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Bobholz SA, Lowman AK, Brehler M, Kyereme F, Duenweg SR, Sherman J, McGarry SD, Cochran EJ, Connelly J, Mueller WM, Agarwal M, Banerjee A, LaViolette PS. Radio-Pathomic Maps of Cell Density Identify Brain Tumor Invasion beyond Traditional MRI-Defined Margins. AJNR Am J Neuroradiol 2022; 43:682-688. [PMID: 35422419 PMCID: PMC9089258 DOI: 10.3174/ajnr.a7477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/07/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Currently, contrast-enhancing margins on T1WI are used to guide treatment of gliomas, yet tumor invasion beyond the contrast-enhancing region is a known confounding factor. Therefore, this study used postmortem tissue samples aligned with clinically acquired MRIs to quantify the relationship between intensity values and cellularity as well as to develop a radio-pathomic model to predict cellularity using MR imaging data. MATERIALS AND METHODS This single-institution study used 93 samples collected at postmortem examination from 44 patients with brain cancer. Tissue samples were processed, stained with H&E, and digitized for nuclei segmentation and cell density calculation. Pre- and postgadolinium contrast T1WI, T2 FLAIR, and ADC images were collected from each patient's final acquisition before death. In-house software was used to align tissue samples to the FLAIR image via manually defined control points. Mixed-effects models were used to assess the relationship between single-image intensity and cellularity for each image. An ensemble learner was trained to predict cellularity using 5 × 5 voxel tiles from each image, with a two-thirds to one-third train-test split for validation. RESULTS Single-image analyses found subtle associations between image intensity and cellularity, with a less pronounced relationship in patients with glioblastoma. The radio-pathomic model accurately predicted cellularity in the test set (root mean squared error = 1015 cells/mm2) and identified regions of hypercellularity beyond the contrast-enhancing region. CONCLUSIONS A radio-pathomic model for cellularity trained with tissue samples acquired at postmortem examination is able to identify regions of hypercellular tumor beyond traditional imaging signatures.
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Affiliation(s)
- S A Bobholz
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | | | - M Brehler
- Radiology (A.L., M.B., M.A., P.S.L.)
| | | | - S R Duenweg
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | - J Sherman
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | - S D McGarry
- From the Departments of Biophysics (S.A.B., S.R.D., J.S., S.D.M.)
| | | | | | | | - M Agarwal
- Radiology (A.L., M.B., M.A., P.S.L.)
| | | | - P S LaViolette
- Radiology (A.L., M.B., M.A., P.S.L.)
- Biomedical Engineering (P.S.L.), Medical College of Wisconsin, Milwaukee, Wisconsin
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Nguyen HS, Milbach N, Hurrell SL, Cochran E, Connelly J, Bovi JA, Schultz CJ, Mueller WM, Rand SD, Schmainda KM, LaViolette PS. Progressing Bevacizumab-Induced Diffusion Restriction Is Associated with Coagulative Necrosis Surrounded by Viable Tumor and Decreased Overall Survival in Patients with Recurrent Glioblastoma. AJNR Am J Neuroradiol 2016; 37:2201-2208. [PMID: 27492073 DOI: 10.3174/ajnr.a4898] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/23/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Patients with recurrent glioblastoma often exhibit regions of diffusion restriction following the initiation of bevacizumab therapy. Studies suggest that these regions represent either diffusion-restricted necrosis or hypercellular tumor. This study explored postmortem brain specimens and a population analysis of overall survival to determine the identity and implications of such lesions. MATERIALS AND METHODS Postmortem examinations were performed on 6 patients with recurrent glioblastoma on bevacizumab with progressively growing regions of diffusion restriction. ADC values were extracted from regions of both hypercellular tumor and necrosis. A receiver operating characteristic analysis was performed to define optimal ADC thresholds for differentiating tissue types. A retrospective population study was also performed comparing the overall survival of 64 patients with recurrent glioblastoma treated with bevacizumab. Patients were separated into 3 groups: no diffusion restriction, diffusion restriction that appeared and progressed within 5 months of bevacizumab initiation, and delayed or stable diffusion restriction. An additional analysis was performed assessing tumor O6-methylguanine-DNA-methyltransferase methylation. RESULTS The optimal ADC threshold for differentiation of hypercellularity and necrosis was 0.736 × 10-3mm2/s. Progressively expanding diffusion restriction was pathologically confirmed to be coagulative necrosis surrounded by viable tumor. Progressive lesions were associated with the worst overall survival, while stable lesions showed the greatest overall survival (P < .05). Of the 40% of patients with O6-methylguanine-DNA-methyltransferase methylated tumors, none developed diffusion-restricted lesions. CONCLUSIONS Progressive diffusion-restricted lesions were pathologically confirmed to be coagulative necrosis surrounded by viable tumor and associated with decreased overall survival. Stable lesions were, however, associated with increased overall survival. All lesions were associated with O6-methylguanine-DNA-methyltransferase unmethylated tumors.
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Affiliation(s)
- H S Nguyen
- From the Departments of Neurosurgery (H.S.N., W.M.M.)
| | - N Milbach
- Radiology (N.M., S.L.H., S.D.R., K.M.S., P.S.L.)
| | - S L Hurrell
- Radiology (N.M., S.L.H., S.D.R., K.M.S., P.S.L.)
| | | | | | - J A Bovi
- Radiation Oncology (J.A.B., C.J.S.)
| | | | - W M Mueller
- From the Departments of Neurosurgery (H.S.N., W.M.M.)
| | - S D Rand
- Radiology (N.M., S.L.H., S.D.R., K.M.S., P.S.L.)
| | - K M Schmainda
- Radiology (N.M., S.L.H., S.D.R., K.M.S., P.S.L.)
- Biophysics (K.M.S., P.S.L.), Medical College of Wisconsin, Milwaukee, Wisconsin
| | - P S LaViolette
- Radiology (N.M., S.L.H., S.D.R., K.M.S., P.S.L.)
- Biophysics (K.M.S., P.S.L.), Medical College of Wisconsin, Milwaukee, Wisconsin
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Bluml S, Panigrahy A, Laskov M, Dhall G, Nelson MD, Finlay JL, Gilles FH, Arita H, Kinoshita M, Kagawa N, Fujimoto Y, Hashimoto N, Yoshimine T, Kinoshita M, Arita H, Kagawa N, Fujimoto Y, Hashimoto N, Yoshimine T, Hamilton JD, Wang J, Levin VA, Hou P, Loghin ME, Gilbert MR, Leeds NE, deGroot JF, Puduvalli V, Jackson EF, Yung WKA, Kumar AJ, Ellingson BM, Cloughesy TF, Pope WB, Zaw T, Phillips H, Lalezari S, Nghiemphu PL, Ibrahim H, Motevalibashinaeini K, Lai A, Ellingson BM, Cloughesy TF, Zaw T, Harris R, Lalezari S, Nghiemphu PL, Motevalibashinaeini K, Lai A, Pope WB, Douw L, Van de Nieuwenhuijzen ME, Heimans JJ, Baayen JC, Stam CJ, Reijneveld JC, Juhasz C, Mittal S, Altinok D, Robinette NL, Muzik O, Chakraborty PK, Barger GR, Ellingson BM, Cloughesy TF, Zaw TM, Lalezari S, Nghiemphu PL, Motevalibashinaeini K, Lai A, Goldin J, Pope WB, Ellingson BM, Cloughesy TF, Harris R, Pope WB, Nghiemphu PL, Lai A, Zaw T, Chen W, Ahlman MA, Giglio P, Kaufmann TJ, Anderson SK, Jaeckle KA, Uhm JH, Northfelt DW, Flynn PJ, Buckner JC, Galanis E, Zalatimo O, Weston C, Allison D, Bota D, Kesari S, Glantz M, Sheehan J, Harbaugh RE, Chiba Y, Kinoshita M, Kagawa N, Fujimoto Y, Tsuboi A, Hatazawa J, Sugiyama H, Hashimoto N, Yoshimine T, Nariai T, Toyohara J, Tanaka Y, Inaji M, Aoyagi M, Yamamoto M, Ishiwara K, Ohno K, Jalilian L, Essock-Burns E, Cha S, Chang S, Prados M, Butowski N, Nelson S, Kawahara Y, Nakada M, Hayashi Y, Kai Y, Hayashi Y, Uchiyama N, Kuratsu JI, Hamada JI, Yeom K, Rosenberg J, Andre JB, Fisher PG, Edwards MS, Barnes PD, Partap S, Essock-Burns E, Jalilian L, Lupo JM, Crane JC, Cha S, Chang SM, Nelson SJ, Romanowski CA, Hoggard N, Jellinek DA, Clenton S, McKevitt F, Wharton S, Craven I, Buller A, Waddle C, Bigley J, Wilkinson ID, Metherall P, Eckel LJ, Keating GF, Wetjen NM, Giannini C, Wetmore C, Jain R, Narang J, Arbab AS, Schultz L, Scarpace L, Mikkelsen T, Babajni-Feremi A, Jain R, Poisson L, Narang J, Scarpace L, Gutman D, Jaffe C, Saltz J, Flanders A, Daniel B, Mikkelsen T, Zach L, Guez D, Last D, Daniels D, Hoffman C, Mardor Y, Guha-Thakurta N, Debnam JM, Kotsarini C, Wilkinson ID, Jellinek D, Griffiths PD, Khandanpour N, Hoggard N, Kotsarini C, Wilkinson ID, Jellinek D, Griffiths PD, Bambrough P, Hoggard N, Hamilton JD, Levin VA, Hou P, Prabhu S, Loghin ME, Gilbert MR, Bassett RL, Wang J, Yung WA, Jackson EF, Kumar AJ, Campen CJ, Soman S, Fisher PG, Edwards MS, Yeom KW, Vos MJ, Berkhof J, Postma TJ, Sanchez E, Sizoo EM, Heimans JJ, Lagerwaard FJ, Buter J, Noske DP, Reijneveld JC, Colen RR, Mahajan B, Jolesz FA, Zinn PO, Lupo JM, Molinaro A, Chang S, Lawton K, Cha S, Nelson SJ, Alexandru D, Bota D, Linskey ME, Chaumeil MM, Gini B, Yang H, Iwanami A, Subramanian S, Ozawa T, Read EJ, Pieper RO, Mischel P, James CD, Ronen SM, LaViolette PS, Cochran E, Al-Gizawiy M, Connelly JM, Malkin MG, Rand SD, Mueller WM, Schmainda KM, LaViolette PS, Cohen AD, Cochran E, Prah M, Hartman CJ, Connelly JM, Rand SD, Malkin MG, Mueller WM, Schmainda KM, Qiao XJ, He R, Brown M, Goldin J, Cloughesy T, Pope WB. RADIOLOGY. Neuro Oncol 2011; 13:iii136-iii144. [PMCID: PMC3222969 DOI: 10.1093/neuonc/nor162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
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