Center, Heidelberg
| | | | - Michael Götz
- Department for Medical Image Computing, German Cancer Research Center, Heidelberg, Germany
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Schmitt N, Floca RO, Paech D, El Shafie RA, Neuberger U, Bendszus M, Möhlenbruch MA, Vollherbst DF. Imaging Artifacts of Nonadhesive Liquid Embolic Agents in Conventional and Cone-beam CT in a Novel in Vitro AVM Model. Clin Neuroradiol 2021; 31:1141-1148. [PMID: 33852036 PMCID: PMC8648665 DOI: 10.1007/s00062-021-01013-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/15/2021] [Indexed: 11/05/2022]
Abstract
Background A major drawback of liquid embolic agents (LEAs) is the generation of imaging artifacts (IA), which may represent a crucial obstacle for the detection of periprocedural hemorrhage or subsequent radiosurgery of cerebral arteriovenous malformations (AVMs). This study aimed to compare the IAs of Onyx, Squid and PHIL in a novel three-dimensional in vitro AVM model in conventional computed tomography (CT) and cone-beam CT (CBCT). Methods Tubes with different diameters were configured in a container resembling an AVM with an artificial nidus at its center. Subsequently, the AVM models were filled with Onyx 18, Squid 18, PHIL 25% or saline and inserted into an imaging phantom (n = 10/LEA). Afterwards CT and CBCT scans were acquired. The degree of IAs was graded quantitatively (Hounsfield units in a defined region of interest) and qualitatively (feasibility of defining the nidus)—Onyx vs. Squid vs. PHIL vs. saline, respectively. Results Quantitative density evaluation demonstrated more artifacts for Onyx compared to Squid and PHIL, e.g. 48.15 ± 14.32 HU for Onyx vs. 7.56 ± 1.34 HU for PHIL in CT (p < 0.001) and 41.88 ± 7.22 density units (DU) for Squid vs. 35.22 ± 5.84 DU for PHIL in CBCT (p = 0.044). Qualitative analysis showed less artifacts for PHIL compared to Onyx and Squid in both imaging modalities while there was no difference between Onyx and Squid regarding the definition of the nidus (p > 0.999). Conclusion In this novel three-dimensional in vitro AVM model, IAs were higher for the EVOH/tantalum-based LEAs Onyx and Squid compared to iodine-based PHIL. Onyx induced the highest degree of IAs with only minor differences to Squid.
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Affiliation(s)
- Niclas Schmitt
- Department of Neuroradiology, INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ralf O Floca
- Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Daniel Paech
- Department of Neuroradiology, INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany.,Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rami A El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Ulf Neuberger
- Department of Neuroradiology, INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Markus A Möhlenbruch
- Department of Neuroradiology, INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Dominik F Vollherbst
- Department of Neuroradiology, INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany.
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Abstract
BACKGROUND Contrast generation by chemical exchange saturation transfer (CEST) is a recently emerging magnetic resonance imaging (MRI) research field with high clinical potential. METHODS This review covers the methodological principles and summarizes the clinical experience of CEST imaging studies in diagnostic oncology performed to date. RESULTS AND CONCLUSION CEST enables the detection of lowly concentrated metabolites, such as peptides and glucose, through selective saturation of metabolite-bound protons and subsequent magnetization transfer to free water. This technology yields additional information about metabolic activity and the tissue microenvironment without the need for conventional contrast agents or radioactive tracers. Various studies, mainly conducted in patients with neuro-oncolgic diseases, suggest that this technology may aid to assess tumor malignancy as well as therapeutic response prior to and in the first follow-up after intervention. KEY POINTS CEST-MRI enables the indirect detection of metabolites without radioactive tracers or contrast agents. Clinical experience exists especially in the setting of neuro-oncologic imaging. In oncologic imaging, CEST-MRI may improve assessment of prognosis and therapy response.
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Affiliation(s)
- N von Knebel Doeberitz
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - S Maksimovic
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - L Loi
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland
| | - D Paech
- Abteilung Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland.
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